Health Bill
Monday 1st June 2026
(1 month, 3 weeks ago)
Commons ChamberRead Full debate Health Bill 2026-27 Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Madam Deputy Speaker (Caroline Nokes)
Mr Speaker has not selected the reasoned amendment.
The Secretary of State for Health and Social Care (James Murray)
I beg to move, That the Bill be now read a Second time.
Madam Deputy Speaker, if you were to ask anyone in Britain what they think about the NHS, I bet they would give you an answer without hesitation. No one would be lost for words, because everyone has an opinion. Regardless of whether they tell you a story about how the NHS has helped them or their family in their moment of need, or whether they share a view on how they would change it for the better, everyone cares about the NHS. The NHS matters deeply to people right across our country because of how deeply it touches all our lives.
For my part, the NHS came to my rescue when I was diagnosed 18 years ago with a serious and rare neurological condition that threatened my ability to run, to write and to talk. After the best care I could have hoped for from my brilliant consultant and his team at the National Hospital for Neurology and Neurosurgery in Queen Square, and from other teams across the NHS, I am now symptom free. It is only thanks to the support of those people working in our health service, and to the faith of the Prime Minister in appointing me to this role, that I am able to stand here today as the Secretary of State for Health and Social Care and set out what this critical Bill will mean for the future of our NHS.
Like me, everyone across Britain will have their own story of the NHS, or a view to share about its future. It is an achievement that we all share together, and one that is personal for us all. My predecessor as Health Secretary, my right hon. Friend the Member for Ilford North (Wes Streeting), has spoken movingly about the importance of the NHS to him. He explained how it saved his life when he was diagnosed with kidney cancer at the age of 38 and how, amidst all his worries, the one thing he never had to worry about was how much the treatment might cost. Let me pay tribute to my right hon. Friend for what he did in the role as a great champion of patients everywhere, and as someone with a huge passion for building a modern NHS—something we can see in this Bill, which he and my hon. Friend the Member for Bristol South (Karin Smyth) put so much energy into.
As a former Chief Secretary to the Treasury and Exchequer Secretary, I have been incredibly proud to support my right hon. Friend the Chancellor in her determination to take the right decisions on the public finances to enable record investment in our national health service. Thanks to that investment, the changes that this Labour Government have begun to make, the leadership at the Department for Health and Social Care and NHS England, and the incredible work of frontline staff across the NHS, in just under two years we have seen: over half a million fewer people on the waiting list; 2,000 more GPs; 8,500 more mental health workers; four in five patients being seen within four hours in A&E; over 100 community diagnostic centres now open in evenings and at weekends; and over 240,000 more people getting their cancer tests on time. That is the difference that this Labour Government are making: an NHS in which more patients get the treatment they need when they need it, and in which taxpayers get better value for money.
Tim Farron (Westmorland and Lonsdale) (LD)
The Secretary of State mentions some achievements and the progress being made within the NHS. May I bring him back to the issue of cancer treatment? According to OECD figures, 53% of cancer patients should receive radiotherapy as their primary treatment. In the UK, the figure is only 35%. In Cumbria and Lancashire, it is only 29%. This is delaying treatment, delaying cures and preventing people from living long lives. Will he take a personal interest in correcting the commissioning so that every single part of this country has access to radiotherapy close to where people live, so that they can be cured with the most up-to-date technology?
James Murray
The hon. Gentleman is absolutely right to draw attention to the importance of having the right approach to cancer, and our national cancer plan sets out what we as a Government are doing to achieve that. He is also right to point to the regional variation in different parts of the country, and to say how important it is not just to raise standards across the country but to ensure that the increase in standards is evenly distributed, so that all areas improve. One of my roles as Secretary of State is to ensure that we not only deliver our national cancer plan but support local areas so that they have the right services.
Catherine West (Hornsey and Friern Barnet) (Lab)
I congratulate the Secretary of State on his excellent speech, and I thank him and my hon. Friend the Member for Bristol South (Karin Smyth) for their work in developing the Bill. Healthwatch Haringey plays an enormously important role in being a champion for the ecosystem within a locality. The Local Government Association is very concerned about some of the discussions. Will he reassure me that as the Bill passes through the House, how we do the NHS, as well as what we do, will be an integral part, so that everybody can feel included in the NHS?
James Murray
I reassure my hon. Friend that what the Bill seeks to achieve, through local health watches across the country, is to bring the voice of patients closer to the people who plan and deliver services. Too often, we have not seen action following feedback. We need to ensure that such feedback is integrated into the planning and delivery of services, so that patient voices are heard.
I have set out some of this Labour Government’s achievements less than two years into office, which shows that decline is not inevitable. Our determination to deliver on what people voted for is making a real difference. We have started to make progress, and we are building an NHS that is fit for the future.
Labour’s choice in government has been, and will always be, to strengthen and improve the NHS as a service that is universal and publicly funded, with use based on need, not on ability to pay. That choice is backed by people across Britain, yet for the first time in a generation, some Members of this House are openly calling for the NHS’s founding principles to be abandoned. The hon. Member for Clacton (Nigel Farage), who I note is not in his place—[Interruption.] He never is—good point. Time and again, he has made it clear that he would tear the principles of the NHS to shreds and bring in an insurance-based system that would benefit only his friends in finance. Be in no doubt: Reform would sell our health service to the highest bidder. That would be a devastating mistake, and we must not let it happen.
Instead of turning our backs on the principles on which the NHS was founded, as some Opposition Members would have us do, I will fight every day as Health and Social Care Secretary to build the modern health service that our country demands and that patients deserve.
Calum Miller (Bicester and Woodstock) (LD)
I welcome the Secretary of State to his place. He has spoken about two themes: the scale of ambition of this Bill, and the need for the patient voice to be heard at the heart of it, given how much all our constituents care about the NHS. In the case of Healthwatch, can he reassure the House that bringing the scrutiny of local voices up to the level of the Secretary of State will not diminish the independence of the local healthwatch organisations that, in Oxfordshire and elsewhere, do so much to promote the patient voice and to hold the NHS to account for its services?
James Murray
I thank the hon. Gentleman for his words about my taking on this post. I can reassure him that, as I will come to in my speech, the Bill sets out to integrate the national Healthwatch into the Department of Health and Social Care through a new patient experience directorate and to integrate local healthwatch organisations into integrated care boards and local authorities, which are responsible for delivering health and care at local level. This measure is about making sure that patient voices at national and local level are closer to those deciding on and delivering services, so that those voices are heard.
Sarah Coombes (West Bromwich) (Lab)
Will the Secretary of State confirm that the heart of this Bill is about modernising the NHS and reducing inequalities across this country, and that since my constituency has the third lowest healthy life expectancy in the UK—it is shocking—my constituents will benefit from this Bill and all the action on inequality that it is intended to deliver?
James Murray
My hon. Friend is absolutely right that this Bill is about modernising the NHS. As a Labour Government, our priority is to boost investment and to modernise the NHS for the future. It is exactly that combination of investment and reform that will deliver the health service that her constituents need and deserve.
Several hon. Members rose—
James Murray
I will give way one more time, and then I will make some progress.
Jim Shannon (Strangford) (DUP)
I welcome the Secretary of State to his place and I wish him well in the role he now takes on. I am very pleased that he has experienced the NHS at its best, and I am glad to hear that.
The Government have called for a duty of candour, so they must ensure that that is still possible, but the decision to scrap independent bodies such as Healthwatch and the Health Services Safety Investigations Body risks silencing the patient voice, so there is a need to be careful. Will the Secretary of State assure us that the Government have taken that on board in this Bill?
James Murray
The hon. Gentleman raises questions relating to Healthwatch and to HSSIB being integrated into the Care Quality Commission. I will set out more detail in a few moments about those decisions, but fundamentally they derive from conclusions arrived at by Dr Penny Dash, whose review of the patient safety landscape found that it was too full of different organisations, and that their impact on the services provided to patients was unclear. We are seeking through this Bill to simplify that landscape, make sure that patients’ voices are heard closer to decision makers and improve the NHS for everyone across the country.
For me, the way to build on the progress of the past two years is not just to maintain the improvement in performance that we have seen, but to accelerate our fundamental transformation and modernisation of the NHS. As Health Secretary, I am absolutely focused on delivery and putting the values that we in the Labour party all share into action. Crucially, I am determined to make sure that we benefit from the fullest possible use of technology, digitisation and artificial intelligence to renew the NHS for the future.
The changes in technology, digitisation and AI are not an add-on to the NHS’s core business. With a determined focus on driving innovation at every level and the confidence to reimagine our approach to the nation’s health for the modern world, they offer us the chance to transform the way the entire NHS works. They will improve the speed of diagnosis, helping people to get the right treatment much more quickly than they do today.
Kim Johnson (Liverpool Riverside) (Lab)
Will my right hon. Friend give way?
James Murray
I am going to make some progress, if I may.
These changes will streamline tasks for NHS staff, freeing them from admin and bureaucracy to focus their energy on caring for patients. They will transform the experience we all have as patients, giving us control and reducing our anxiety over the care we receive. They will reduce the costs of delivering healthcare, so that more of the money we spend goes to the frontline, where it belongs. That is the future we must build, and the road to that future runs through this Bill.
For many years, patient groups have warned about the pitfalls and shortcomings of fragmented information systems in the NHS, and they are absolutely right. Right now, information in the NHS tends to follow the institution, not the individual. That is why we all know the familiar frustration of having to repeat the same story over and over, every time we see a new nurse, doctor or consultant. The reason for this is that too often no one, including the patient themselves, can see a full summary of a patient’s medical record in one place. Those patchy care records are not just an inconvenience or a source of anxiety and distress; they can also be a risk to patient safety.
Ben Obese-Jecty (Huntingdon) (Con)
I welcome the Secretary of State to his place. Hinchingbrooke hospital in my constituency is one of the new hospitals to be built as part of the new hospital programme—it is in wave zero—but it currently does not have an electronic patient record system, so we have the fragmented patient history that he has just mentioned. It desperately needs to increase its rating on the HIMSS—Healthcare Information and Management Systems Society—scale as a new hospital, but it does not have the funding required to install a patient record system. Will he guarantee that the hospital will receive the funding required to deliver a new electronic patient record system?
James Murray
I am happy to look into the specific circumstances the hon. Gentleman refers to and get back to him. More widely, however, the investment is secured across the Government for implementing the single patient record system. That will mean that, rather than data being transferred from where it exists at the moment to a new system, it will remain where it is—in GP surgeries, hospitals and so on—but it will be linked up so that one person, including the patient, can see all that data from the middle of the network of information.
Several hon. Members rose—
Sarah Champion (Rotherham) (Lab)
Specifically on the single patient record, the explanatory notes say that it will
“allow patient information to be shared with patients and their relevant health and social care providers (such as GPs, hospital doctors, social care workers and others involved in their direct care)”.
By my maths, that is probably a couple of million people, so could the Secretary of State please talk about how safeguards will be implemented, particularly for children’s care data?
James Murray
I thank my hon. Friend for raising the very important question of data privacy and security. I will address that in a moment, because I am going to set out some of the protections in our approach to the single patient record, and I think that will exactly answer the questions she raises.
I will make progress, because I am conscious of time. As I have said, the patchy records are not just an annoyance or a source of anxiety or distress; they can also be a risk to patient safety. In other areas of our lives, getting information wrong or not having it immediately available may be an inconvenience; in a health service, the consequences can be profound. What happens to the patient who is rushed to accident and emergency and has complex conditions that require multiple medications, if the emergency team have no way of knowing that? What happens to the dementia patient who cannot keep track of all the different documents from all the different specialists in all the different providers? In today’s NHS, the GP or practice nurse at the clinic, the paramedics stepping through the front door and the consultant at the bedside are doing everything they can to try to solve a puzzle, but without all the pieces. This Bill will change that. It will do so by introducing a new approach—the single patient record—and that is nothing short of a game changer.
Dame Chi Onwurah (Newcastle upon Tyne Central and West) (Lab)
I congratulate my right hon. Friend on his new position.
On Wednesday, my Science, Innovation and Technology Committee will publish our report on the Government’s digital ambitions. My right hon. Friend will not be surprised to know that we will be raising serious concerns about data management, data hygiene and vendor lock-in. Many projects such as the single patient record have failed over the last 20 years. Will he confirm to me that he will ensure that patients can control when and how their data is seen, that he will be building on existing records such as the great north care record, and that this will be treated as critical national and sovereign infrastructure, not subject to capture by a single provider such as Palantir?
James Murray
I thank my hon. Friend for her intervention. She is absolutely right to underscore the importance of data security and data privacy. That is essential in building trust in what we are seeking to do.
To be clear, the single patient record, as I was just saying a moment ago in response to the hon. Member for Huntingdon (Ben Obese-Jecty), does not move data from one system to another; it preserves the data where it is, and builds links between systems so that one person, whether a clinician or a patient, can see all the data at once. The data will still be governed by the same privacy policies on a GP system, in a hospital trust system and so on. When linked together through the single patient record, it will be governed by the highest levels of security: only authorised individuals will be able to access the data, there will be an audit trail of anyone who has accessed it, and the cyber-security protection will be the strongest available.
Kim Johnson
I really appreciate the Secretary of State giving way on that point. This morning on Radio 4, he failed to rule out Palantir being awarded the single patient record. We know that the £330 million offered to it for the current federated data has been highly criticised by unions and the British Medical Association. What assurances can he give us that patient safety will be free from abuse and misuse?
James Murray
As my hon. Friend will have heard, as she listened to the rest of my interview on Radio 4 this morning, the situation with the single patient record is very different from that of the federated data platform, because it is likely that we will let a series of contracts to de-risk the delivery of the single patient record. The situation with Palantir is that the contract for the federated data platform is, as I am sure she knows, being reviewed ahead of a potential break clause in 2027, but the situation with the single patient record is a very different set-up. As I have said a couple of times now, information is stored on individual systems—in GPs, hospitals and so on. The single patient record links them up and will be delivered through a range of different contracts to make sure that the system works in the interests of clinicians and patients.
Jeremy Corbyn (Islington North) (Ind)
Will the Secretary of State give way?
James Murray
I am going to make some progress.
The single patient record will mean that wherever a patient is being treated, even if they are not at their local GP or are in a hospital they have never been to before, those caring for them will have access to all the accurate, relevant, up-to-date information they need. Through this new approach, we will bring together people’s health and social care records digitally, securely and conveniently, and make them available to patients on the NHS app.
A number of Members have raised questions about data privacy, so let me be very clear on that point. Patients rightly expect their highly personal and sensitive medical details to be protected, and they will be. Under our plans, strict safeguards, strong cyber-security and clear controls on who can read information will be backed by an audit trail of who has accessed what. The single patient record will also be subject to existing forms of scrutiny and oversight in the NHS, from data protection officers to legislative safeguards. Where the single patient record is being used for research or planning, it will be treated the same as all other sensitive health data, subject to the same legal protections, ethical approvals and governance.
Dr Luke Evans (Hinckley and Bosworth) (Con)
The Secretary of State is making himself the data controller of all the data that will be in place. What impact does that have on the sections he has just talked about?
James Murray
When the data is held by a GP surgery or an NHS hospital trust, for instance, the relevant bodies will remain the information controllers. Where that information is then shared through the single patient record, the Department of Health and the Secretary of State will take on a role as data controller as well. That will all be governed in the way that data protection currently applies across the NHS, through existing forms of data security. Fundamentally, it will reorientate the NHS to be a service that revolves around patients, rather than patients having to revolve around the NHS.
Ms Julie Minns (Carlisle) (Lab)
Just before my right hon. Friend moves away from the single patient record, may I highlight the challenge remaining in cross-border communities such as mine in Cumbria? My constituents in Carlisle often register with a GP across the border in Scotland. Unfortunately, at present that means that their single patient record will not necessarily flow with them. Will he work at pace with his colleagues in Scotland —and Wales; I can see my hon. Friend the Member for Clwyd East (Becky Gittins) nodding in front of me—to ensure that we get this right for anyone, regardless of where they live?
James Murray
My hon. Friend is absolutely right that the single patient record applies to the NHS in England, but my colleagues in the ministerial team have regular conversations with our counterparts in Scotland and in other devolved Governments to ensure that we are working on such cross-border issues wherever we can.
Becky Gittins (Clwyd East) (Lab)
Does the Secretary of State agree that the introduction of the single patient record will be a huge step forward in the safe treatment of people with allergies? Will he join me in calling on the new Minister in the Plaid Cymru Government in Wales to follow our lead for the betterment of allergy care for people in Wales?
James Murray
I very much join my hon. Friend in urging the new Health Minister in Wales to follow our lead by introducing a way for patients to access the data and, crucially, for clinicians to be able to see all a patient’s data when making those decisions. With complex cases, where people see multiple nurses, doctors, consultants and so on, it can be crucial that clinicians see all the relevant information when making choices on how to treat their patients. I thank my hon. Friend very much for her question.
Madam Deputy Speaker, I should make some progress, as I know that many Members wish to speak this evening. I am getting a nod from you that that is the right thing to do.
As I have set out how the single patient record will help to improve patient safety, I also want to be clear that no Government should ever pretend that things do not go wrong. When they do, it is crucial that the right systems are in place to hold people accountable, and to ensure that we learn from mistakes in order to prevent them from happening again. As I mentioned earlier, Dr Penny Dash conducted an independent review into the patient safety landscape. What she found was a confusing landscape of multiple, overlapping organisations that are responsible for patient safety in the NHS, making it harder for staff and organisations to do the right thing. That is why the Bill simplifies the patient safety landscape, streamlining and consolidating functions to make the system more effective and efficient, and to restore patient confidence.
Tom Gordon (Harrogate and Knaresborough) (LD)
Will the Secretary of State give way on that point?
James Murray
I am going to make some progress.
Following Dr Dash’s recommendations, the Bill will embed the mission and functions of the Health Services Safety Investigations Body into the Care Quality Commission to establish a clearer link between investigating safety concerns and increasing the quality of care. We will ensure that we protect the principle of a safe space for people to share their concerns. To ensure that patients are heard at every stage, from commissioning to delivery, we will make sure that patient feedback is embedded alongside decision makers at every level.
Sir Bernard Jenkin (Harwich and North Essex) (Con)
I am most grateful to the Secretary of State for giving way, and I congratulate him on his appointment. He has inherited this policy—it is not his own. I assure him that the abolition of the Health Services Safety Investigations Body is a dreadful mistake, because which other investigative function in the healthcare system is completely unconflicted in what it does? By abolishing HSSIB he is taking its functions into the CQC, which is a regulator and compliance enforcer, not an investigator, so that there is no longer any independent, unconflicted body conducting healthcare investigations. Has he consulted the royal colleges about this? I have not spoken to a single royal college that is in favour of the abolition of HSSIB.
James Murray
As I made clear, we will protect the principle of a safe space for people to share their concerns. The investigatory function will remain protected within the CQC. The benefit of embedding the HSSIB in the CQC will be to establish that clearer link between investigating safety concerns and increasing the quality of care. That is something on which we can all agree.
James Murray
I am going to make some progress, because, Madam Deputy Speaker, you have asked me and looked at me several times, suggesting that that is what I should do.
I mentioned the changes that the Bill makes to HSSIB and the CQC, but the functions of Healthwatch England—I spoke about that earlier—will move to a new patient experience directorate within the Department of Health and Social Care. The functions of local healthwatch groups will be incorporated into ICBs and local authorities. That approach brings the voices of patients closer to decision makers, so that people have a direct impact on the services they receive. Of course, the changes will neither fix everything at the stroke of a pen, nor take effect overnight, but rather than the voices of patients being kept at arm’s length, the Bill puts them where they should be: right at the heart of the NHS.
Vikki Slade (Mid Dorset and North Poole) (LD)
The Secretary of State has not talked about the role of the governors of hospital trusts, which also appear to be abolished by the Bill. With the creation of mega-ICBs, the removal of healthwatch, and the removal of governors, I am worried that the voice of the local community is reducing rather than increasing.
James Murray
The principle behind the changes to local healthwatch organisations is to bring the voice of patients closer to those who are planning and delivering services. Whether through ICBs or local authorities for health and care, it is an important principle to ensure that feedback is followed by action, and that people can have an influence on the design and delivery of health and social care at an earlier stage in the process.
James Murray
I am going to make some progress, because I need to update the House on the important measures in the Bill to abolish NHS England. Those critical measures will reduce bureaucracy so that more energy, time and funding in the NHS can be focused on the frontline, helping patients. The Bill will abolish the world’s largest quango by merging NHS England into the Department of Health and Social Care and the wider NHS system.
Gregory Stafford (Farnham and Bordon) (Con)
I have asked this question both as a member of the Health and Social Care Committee and on the Floor of the House to the Secretary of State’s predecessor. Given that the new Secretary of State is a numbers man, I hope that he can answer it where his predecessor could not. How much in redundancy payments will this measure cost the British taxpayer, and can he confirm that no person currently employed by NHS England will be fired, paid a redundancy fee, and then rehired by the Department of Health and Social Care?
James Murray
As the hon. Gentleman will appreciate, we are going through that process with the workforces at NHS England and the Department of Health and Social Care. Crucially, however, by 2028, across the Department of Health and Social Care, NHS England and ICBs, we will see a 50% reduction in headcount. That means that the money that would otherwise be spent on those members of staff will now go towards healthcare on the frontline, which is what patients want to see.
As hon. Members will know, NHS England was established by the Health and Social Care Act 2012. That Act established more than 300 new NHS organisations, and has led to too much time, money and effort being wasted on overlapping processes, as good people try to navigate a labyrinthine system that holds them back from delivering for patients. In short, we have a system that gets in the way of what staff, patients and taxpayers want to see.
Wendy Morton (Aldridge-Brownhills) (Con)
I welcome the right hon. Gentleman to his new role as Secretary of State. The point about ICBs and the devolution of responsibility for NHS eye tests is one that we often forget to talk about in this place, as is the case with eyecare—I know that there are some ophthalmic experts in the Chamber. On that point, can the Secretary of State assure me that the changes will not result in a postcode lottery in the provision of eyecare tests? At the end of the day, NHS sight tests are a universal entitlement, so can he ensure that that will continue?
James Murray
The right hon. Lady raises an important point, but local services are already commissioned locally in many cases. The changes that we are making by abolishing NHS England will mean that more power and resources go to ICBs and local areas to allow them to make the right choices for their local area. That is a way of bringing the services that we deliver closer to the people who need them.
Let me be absolutely clear that abolishing NHS England is in no way a reflection on the committed public servants who work at NHS England and in my Department. The truth is that unnecessary structures are getting in the way of them doing their crucial work and it is time for us to change that. The Bill will mean that more time, money and effort will be spent on improving the care that patients receive, rather than navigating the system around them.
Tom Gordon
Obviously, the Secretary of State has just outlined a huge raft of changes that are coming with the abolition of NHS England and everything else that goes with that. Last year, families and MPs got the inquiry into the Tees, Esk and Wear Valleys health trust—the mental health trust in the north of England that had been failing. My worry is that a chair of that inquiry was meant already to be in place. Will that inquiry now be lost amid all the changes to the healthcare system? Will the Secretary of State commit to meeting the families of those affected by the TEWV scandal, and will he get a chair in place as soon as possible?
James Murray
I am happy to look into the case to which the hon. Gentleman refers. The abolition of NHS England and the transfer of its responsibilities either to the Department of Health and Social Care or to local ICBs is being managed carefully, to ensure that we can continue making progress while the structural change happens. To return to my earlier point, the money saved as a result of these changes can go directly to frontline patient care. We expect about £1 billion to be saved, which is the equivalent of 15,000 nurses. I do not see how anyone can disagree with our decision to ensure that resources are spent on the frontline.
As I have explained, abolishing NHS England as a separate organisation will strip out bureaucracy and ensure that we focus on delivery. The decision also has an important democratic role. The core goal of the 2012 Act, brought in by the Conservatives and Lib Dems, was to take politics out of the day-to-day running of the NHS. However, that is a fundamental misunderstanding of the NHS and its place in the democratic life of the nation. The public pay for the NHS; they own it, use it, care deeply about its future, and so they should always have a say in how it is run.
People voted Labour because they trust us to build on our party’s legacy by transforming the NHS for the future, and they will rightly hold us responsible for the decisions we take as we do so. It is not about politics getting in the way; it is about accountability driving change. That accountability has been lost in the confusion of having two separate centres for the NHS, and the Bill will end that.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
I welcome the Secretary of State to his post. Could he explain what the pathway of local accountability is for ICBs?
James Murray
ICBs, as the hon. Gentleman will know, have a board structure that oversees how they operate. The removal of local healthwatch organisations will mean that the voice of patients and their experiences go directly into the bodies that are commissioning and overseeing services. One of the changes the Bill makes is to ensure that strategic mayoral authorities will have a place on the board of ICBs, which helps them ensure that wider objectives in an area of health are aligned.
Several hon. Members rose—
James Murray
I am going to make more progress.
Alongside the removal of confusion and duplication at a national level, the Bill also gives those with local expertise the power, resources and flexibility they need to design and deliver health and care services for their area. The Bill will empower them to innovate, drive progress and do what is in the best interests of the patients they serve.
Under the Bill, ICBs will have more direct responsibility for their services than ever before. They will be at the heart of integrating health and social care, and they will include those people responsible for housing, transport and jobs, so that we can tackle the root causes of ill health, which is better both for patients and for the NHS.
The NHS gave me a second chance at life, and so as Health Secretary I will fight for the NHS every day with the strength it has given me back. The Tories ran down the NHS through 14 years of neglect, and the Lib Dems enabled them. Reform wants to abolish the NHS altogether and replace it with an insurance-based system. The Greens seem intent on ignoring clinical advice and have no practical solutions for the health service. Only Labour has a plan to get the NHS back on its feet. Only Labour is determined to both invest in and fundamentally transform the NHS for the future. Only Labour is showing that change is possible.
We promised to cut waiting lists—we delivered the biggest annual fall in 16 years. We promised an extra 1,000 GPs in our first year—we delivered twice that number. We promised 8,500 more mental health staff by 2029—we have delivered them three years early. We promised 700,000 more NHS dentistry appointments—we have delivered an extra 1.8 million already.
We promised to transform the NHS for the future, and that is what this Bill will do. We are already boosting investment in the NHS where it needs more. We have begun stripping out bureaucracy from the NHS where it needs less. And now we will build a truly modern NHS that will be there for generations to come. The Bill is the next crucial step in our mission, and I commend it to the House.
Madam Deputy Speaker (Judith Cummins)
I call the shadow Secretary of State.
Stuart Andrew (Daventry) (Con)
I begin by welcoming the Secretary of State to his new post, and thank him for sharing his very personal story about what the NHS means to him. I look forward to our future exchanges, however long he is in post. I also pay tribute to the former Health Secretary, the right hon. Member for Ilford North (Wes Streeting), with whom I have had a few moments across the Dispatch Box. I know that the NHS has also been very important to him personally. During my time in hospices, I saw the incredible work that the NHS does, and despite the politics that we may have—and I will be referring to the right hon. Gentleman a bit more later on—we all care deeply about the national health service and want the very best for it.
There are moments in politics when one almost has to admire the confidence of Governments—not their competence, necessarily, or their judgment, and sometimes not their timing, but certainly their confidence—and nowhere has that confidence been more magnificently displayed than in the presentation of the Health Bill. If one had listened carefully to the former Secretary of State for Health and Social Care over the past two years, one could conclude only that this Bill was not merely legislation, but apparently the parliamentary equivalent of the second coming. In every speech, interview and carefully staged hospital visit with sleeves rolled up, they delivered the same message: at last—at long last—the NHS was to be modernised, integrated, digitised, streamlined, revolutionised and transformed into a gleaming technological marvel, where patients floated frictionlessly through a system powered entirely by innovation, efficiency and ministerial self-belief.
I say gently to Ministers that whenever a politician begins using the phrase “once-in-a-generation change” on such a regular basis, it is usually wise to place one’s hands protectively over one’s wallet, given the sheer cost of what is to follow. What became increasingly striking was not simply the scale of the promises, but the sheer showmanship of them, with the former Health Secretary speaking less like a Cabinet Minister wrestling with one of the most complex public services in the world and more like a man auditioning to narrate the trailer for his own leadership campaign documentary. And now, Madam Deputy Speaker, we arrive at the great political twist: the man who spent two years announcing the future has departed before the delivery date arrived, like an architect unveiling magnificent blueprints before quietly moving abroad just before construction begins.
Into this situation walks the new Health Secretary. Members can imagine the scene: the Prime Minister sits stubbornly in No. 10, grinning with all the reassuring confidence of a man standing knee-deep in a flooded rowing boat insisting that the situation merely requires a modest redistribution of water. Into this bunker is summoned the new Secretary of State—formerly the Chief Secretary to the Treasury, the very man who helped to allocate the famous £202 billion funding settlement now repeatedly cited as proof that every problem in British healthcare has theoretically already been solved.
Jessica Toale (Bournemouth West) (Lab)
I would not give the right hon. Gentleman’s political adviser a raise for their speechwriting abilities just yet. Why does he think we are having to talk about once-in-a-generation change to the NHS?
Stuart Andrew
I would point the hon. Lady to how the NHS was being run in Wales—it certainly was not the great success that she is trying to allude to.
In politics there are difficult jobs and there are impossible jobs, and then there is inheriting a Department after one’s predecessor spent two years promising the electorate that this is the one Bill to rule all Bills and fix virtually everything short of death itself. This was not just a hospital pass, but a hospital pass delivered by catapult.
One can almost hear the poor Secretary of State gulping. “Thank you, Prime Minister,” he replies faintly, in the tone of a man accepting command of the Titanic after it has already struck the iceberg. Off he trudges to the Department of Health and Social Care, where the automatic doors open and his nostrils are struck immediately by a strange, lingering aroma. It is not the scent of modernisation or the smell of efficiency, and it is certainly not the fragrance of falling waiting lists. No—it is the unmistakeable odour of political panic, mixed delicately with the perspiration of failed leadership manoeuvres and lightly seasoned with the ashes of abandoned promises. There waiting for him, naturally, is Sir Humphrey—because however much Governments modernise, digitise, integrate, recalibrate or synergise, Whitehall always produces a Sir Humphrey.
I can imagine the conversation. The new Secretary of State says brightly, “Good news, Sir Humphrey. I understand that my predecessor has already solved everything through the Health Bill.” At this point, an eerie silence descends. Civil servants suddenly become more fascinated by ceiling tiles, and one junior official attempts to escape through a stationery cupboard. Sir Humphrey clears his throat in the way only permanent secretaries can; a sound rather like an early—
Stuart Andrew
Give me time, give me time.
“Well, indeed, Minister,” says Sir Humphrey.
“I understand,” says the Secretary of State, “that abolishing NHS England will instantly reduce bureaucracy, improve accountability and unleash vast efficiencies.”
“Well, Minister, it will certainly create a large number of meetings.”
“And the single patient record will revolutionise healthcare, won’t it?”
“Yes, Minister—assuming the NHS IT systems eventually stop communicating with each other via what appears to be medieval semaphore.”
“But we have delivered 5 million more appointments.”
“Certainly, Minister—only 1.5 million appointments behind the last Conservative Government.”
“And integrated care boards now answer directly to Ministers.”
“Yes, Minister.”
“So accountability is now indisputable.”
“Well, Minister, blame certainly is.”
And so the conversation goes on. The Secretary of State asks, “And what about the workforce plan?”
“Still developing, Minister.”
“And social care?”
“Still delayed, Minister.”
“And mental health implementation?”
“Still proceeding at approximately the speed of continental drift.”
“And pharmacies?”
“Still under pressure.”
“And GP contracts?”
“Still alarming GPs.”
“And productivity?”, the Secretary of State asks desperately.
“At present, Minister, the NHS measures productivity in the same way that astronomers in ancient Greece measured distant planets: with great optimism and very limited visibility.”
At this point, the Health Secretary clearly begins searching the office for the exit map. “But Sir Humphrey,” he says, “surely my predecessor left me with a fully deliverable programme.”
After a long pause, Sir Humphrey replies, “Well, your predecessor was primarily focused on a different pathway.”
“A different pathway?”
Stuart Andrew
“Yes—the pathway to No. 10.”
And now I will give way to the right hon. Member! [Laughter.]
Wes Streeting
I am sure that sounded really good in the mirror when the right hon. Gentleman practised this morning, but can I bring him back to the real world, where the permanent secretary is, in fact, a woman and an outstanding leader at that? In the real world, I am able to say something that not one of my Conservative predecessors was able to say when they left office, which is that I left the NHS in a better state than I found it. Why is he so determined to defend the bloated bureaucracy that his party created over 14 failed years?
Stuart Andrew
Well, let me say directly to the right hon. Gentleman that there have been a lot of announcements from the Government. We know all about the fall in waiting list figures, and not just from comments from us in this Chamber challenging what is really happening—we are receiving email after email from people who have been taken off waiting lists despite still needing treatment. Patients are being taken off waiting lists, sometimes without their knowledge. This has not been about more appointments for patients—it is about massaging the figures, and he knows it.
There is a lot in this Bill that we will support, and there are many areas where we would like the Government to perhaps go further, but there is also a rhetoric that needs to be addressed, because there are unresolved problems still. Social care is unresolved. Workforce pressures are unresolved. Mental health backlogs are unresolved. Productivity is unresolved. Pharmacy pressures are unresolved. GP satisfaction is unresolved. The Secretary of State is inheriting not just a Department but an expectations crisis, because the greatest danger in politics is not under-promising; it is convincing the public that complexity itself can be announced away.
The Bill abolishes NHS England and centralises significant powers to be governed by the Secretary of State. It takes control out of patients’ hands.
Jim Shannon
The shadow Secretary of State rightly said that there is a lot in the Bill to be welcomed in principle, including the cutting of red tape, and we must recognise that, but unchecked state control must be resisted. The shadow Secretary of State mentioned accountability. Does he agree that we must ensure that accountability is part of the Bill?
Stuart Andrew
The hon. Gentleman raises an important point, and it is exactly the sort of issue that will need further scrutiny in Committee. I note that local authorities will not have the same seat at the table and that it will be transferred for mayoral regions, but what about regions that do not have a mayor? That measure will create a real democracy deficit in the NHS. I hope that we can look at this in detail in Committee, because that serious oversight absolutely needs addressing.
Gregory Stafford
On the point of accountability and scrutiny, the Government are looking to abolish HSSIB or bring it into the CQC, they are getting rid of Healthwatch—which serves my constituents so well—in places such as Surrey and Hampshire, and they are getting rid of governors from the boards of foundation trusts. That does seem to suggest that they have not really thought the accountability point through. Would not this be the occasion for the new Secretary of State to stamp his mark on this Bill by conceding that some of the changes in the Bill are not what was intended, and to take this opportunity to give confidence back to the public that they will have the accountability and scrutiny that they deserve?
Stuart Andrew
My hon. Friend raises a very important point; it is an area that the Committee will have to look at very carefully.
I listened carefully to what the Secretary of State said, and I believe that he wants there to be a patient voice, but there is a serious flaw in the Bill. Abolishing Healthwatch and HSSIB is a terrible mistake, and I praise my hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) for the work that he has been doing on this. The reality is that HSSIB gives members of staff who work in the NHS the confidence to come forward and be a whistleblower. We need that. We need people to feel that they are in a safe environment. The CQC is a totally different beast in the minds of people who work in the NHS and social care, so to put those functions within that organisation is a terrible mistake and one that I hope the Committee will look at very carefully.
Saqib Bhatti (Meriden and Solihull East) (Con)
The shadow Secretary of State is making an excellent speech, and I commend his speechwriter! I am sure my right hon. Friend wrote it himself.
On accountability, the Secretary of State spoke repeatedly about devolving powers, but this Bill is a massive power grab by the Secretary of State, and our constituents will not get the accountability that they crave and that some of the reforms we implemented in 2022 gave them. Does my right hon. Friend share my concern?
Stuart Andrew
I am genuinely concerned about that. Members of Parliament from across the House have often brought to the House some very serious cases—things that have gone terribly wrong for their constituents, services that have been commissioned in their area, and awful things that have happened to patients. It is because of organisations like Healthwatch and the HSSIB that those issues have come to light, and work has gone into improving those services. That is what we all want to see, but I am really worried that that progress will be lost. If those functions are absorbed into the Secretary of State’s office, I really do not think it will be able to cope with the sheer volume. It needs to be done on a much more localised basis.
Robin Swann (South Antrim) (UUP)
I thank the Secretary of State for raising that. If I read the Bill right, schedule 8 allows the CQC to carry out investigations into Northern Ireland and Wales, whereas the CQC has no presence or remit within Northern Ireland, because health is devolved and those functions are carried out by the Regulation and Quality Improvement Authority. Can the shadow Secretary of State comment on how the Secretary of State is now reaching into devolved matters in regards to regulation, quality, improvement and assessment?
Stuart Andrew
That is exactly one of the issues that needs to be ironed out. I am sure that the hon. Gentleman will ensure that the Committee considers the impact for devolved Administrations, particularly where they have responsibility for health in their areas. I hope that he will raise that with members of the Committee.
Anna Dixon (Shipley) (Lab)
I worked in the Department of Health at the time that NHS England was created. I have always been sceptical about the Lansley fantasy that somehow the NHS could be made separate from the Department of Health and Social Care. I saw at first hand man-marking and duplication of function. This Bill finally puts the nail in the coffin of the complex arrangement of masses of arm’s length bodies that was created by Andrew Lansley. Will the right hon. Gentleman please agree that this is the time to restore stronger democratic accountability for our NHS?
Stuart Andrew
I gently remind the hon. Lady that it was the former Secretary of State who said that he did not want to go through another reorganisation, because it would be very costly. We still cannot get a clear answer from the Government about how much this is all going to cost the taxpayer, and there are estimates of £1 billion. There are still serious questions to be answered. The hon. Lady talks about democratic responsibility and accountability, and she is right to do that. She is fortunate—depending on one’s point of view—to have a mayor, but my constituency and county do not. Will my constituents get less of a voice in their NHS than her constituents in Shipley? That does not seem fair to me.
Jen Craft (Thurrock) (Lab)
Is it not the case that transferring powers from an unelected quango to the Secretary of State, who is directly accountable to this very House, increases, not diminishes, accountability in the NHS?
Stuart Andrew
I am talking about trying to get accountability down to the local area. That is where it matters, and that is where my constituents want to see it. They know their local services and the hospitals in their areas, and they are the ones who should have their voices.
Dr Spencer
I am glad that we are having this important debate on accountability. Is there not a danger that the centralisation of this direction power in the Secretary of State effectively signals to MPs, “Don’t engage with ICBs, as they will not have accountability to local MPs. If you want changes to happen, go through the Secretary of State rather than engaging locally, because that is where the power is going to lie”?
Stuart Andrew
Yes, and this is—[Interruption.] It is slightly patronising to say to someone, “Read the Bill”. Clearly my hon. Friend has, and we have been talking about this in great detail.
There is a real concern here. We need much clearer answers to these questions, which many of our constituents will have. Those who give up their time to work in organisations to make the NHS better deserve decent answers to those questions and concerns. I certainly hope that reflection will be taken on those points.
At its heart, the Bill is not simply a debate about technology or bureaucracy; it is about who holds, controls and safeguards the most personal data that any of us will ever possess. This is one of the most significant reorganisations of the NHS in modern political history, but it is wrapped carefully in the language of managerial simplification.
Perhaps part of the Bill will help, and of course some reforms are necessary. Conservatives are not afraid of reform—definitely not. Indeed, if the NHS is to survive the demographic, technological and fiscal pressures ahead, modernisation is essential. That is because technology matters, innovation matters, integration matters, data matters, prevention matters, productivity matters and, yes, accountability matters too. That is why, where we see good work in the Bill, we will back it, and where we think there are questions that need to be drilled down into, we will do so. We want to ensure that the Bill works.
There is a difference between modernisations rooted in political realism and announcements designed primarily for political theatre, and too much of the approach we have seen so far is Whitehall talking to itself; meanwhile, outside this Chamber, reality continues uninterrupted. Patients still wait, ambulances still queue outside A&E, the family still worries, the exhausted nurse still works a double shift and the GP still battles impossible demands.
Here is the truth: the NHS does not primarily suffer from a shortage of announcements; it is marked by a persistent lack of grip and direction. The Government today increasingly resemble a man frantically changing labels on a filing cabinet while the building itself quietly catches fire.
The Government say that abolishing NHS England will reduce bureaucracy—perhaps it will—but let us not forget that Whitehall sometimes possesses a remarkable historic talent for abolishing bureaucracies ceremonially before quietly recreating them under another name with slightly different headed paper. We need to ensure that that does not happen in this instance.
We also have to think about the huge amounts of public money involved—yes, nearly £202 billion; an extraordinary sum of money. We understand that pressures rise—of course we do—we understand about ageing populations, we understand that medical advancement increases costs and we understand the aftershocks of the pandemic. But when a Government spend record sums while presiding over delays, workforce uncertainty, transformation paralysis, productivity collapse and public frustration, eventually the British public are entitled to ask a simple question: where has all my money gone? The Government are not judged by the size of the press release; they are judged by whether the thing actually works.
We must now do everything to ensure that the Bill goes through with great scrutiny, as it needs to do, because healthcare is difficult, trade-offs are real and workforce shortages cannot simply be rebranded as opportunities. Indeed, the public increasingly suspect something very different here: they suspect that too much of modern politics has become performance without consequences, announcements without accountability and presentation without delivery. That is ultimately why the Bill matters. If this enormous centralisation of power succeeds, Ministers will claim vindication, but if it fails and bureaucracy persists, waiting lists remain stubborn, workforce pressures deepen and promised transformation dissolves into another cycle of reorganisation, the Government will no longer possess anyone else to blame—not NHS England, local structures, quangos or the system—because the Bill places responsibility squarely where the Government claim it belongs, on the shoulders of Ministers. Perhaps that honesty will prove the Bill’s greatest contribution.
The British people are patient, but they are not naive. They can distinguish between serious transformation and political choreography, and they increasingly understand that there is no technological shortcut around the fundamental challenge facing healthcare. The Government cannot run a service this large, pressured and so deeply connected to people’s lives and wellbeing primarily through presentation. Eventually, every Government collides with reality, and reality—unlike leadership campaigns—cannot be managed through slogans. That is the inheritance facing the new Health Secretary, and that is why the House should approach the Bill not with breathless excitement but with very hard-headed scrutiny indeed so that we get the NHS we all want to see.
Several hon. Members rose—
Madam Deputy Speaker (Judith Cummins)
Members will have noticed that about 50 Members want to speak in the debate, so with the exception of Front Benchers I will be starting with an immediate six-minute time limit.
Andy McDonald (Middlesbrough and Thornaby East) (Lab)
May I begin by welcoming the Secretary of State to his place and wishing him well in the responsibilities that he carries on behalf of patients, NHS staff and communities across the country? I welcome the Bill and its intention to improve patient care through investment, modernisation and better integration across the health service.
It is right to acknowledge the progress made on waiting times and waiting lists since Labour returned to government, with the overall waiting list falling significantly and long waits continuing to come down, but may I add my voice to those of others about the appointment of a chair for the Tees, Esk and Wear Valley inquiry? My right hon. Friend the Member for Ilford North (Wes Streeting) gave that commitment, which we were pleased to hear, but we have yet to see that chair appointed. If that could be given attention, we would be most grateful.
I remain concerned about the continuing impact of historic private finance initiative costs on NHS trust budgets, including the pressures facing South Tees hospitals NHS foundation trust in my patch. Too much money is still being diverted from frontline care. I regret that this issue remains unresolved.
The principal reason I rise today is as chair of the all-party parliamentary group on spinal cord injury. Last summer, the APPG’s inquiry into spinal cord injury services reached a clear conclusion: the evidence points to the need for more national co-ordination, not less. Spinal cord injury is a low-volume but highly complex condition requiring specialist pathways, lifelong rehabilitation and co-ordinated support, yet the inquiry heard repeated evidence of fragmented services, postcode variation, delayed rehabilitation and patients being lost within the system. The APPG therefore called for a national strategy and a modern service framework for spinal cord injury care. As we intend to hold a lived experience roundtable shortly, I invite the Health Secretary to come and meet people with spinal cord injury to hear their concerns about the proposed changes to commissioning.
We welcome the excellent constructive engagement from the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson), and NHS England officials, but we remain deeply concerned about proposals to transfer spinal cord injury commissioning from national oversight to integrated care boards. Indeed, NHS England’s own evidence to the inquiry emphasised national standards, national quality metrics and nationally co-ordinated pathways, quality measures and oversight. If national consistency has not yet been achieved under national commissioning, what evidence demonstrates that transferring responsibility to multiple ICBs will improve outcomes or equity?
What is at stake is not abstract. When somebody sustains a spinal cord injury, their life changes overnight. They may require specialist rehabilitation, housing support, benefits advice, mental health support and long-term clinical care. Patients and families should not be left to navigate a fragmented system alone. That is why I welcome the ambition behind the single patient record and Diagnosis Connect.
Connecting newly diagnosed patients directly to specialist support reflects one of the APPG’s recommendations. Organisations such as the Spinal Injuries Association help people rebuild their lives after life-changing injury. I hope that Ministers will consider including spinal cord injury within the early phases of Diagnosis Connect.
The question is not whether structures change on paper; it is whether people living with spinal cord injury will experience safer, more equitable, more co-ordinated care. I hope that the Secretary of State will answer some straightforward questions. If NHS England accepts that national consistency has not yet been achieved, what evidence shows that localised commissioning will improve it? How will national standards, benchmarking and quality oversight remain coherent under a fragmented arrangement? Do the Government accept that spinal cord injury differs fundamentally from standard population health commissioning because of its low volume, high complexity and cross-boundary nature? What safeguards will prevent widening regional inequity, if accountability is dispersed across multiple ICBs?
The APPG’s inquiry concluded that spinal cord injury services require stronger national co-ordination and oversight, not greater fragmentation, and I hope the Government will reflect carefully on that evidence. This country led the world in spinal cord injury provision under the leadership of Professor Ludwig Guttmann after the second world war, with the remarkable work that he achieved. We need to return to those days of being pioneering and world-class. As a lawyer who previously practised in this area, I am afraid that over the past several decades services have deteriorated and gone backwards. We must restore those services and bring trust to people who so desperately want reassurance that there is a national system for them to rely on that will address their needs. We are currently not in that place at all. The Bill is an opportunity to address that, and I trust the Minister will take that on board.
Madam Deputy Speaker (Judith Cummins)
I call the Liberal Democrat spokesperson.
Helen Morgan (North Shropshire) (LD)
I start by declaring an interest as a member of the all-party group on patient safety and as a vice-president of the Local Government Association, and also by welcoming the new Secretary of State to his place. I very much look forward to working constructively with him during the passage of the Bill.
We all know that our NHS is in desperate need of transformation. Hospitals are in chaos, social care is overloaded and getting a GP appointment is a huge challenge for many. Labour has promised to put patients and communities at the heart of the NHS, but I fear that the Bill does not fulfil that promise. The Government promised to sort out social care, but two years later they are still only part-way through a three-year review. They promised to treat mental health with parity, but although mental health accounts for 20% of the disease burden, its share of NHS budgets is falling to just 8.4%. The Government promised to protect women’s health, but the women’s health strategy published this year was significantly weaker than the men’s health strategy, which received 60% more funding for new research. Healthy life expectancy in the UK is stagnating, and adult social care is under ever more pressure, putting immense stress on the budgets of councils and other local authorities.
The reality in rural North Shropshire is that people struggle to get GP appointments, 12-hour waits in A&E have become normal and finding an NHS dentist is becoming impossible. The social care crisis has left Shropshire council’s finances in a dire situation. A real NHS reform Bill would have changes to social care, general practice and prevention at its heart. Instead, this Bill passes responsibilities around Whitehall, centralising more power with the Secretary of State, while chaos reigns following 50% cuts to ICB budgets.
Early in his term, the right hon. Member for Ilford North (Wes Streeting) promised that another top-down reorganisation of the NHS was the last thing he wanted to do. Yet the abolition of NHS England is exactly that—focusing on reorganisation at the top, while failing to deliver real improvements for patients and staff. It is true that NHS England has allowed Ministers to shirk responsibility and accountability, but its abolition has been poorly planned, leaving both ICBs and specialised commissioning in chaos. Instead of the Government’s advertised aim of creating a more community-based NHS, the Bill centralises power in Whitehall, giving sweeping Henry VIII-style powers to the Secretary of State. Such powers carry a real risk that political considerations could influence what should be operational decisions about how the NHS provides for patients in future. That is particularly concerning in the current febrile political climate, and the Government must ensure that protections are in place for what may happen in the future.
The Government have made 50% cuts to ICBs, but the Bill gives them new legal responsibilities, different structures and centrally directed spending objectives. It is indicative of a lack of planning that could plunge ICBs into chaos. Meanwhile, the removal of the integrated care partnership and the extension of ICBs to cover multiple local authorities raises unanswered questions about the future of social care planning. In Shropshire, the council already spends around 80% of its budget on social care provision. That has a monumental impact on all services, as constant savings have to be found. Removing the pooling of the better care fund among local authorities and ICBs will discourage integrated working between these bodies on social care. Given existing complications over the sharing of costs and social care provision, the chaos of that reorganisation may only exacerbate confusion.
It is also astounding that the Bill plans to remove the duty of GP representation on ICBs, along with local authorities and NHS trusts. The replacement of council representation with mayors is extremely problematic for the many areas that do not have a mayor, and it removes the local accountability needed to ensure true community representation. Like so much Labour policy, such changes risk benefiting concentrated urban areas, while letting down rural communities such as those I represent.
Steff Aquarone (North Norfolk) (LD)
My hon. Friend will be aware of clause 4 on reducing health inequalities, which I welcome. As a rural MP, like me, she will also know that access and outcomes are poorer in our communities. Does she agree that the Government should go further and ensure that the Bill explicitly refers to equality of access and outcomes for rural and coastal communities such as North Norfolk?
Helen Morgan
My hon. Friend will not be surprised to hear that I agree with his point.
ICBs are already overstretched and underfunded. In North Shropshire, both Shawbury medical practice and Prescott surgery in Baschurch are in desperate need of expansion. Community infrastructure levy money is available and land is earmarked for a new site, but progress is being held up by the ICB’s inability to agree notional rent. That situation is replicated across the country, and there is no sign of such problems being solved by the Government’s changes.
The plan to abolish Healthwatch will ultimately strip patients of their voice. There has been a statutory independent patient voice in the health and care system for more than 50 years. More than half of patients who experienced poor care in 2024 did not take any action, with many citing fears that giving negative feedback directly to the NHS might affect their ongoing treatment. That is why it is crucial that we have an independent patient voice, rather than leaving the Department or the ICB to mark its own homework.
We need only look at the devastating consequences of the failings uncovered during the Mid Staffordshire scandal, and the long list of maternity failings since, to see how important it is to have Healthwatch exposing challenges in the health service and listening to patient feedback, and how the CQC can fail in that operation. In Shropshire more than 200 babies are thought to have died due to maternity failures; in the reviews that followed, the one thing that came up time and again was that grieving parents were not listened to.
Patients and their families must have a voice. The new system will give no incentive to investigate such issues, which are invisible in the main performance metrics of the NHS. To see the value of Healthwatch, we need only look at the Cabinet Office King’s Speech briefing for the Bill, which refers to a Healthwatch report from May 2025 on missing medical records in order to make the case for the single patient record. I urge the Government to protect both national Healthwatch and local healthwatch organisations, and the independent whistleblowing routes that empower and advocate for patients.
The Liberal Democrats welcome the move to create a single patient record; that part of the Bill could prove to be the most transformational for patient experience and, most importantly, for patient outcomes. People are tired of endless NHS admin and of having to reconfirm their medical histories over and over to different medical professionals. Patient harm has often occurred where clinicians have not had a patient’s full medical history, and different parts of the NHS having access to the same patient information is clearly necessary. However, that must come alongside essential new privacy protections and safeguards for patients, particularly given the understandable concerns surrounding Palantir’s involvement with the federated data platform. We would introduce a health charter to set out guiding principles for data sharing across the NHS, ensuring that patients are in charge of their own data.
The Bill’s references to carers are welcome, as is the Secretary of State’s duty to promote the involvement of carers alongside patients in decision-making around care and commissioning. However, the Bill goes nowhere near tackling the social care crisis and demonstrates a pitiful lack of ambition on one of the biggest challenges we face. As I mentioned, the chaos caused by the restructuring of ICBs will only worsen the challenges that local authorities face in providing care for an increasingly ageing population. We want to transform the NHS so that patients are empowered to live more healthily, for longer and in dignity. The nation’s health is stagnating, with an ever-widening gap in healthy life expectancy between the country’s most and least deprived areas and growing pressure on adult social care.
Fixing social care is fundamental to our vision for the NHS. It is the key to providing a better quality of life for the frail and vulnerable, freeing up hospitals and building independence for an ageing population. It also empowers our constituents to live as independently as possible in their homes and near to their families and communities. We cannot fix the NHS and move care to the community while ignoring social care—yet the Bill ignores it and, as I have outlined, the changes to ICB commissioning will undermine the structures that are supposed to integrate social care with the NHS.
Liberal Democrat plans will give people control, rooting services in communities, listening to patients and making it much easier to see a GP. We will give patients a right to see a GP within seven days, reverse surgery closures and ensure proper personalised management of chronic conditions and frailty, with guaranteed access to a named GP for those patients. We will also protect the mental health investment standard so that we can rebuild community mental health services—something that this Government have failed to do— empowering individuals with poor mental health by intervening early and allowing them to access care in their community. Our maternity rescue plan will ensure that Britain is the safest country in the world in which to have a baby, offering one-to-one midwifery care and empowering women at this most important moment.
This Health Bill could have been a moment for real change. Liberal Democrats are clear about what real modernisation of the NHS would look like. Our vision for a reformed, community-based NHS is one where proper care and restored investment in public health ultimately cut NHS waste and empower people to live healthier and more independent lives. This Bill focuses on shuffling responsibility around Whitehall and gives the Secretary of State the role of chief micromanager. The Government continue to procrastinate over bringing in real change to fix social care, empower patients and save our NHS. In Committee and on Report, Liberal Democrats will use every lever at our disposal to deliver the transformation the NHS so desperately needs.
Dr Zubir Ahmed (Glasgow South West) (Lab)
Twenty-one years ago, when I started my NHS career as a junior doctor, there were Labour Governments in every part of Britain, and I was proud to have practised in every single nation of our country. The NHS then exemplified the mood of our nation: hopeful, comfortable in its own skin and confident about embracing, even shaping, its future. And we did shape that future. The Labour Government delivered world-class heart attack care, stroke care and cancer care, regardless of where someone lived and their ability to pay for it. We also drove through controversy to secure a smoke-free generation, starting in Scotland and then delivering it all across these isles. The success of that legislation is perhaps best exemplified in the fact that we now have a whole generation who feel it is their inalienable right to go indoors and never have to inhale passive smoke or suffer all the deleterious effects that come with it.
Now, as then, the NHS is holding a mirror up to our society. For those who rely on it, there is anxiety and frustration about why, so often, we do not get the basics right, from grappling with the uncertainty of simply seeing a doctor or specialist to the anxiety that comes with waiting for a scan or its results. There are 1.5 million people working in the NHS—including once-idealistic surgeons like me, who unapologetically gave our youth to the NHS because we enjoyed our craft so much that sometimes it did not even feel like work—but those staff have been battered by austerity and covid. They are hoping for better days but, despite the improvements that have been made in the last two years, I know that they harbour a quiet hopelessness that perhaps their workplace can never be joyful again. They are good people who are resigned to running faster just to stay still and keep their patients safe.
All that is because of a 14-year-long Tory Government and the choices they made. They made political choices to rob Peter to pay Paul, and to fail to invest in our NHS. In an era of AI, technology and digital transformation, they left highly skilled staff with 21st-century clinical skills and 20th-century equipment, and left the public feeling more adrift than ever from their most prized national asset. Let us also not spare their handmaidens in Scotland, the Scottish National Government, who fared no better: NHS spending going up and productivity coming down; no NHS app to book appointments or get test results; lung cancer screening lagging behind; and 24/7 21st-century stroke care that is more like Russian roulette.
It is in this mood of cynicism and despondency that this Labour Government are charged with the responsibility of modernising our NHS and showing that we dare to go big again: going big on giving more power and control to patients and the staff who look after them; going big on taking the bold decisions, even if controversial, on becoming the healthiest generation that has ever lived; and going big on grasping the opportunity that technology presents us with. That is the path we start on today. It answers the cries of patients and answers the call of those who want to look after them.
Take the single patient record, which has been lauded in the news today as an exemplar of this Bill. It is a programme that, as health innovation Minister, I was proud to start off and bring my NHS experience to. It is a simple concept, demanded by patients and the vast majority of people who look after them, that there should be a single and comprehensive source of truth about a patient’s history when it is most needed. Most of the public believe it already exists, yet it has proven harder than ever to deliver because of conservatism, paralysed by the thought of the worst outcomes and unable to plan for the best outcomes, and by a belief that patient safety and data safety are somehow tangled up in the status quo. There is nothing safe about going from one hospital to another where a consultant cannot see your scans, or your child urgently attending an A&E department where their medical history cannot be seen or, as recently happened in my own practice in the middle of the night, having to turn down an organ donation because we could not access GP records at the weekend.
What about data security? The NHS is dependent on thousands of IT systems born out of necessity rather than design. If we were designing it, we would never have done it this way, but we must now be absolutely committed to making sure that data is safe and that military-grade security prevails. During my time as health innovation Minister, I was clear—as those on our Front Bench today are clear—that NHS data is sovereign and must be used for the benefit of patients.
We can no longer afford to look the other way. We have to lean in to the arguments and the headwinds that say, “No, not yet” or, “Not this much all at once.” We have to say to our citizens, and to our NHS staff who demand we get the basics right, that we are ready to face down those headwinds, those noisy tweets and those vested interest positions and say loudly, “Yes, right now” and, “Yes, as big as we can,” because our NHS can, because its patients expect us to, and because its users demand us to go further. This movement and this party were born of difficult times to deliver in difficulty, and this Bill will definitely and ultimately deliver on that promise.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
It is a real pleasure to follow the hon. Member for Glasgow South West (Dr Ahmed). I did not agree with everything in his speech, but I know of his passion for NHS services and I am grateful for the work that he did as a Minister, particularly in helping me to advocate for my constituents, which I will come to in the main part of my speech. I should start with the standard declarations: I am a former NHS doctor and my wife is a current NHS doctor.
There is a lot of good and very reasonable stuff in this Bill. I very much support the abolition of NHS England and I am glad that is being taken forward. The single care record makes complete sense. It is pretty crazy that we do not already have a national system in place. I think there will be some speed bumps in terms of administration, and the question I have is this: how is it going to encode sex data? What data is the record going to use as sex data, given the problems and the discussion that we had just before this debate?
For me, the problem is about accountability. I have a local integrated care board. I also have NHS trusts, one of which is Surrey and Borders, which has been failing to deliver rapid, timely autism spectrum disorder and attention deficit hyperactivity disorder assessments for children. Frankly, that failure to provide a speedy assessment for ASD or ADHD locally is a disgrace. I have been putting pressure on my local trust to try to change that. My constituents expect me to do that. Some of my constituents expect me, as an MP, to be able to click my fingers to make this happen, but of course I cannot do that because this is the NHS trust, the chief executive and the ICB.
I raised this issue in Parliament with the then Secretary of State, asking him to investigate my local mental health trust and look at the failings, and I am grateful that the then Minister, the hon. Member for Glasgow South West, responded to me and wrote to my ICB. The response I got was that this was within the ICB’s framework, and that what ICBs do is essentially up to them. My ability to go about changing this is therefore very limited.
I get the point about clause 11 and the Secretary of State taking a few more powers to direct ICBs, but that is a very blunt tool. In reality, it will not be accountability. I cannot quite believe that it will work in such a way that, if I raise something in Parliament, a directive will force my ICB to deliver better for my patients. I cannot quite see that that will happen in reality—or perhaps I am wrong and it will. In that case, Parliament will essentially become a forum for MPs—all of whose constituents will expect them to be able to give directives to our NHS trusts and ICBs—to raise these issues so that the Secretary of State can take forward a directive.
It would be far better if ICBs were directly accountable to local politicians. I heard the response that the plan is for ICBs to be accountable to mayors, but we do not have a mayor in Surrey and, even though many of us have been calling for a mayor, there is no timescale for getting one. ICBs need to be directly accountable to locally elected representatives in some way, shape or form, and the logical group is Members of Parliament, because that is what the public believe and expect. I hope that, as the Bill goes through, we will investigate the local accountability of ICBs in the NHS and that perception.
One of the biggest dangers is the sense that we, as MPs, can deliver direct changes in day-to-day clinical commissioning, from which, of course, we have a degree of distance. I reiterate that, at the moment, the public perspective and public belief is that that is what we are empowered to do. We therefore have to be empowered to do that, or we have to have mechanisms to make it clear to people that local NHS care is not in the direct control of myself or anyone else here, apart from Ministers on the Front Bench.
Patient groups are an important mechanism, but they are also important in terms of consultation. I worry about what will happen when ICBs consult on plans. What is the number? What is the survey? What is the metric? Who is appointing the ICB chair? Who is appointing the NHS foundation trust chair? Who is appointing the members of all these quangos? Where do democratically elected representatives sit in these appointment decisions?
Given the time limit, I will finish on this point. Accountability is critical in getting this right. Care models need accountability. I have raised this matter in Parliament for many years now. I hope that we can use the Bill as an opportunity to give our constituents the accountability they need and deserve in the delivery of local health care.
Wes Streeting (Ilford North) (Lab)
That was a characteristically thoughtful speech by the hon. Member for Runnymede and Weybridge (Dr Spencer). It is also a particular pleasure to follow my hon. Friend the Member for Glasgow South West (Dr Ahmed), who was an outstanding Minister in the Department of Health and Social Care and has demonstrated again today why his expertise and integrity are highly valued on the Government side of the House.
I strongly supported the speech made by the Secretary of State. He has hit the ground running, and he knows that he has my full-throated and wholehearted support. He does not need a predecessor being a back-seat driver—something that I am sure the Prime Minister feels about one or two of his predecessors after recent days. I also thank the Minister of State for Health, my hon. Friend the Member for Bristol South (Karin Smyth), for her leadership on the Bill, and the brilliant team of officials, who have worked exceptionally hard to prepare the Bill for its introduction.
It will come as no surprise to anyone that I strongly support the Bill. The latest NHS waiting list figures show the biggest cut to NHS waiting lists for 17 years, and as we heard from the Tories today, they cannot stand it. They cannot stand that within less than two years we have done something that they failed to achieve in 14: lowered waiting lists. Waiting lists are shorter than when we came in—lots done, and lots more to do, but the numbers are there. Despite record levels of demand and strike action by the British Medical Association, we delivered record levels of activity and waiting lists are falling. That is the difference that a Labour Government make.
To understand how and why this happened is to understand why the Bill matters. Those who claim that recent improvements in NHS performance are simply the result of more money are making exactly the same mistake that held the NHS back for years under the Conservatives. Investment matters—of course it does—but, as the Secretary of State outlined, we are combining investment with reform. We are embracing technology, cutting bureaucracy, improving productivity and changing how care is delivered—from cutting £1 billion from spend on agency staff to funding GPs to treat more patients in the community, equipping NHS staff with the latest AI tools, and sending crack teams of top clinicians to bust the backlogs in hospitals with the most patients off work sick. Every single change has been opposed by vested interests, but that is why we are seeing more patients treated and better value for taxpayers. That is the difference between managing decline and delivering change.
For all our progress, we know that there is so much more to do. Too many people are still waiting too long. Too many staff are working against systems that make their jobs harder, not easier. Too many patients have to tell their story over and over again. Too much money is trapped in bureaucracy when it should be reaching the frontline. Too often, accountability is blurred between two different headquarters or two different boards, bodies and acronyms that the public do not know and cannot hold to account. This Bill is the NHS modernisation Bill, and it addresses every single one of those challenges, giving expression to the principle that the NHS should be run for the patient, not the other way around.
The Leader of the Opposition recently claimed that we have not kept our promise to abolish NHS England. In fact, we have already started: 7,000 posts removed from ICBs, and 4,500 more posts going from NHS England and the Department of Health and Social Care. I know that those changes are not easy for the people affected, and I never treated them lightly, but abolishing NHS England is about cutting duplication, reducing bureaucracy and putting responsibility for the NHS where it belongs: with elected Ministers who are accountable to the public.
Every pound wasted on administration is a pound that could be spent on patient care. That is why we are stripping out unnecessary layers and directing more resources to the frontline. Hearing the opposition from Conservative Front Benchers, it is no wonder that they presided over such a bloated bureaucracy. This Bill will save money, but they never once asked how much it would cost to pile on layer after layer of bureaucracy, saddling the NHS with top-heavy management, which frustrated patients and really frustrated staff.
Some will say that there is a contradiction: that centralising accountability and giving patients more control over their own data pull in opposite directions. But that is precisely the point. For too long, power in the NHS has sat in a no man’s land—an accountability sink, too distant from patients and citizens to be meaningful and just far enough away from Ministers that there is plausible deniability when things go wrong. The Bill takes back power in order to give it away: accountability for Ministers where it belongs, and power for the patient where it belongs, too.
The Government must face down powerful producer interests on patient data. Our health data is precious. Two things matter above all else: that our data is held securely and that it is used ethically. However, the single patient record is one of the most important reforms of the NHS for decades. It is frankly unsafe, as well as absurd, that patients are still being asked to repeat their medical history every time they access a different service. We also have to take on the producer interest of those who think patient data belongs to them rather than to patients. Our health, our data, our NHS—patients should control who can access their data, and they should control their own data.
By all means let us scrutinise the Bill and suggest improvements, but do not slow it down. The NHS does not have time to waste. The NHS is on the road to recovery, and this Bill puts the foot down on the accelerator.
Madam Deputy Speaker (Judith Cummins)
I call the Chair of the Health and Social Care Committee, after whose speech there will be a four-minute time limit.
Layla Moran (Oxford West and Abingdon) (LD)
It is a pleasure—and slightly surreal—to follow the former Secretary of State, the right hon. Member for Ilford North (Wes Streeting), because he is very much an architect of the Bill, and I am sure that we would have had many questions for him about what he meant by parts of it. It was a pleasure to work with him when he was in the role, and I look forward to working with the new Secretary of State too.
We all understand what is at stake here: far too many feel that the system is not working for them. The latest British attitudes survey showed that more than half of people in this country are dissatisfied with the NHS. That should give us all pause. When the abolition of NHS England was first announced, I welcomed its boldness because our population faces enormous challenges. Healthy life expectancy has not just stalled; it has gone backwards. We are getting older and we are getting sicker—so, yes, we need to be bold. There is widespread recognition that the three shifts in the 10-year plan, to community, to prevention and to digital, are the right ones, and if achieved—and that is an “if”—they will be transformative, but along with the enthusiasm, which I share, there is a big dollop of scepticism. Twenty-five per cent of the public do not believe this plan will make any difference to them, and we must prove them wrong.
My message to this Government is this: “Focus on the plan. It is the right plan, and achieving it will be an enormous challenge. Also, please do not forget social care.” We must remember that this merger, which could risk becoming a distraction from the plan, did not start with the Bill; it started with the announcement in March 2025, and the effects are already being felt in the NHS. This was not in the manifesto, so it came completely out of the blue, with many people waking up and discovering that their jobs were at risk only from reading the news. It has been brutal. As a result, the Institute for Government told the Health Committee in our hearing just before the recess that there has been a “large drop in morale”, which is unsurprising. There has been uncertainty, poor communication and disruption. I have heard at first hand how decisions have been snarled up as key people have left, and we must learn from previous reforms that the savings often do not materialise because many of the same people who leave first end up being rehired—a point made in the Committee hearing a couple of weeks ago by the chair of NHS England, Penny Dash. So, despite my initial enthusiasm, there is much that we need to chew over.
In the six inquiries and 13 one-off sessions that our Committee has done so far, there are clear themes for change, and it is on those that I will judge the Bill. The first theme is innovation. Pilots and moonshots are good, but they should not replace evidence-based prevention and joined-up thinking. For example, the Government’s obesity moonshot focuses on weight-loss drugs, but ignores the obesogenic environment of advertising, ultra-processed foods and lifestyle pressures. It tackles the symptoms and not the cause. And too often, these pilots show promise but are then never scaled up. What a waste! Innovation should be a mindset, not a buzzword, and we should strengthen clause 6 of the Bill to ensure that the long term is embedded from the outset.
The second theme, which has come up already, is patient voice. Our inquiry into severe mental illness laid bare a system where vulnerable people feel like pinballs in a machine.
Alex Brewer (North East Hampshire) (LD)
In my area, children waiting for ADHD assessments—many already on the standard pathway for years—have been told that they will have to wait until 2027 at the earliest. We know this is happening nationally, because Healthwatch told us in its 2024 report. Does my hon. Friend agree that abolishing Healthwatch—the only statutory independent body holding our NHS to account—will leave the most vulnerable patients without a voice and the NHS marking its own homework?
Layla Moran
I do have concerns over Healthwatch; I have even more concerns over the role of the HSSIB. We cannot have it both ways: people cannot sit at desks near other people who are making decisions and at the same time be perceived as entirely independent. The perception of independence cannot be legislated for—the perception is everything, and that is my concern. Clause 15 talks about co-creation, but getting this point right is key to making the system work. There are many examples of where it has been done correctly, but all too often it is just a tick-box exercise.
The third theme is financial flows and integration. Time and again, the Committee is in rooms with local authorities, social care and the voluntary sector all saying that they know how to do this for their local area and it is the system that gets in the way. Section 75 arrangements are a good start and should be strengthened, and there is a lot of promise in the neighbourhood health plans under clause 24. Our concern is over clause 21, because if local authority representation is removed from ICB boards, then social care is not present in those first conversations. That is critical and needs rethinking.
The fourth theme is data. Recently in my surgery, I spoke to a woman called Freya-Rose, who described how repeatedly recounting traumatic experiences compounded her own suffering. The single patient record could be transformational for her and others who find recounting traumatic experiences difficult. We therefore welcome clause 47, but we must be careful about the risks, especially around sensitive data. On that, the Committee will be having hearings on the federated data platform and Palantir, which has already been mentioned today.
The final theme that has emerged in our work is inequalities, so I am excited about the potential of clause 4. I am proud of the Liberal legacy that this NHS is built on. In his seminal report, Beveridge rightly pointed to want, disease, squalor, idleness and ignorance as the five giants that needed to be slayed on the road to recovery following world war two. Obviously, we have come a long way since then, but I would argue that it is time to define some new giants, and health inequality must be one. It is self-evidently the moral thing to do, but—here is something I think the Secretary of State will like—it is also the economically wise thing to do, because study after study shows that tackling inequalities is the key to unlocking productivity in the NHS. Simply put, helping those who need it the most helps us all. This Bill needs to do more than just “have regard” to inequality; I would urge the Government to make it its core mission.
I end by simply saying what I started with: I will work constructively to help the Government make this the success that I hope they want it to be. I would urge them to think about the downsides, because there are some and they need sorting out. Above all, the Bill will be judged not by us, but by Chris and Freya-Rose, the very patients who deserve to be put at the heart of this legislation moving forward.
Liam Conlon (Beckenham and Penge) (Lab)
Like others, I start by paying tribute to the NHS. I know from first-hand experience how important the NHS and its staff are. When I was 13, I had an accident that left me unable to walk for four years. I spent so much time on NHS children’s wards that I went back a year at school and, as a sixth-former, I was one of the youngest people in Britain to have a hip replacement on the NHS. I want to thank the staff at the Royal London hospital and the Royal National Orthopaedic hospital who cared for me. Last year, I went back to the children’s ward that I had been on and opened a new outdoor play area for the children on the ward today; it was one of the greatest privileges I have had since being elected.
I am pleased that the waiting list for hip replacements has come down and that opportunities for children to access education in hospital are improving, but I want to focus my remarks today specifically on brain cancer and brain tumours. Brain tumours are considered rare, but 12,000 people a year are diagnosed with a brain tumour. Just one in 10 adults diagnosed with brain cancer in England survive five years or more, and it is the biggest cancer killer of children and adults under 40.
Behind those statistics are the real lives of people and their families, such as my friend and constituent, Alex Savage. Alex was diagnosed with a glioblastoma in 2021 at just 33 years old and sadly passed away in April this year, aged 38. He leaves behind his daughter Etta—who is now not even two years old and will grow up without her dad—his wife Anna, his mum Marie, his dad Ed, his brother Nick and his sister Rebecca. Alex was intelligent, warm, funny, fearless and full of life. He spent his final months campaigning for change on brain cancer, working closely with the Tessa Jowell Foundation—a cause close to my heart—and I know he will be much missed by the staff there. Alex spoke extensively about how he lived well with brain cancer, and also how severely it impacted his independence and how his family often had to pick up the pieces. They are a real credit to him and to themselves, but the strain this must have had on them is undeniable.
Our improvements to the NHS must be a rising tide that lifts all ships, not just for common conditions, but for rare and difficult ones such as brain cancer. I believe that we have begun to provide answers, many of which are covered in the Bill. First, we have the creation of a single patient record. It is not acceptable, in 2026, to have a health system that is still operating in the analogue age. It was only after the intervention of this Government —particularly the previous Health Secretary, my right hon. Friend the Member for Ilford North (Wes Streeting), and the previous Minister for Health Innovation and Safety, my hon. Friend the Member for Glasgow South West (Dr Ahmed)—that the last NHS trust stopped using fax machines. The single patient record is an important step towards the digital age, finally bringing together patients’ data in one easy-to-access place.
Secondly, if we want to improve the prognosis for patients like Alex, we need to improve the funding and infrastructure behind research and clinical trials. I am glad that the Government have committed to taking action on this by increasing access to trials, giving greater hope to other families who are suffering.
Thirdly, I welcome the Government’s endorsement of the work of the Tessa Jowell Brain Cancer Mission, which has done so much for brain cancer patients by reducing the postcode lottery and raising overall standards of care. However, as Alex’s case shows, we still need further improvements. This means making a sustained commitment to improving outcomes for those with brain tumours, backed by meaningful increases in funding to reflect the incredible burden of this cruel disease.
I am proud of the improvements that we are making to the NHS. I know the impact they will have on the lives of millions of people across the country, including in my constituency of Beckenham and Penge. However, we also need a specific approach to tackling brain cancer. As Tessa Jowell said in her final speech in the other place, it cannot be
“put into the “too difficult” box”.—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]
Through funding, improvements in trials and further expansion of the mission model, I am confident that we can make progress, and I look forward to being a part of that progress throughout this Parliament.
Sarah Bool (South Northamptonshire) (Con)
As an active user of the NHS, I welcome steps that can be taken to help improve patient experience and care, but the NHS is a delicate ecosystem: mistakes and errors do not just lead to a loss of money—they can be life-changing and, quite literally, a matter of life or death—so it is absolutely essential that we get these changes right.
Conscious of time, I will focus on a few points that I want to raise. The single patient record has already been mentioned a number of times. There is no hospital within the boundary of my constituency of South Northamptonshire, so my constituents can be treated at a variety of hospitals, including Northampton, Milton Keynes, Kettering, John Radcliffe or the Horton. Working cross-county and across the country, I can see the value in creating a single patient record, ensuring that notes are available. It really could transform care co-ordination. For example, the wife of one of my constituents was almost given medication that would have killed her—she would have had an allergic reaction—because of the use of old notes. Only her husband’s presence saved her life. We cannot allow that in this day and age.
As the Royal College of Nursing has indicated, we must ensure that any new system has robust safeguards around data privacy, transparency, access, procurement and secondary uses of data. I acknowledge that the Secretary of State has put an emphasis on looking at that, but I think we all need more assurances. Even the Royal College of General Practitioners is asking whether the Government will provide any assurances around indemnity for GPs to protect against liability if there are breaches of data protection regulations or instances of mishandling patient records.
All in all, the single patient record will work only if the system has the confidence of patients and staff. Nursing staff have been asking through the Royal College of Nursing if they will be involved in the creation and design of the single patient record, to make sure that it will actually work in practice. Will the Minister confirm whether that will be the case?
Without careful safeguards, structural changes could risk undermining some of most significant advances that we have seen in recent years. As many Members will not fail to know, I am a type 1 diabetic and I will always passionately talk about diabetes. Diabetes UK has highlighted concerns about some of the changes. We have seen some incredible movements in diabetic technology, including the development of continuous glucose monitoring and, most recently, of hybrid closed-loop systems, which I am wearing and using as I speak. Central co-ordination has ensured that funding agreements are secured and access is prioritised. A shift to purely local decision making risks fragmentation and widening inequalities.
Many new treatments are being created and progressed. For example, I introduced a ten-minute rule Bill about type 1 diabetes screening in children. We need to ensure that this is prioritised, along with access to emerging immunotherapies. As this is an incredibly specialised area, it requires expert national oversight and co-ordination. It would be inefficient and potentially ineffective for such developments to be pursued on a purely local basis. We want to ensure that we do not see any progress falling through the cracks as changes are made.
Finally, I want to touch on patient voices. The abolition of Healthwatch England has been mentioned numerous times during the debate. Many patients have to be incredibly vocal about the care that they need. Often, they cannot make those points as strongly as we might, so it is vital that we maintain bodies that can speak on their behalf, especially those that ensure the voices of young children and youth are prioritised. I am supportive of some of the changes that are coming, but we do need to exercise some care and caution.
Jen Craft (Thurrock) (Lab)
The NHS is at a critical juncture in its existence. In order to survive, it needs radical change in how it is run. I welcome the measures in the Bill to keep the NHS around for generations to come, but there are opportunities for the Bill to go further.
I will briefly touch on the situation in my constituency, where an acute care trust has been under-delivering for decades. It constantly gets terrible CQC ratings, whether they relate to how it is run, specific departments or access to services such as A&E. During a recent inspection, two of the inspectors had to stop the work that they were carrying out to point out that there was a deterioration in a patient that had not been noticed by the medical staff on duty. The previous Secretary of State, my right hon. Friend the Member for Ilford North (Wes Streeting), placed the trust into an intervention programme, naming it as one of five trusts across the country that were “challenged”, which means it will be subject to significant NHS intervention.
I strongly welcome the measures in the Bill, particularly those that put a clear emphasis on accountability and preventing historic patterns of underperformance and that allow the Secretary of State to deauthorise failing foundation trusts, taking away some of their independence and bringing them under the control of the Secretary of State. Ongoing interventions have not delivered the healthcare that my constituents need, so this might be the final measure that ticks the trust into working, benefiting from the wealth of expertise and experience within the Department of Health and Social Care.
I believe that the Bill can go further in the area of special educational needs and disabilities, delivering for children with disabilities or extra educational needs. There is a systemic problem that is not related to individual instances in specific trusts or areas of the country. Far too often, health is not at the table when it comes to commissioning services for disabled children or meeting the needs of children with additional needs, so there is an onus on local authorities, who have a statutory duty to provide services that it is not in their gift to provide. We hear from local authorities, schools, academy trusts, parents and sometimes even children that the absence of health in these discussions is critical.
The crucial role that the Department of Health and Social Care can play in delivering the SEND White Paper relates to the “Experts at Hand” model. These experts provide an early intervention model, so that all children who exhibit an additional educational need can access expert advice from a panel of people who make up part of the allied health professions. We know that there is a huge shortage in this workforce and, again, it is in the gift of DHSC to remedy that. The Bill could go further to create a change in the commissioning and the development of a workforce strategy, moving the responsibility from NHS England to the Secretary of State. The Bill should mention allied health professionals and paediatric allied health professionals, which would put them on an equal footing with normal clinical staff.
Another way in which the Bill could go slightly further is by putting a duty of partnership and a duty of commissioning on ICBs around SEND services, particularly paediatric services. As I said, there is currently a statutory duty on LAs. We have heard time and again that a similar statutory duty on ICBs would help delivery.
Josh Fenton-Glynn (Calder Valley) (Lab)
My hon. Friend is making some powerful points. I hear again and again from parents that while different commissioning bodies argue about who is responsible, children fall through the cracks. Does she agree that we must urge the Secretary of State to go further and ensure that these children do not fall through the cracks?
Jen Craft
My hon. Friend is completely right.
One of the biggest issues with delivering care for children in the SEND system and for disabled children more widely is the lack of join-up between the various services that they should be able to access. The single point of access in this Bill is a great way to deliver on the health aspect of that. I hear from my constituents who parent children with chronic or complex medical needs, and they find it extremely frustrating that they are the one nexus holding all the information about their child’s healthcare and what they need. They are quite often battling a number of healthcare bureaucracies to get their child the healthcare and support that they need.
I believe that with a few tweaks, this Bill could be truly revolutionary in delivering the healthcare and support that disabled children and children with extra educational needs require and in taking the onus and the stress away from their parents.
Steve Darling (Torbay) (LD)
As I am sure is the case in many other constituencies, the NHS is perhaps the most valued service in Torbay, where it is the largest employer. Ironically, while the Government talk about investing in the NHS, Torbay is looking at 300 voluntary redundancies. Rather than the investment that the Government talk about, the reality in Torbay is job cuts, many of which are likely to be to clinicians. That is the background to my comments, which I will limit to the crucial ones.
Torbay has had the luxury of an integrated care organisation, which has been vaunted internationally as the way forward. The direction of travel of the Government is very much toward integrated care organisations, as my hon. Friend the Member for North Shropshire (Helen Morgan) alluded to. We have section 75 arrangements, yet because there has been a failure of focus on this matter by NHS colleagues over a number of years, they have been binned in recent months. We have appealed to the Secretary of State to intervene, but he has failed to do so. In the light of that, how can we have any confidence about greater influence from the Secretary of State? When the appeal happened, he said, “It is a contractual relationship.” The integrated care organisation has resulted in many people being discharged early and people being cared for in the community at a grassroots level. As Liberal Democrats, we know that that is desperately important.
The binning of Healthwatch is disturbing. I pay tribute to Kevin Dixon, who heads up the organisation in Torbay and Devon. Only a few years ago, it identified a failure by domiciliary care workers who were supporting the most vulnerable people in their own homes. That resulted in an investigation, which took away the contract from that provider, and another provider ended up better supporting those people. How can we expect that to happen if we effectively give the duty to providers to mark their own homework?
Let me focus on the better care fund. It is bonkers that this is being handed on a plate to the NHS acute care services. There needs to be partnership working between adult social care providers and the NHS. It should be driving better care—it says that on the label. This is extremely perverse. I hope that as the Bill progresses, common sense will prevail in a number of areas.
Paulette Hamilton (Birmingham Erdington) (Lab)
As someone who has worked in the NHS for 25 years as a district nurse and who has been involved in integrated care systems in Birmingham and Solihull since the very beginning, I will focus my contributions on three areas of the Bill: health inequalities, patient voice and integrated care boards.
Let me start by saying that I support the principles of the Bill. My constituents want services that work better. They want care that is easier to access closer to home and properly joined up, and parts of the Bill help to support that ambition. I want a focus on neighbourhood health plans and shifting more care into communities. Some of the best healthcare happens in people’s homes, in clinics and through early intervention before problems become a crisis. That is why the investment in Stockland Green health centre in my constituency in Birmingham matters so much to my residents and to me. It represents the right ambitions: shifting care into the heart of the community, bringing services together locally and making healthcare more accessible for residents in Birmingham Erdington. The principle of that is absolutely right.
My concern is that parts of the Bill risk moving us away from the original purpose of integrated care. Integrated care systems were created because health is shaped by far more than hospitals alone. I am concerned that the Bill risks moving us away from that local collaborative model and towards something far more centralised. As a former cabinet member on Birmingham city council with governance responsibility for health and social care and public health, and as the chair of Birmingham health and wellbeing board, I know how important local government involvement is in these decisions, yet under these proposals, somebody in that position would not automatically have a seat around the table—they would have to compete for it.
I believe the Bill should protect three things in relation to ICBs: genuine local partnership, a combined focus on health inequalities and prevention, and a strong focus on place, reflecting the needs of local communities like mine. One of my biggest concerns about the Bill is the reduction in independent patient representation, including the abolition of Healthwatch structures. If patient voice is weakened at the same time that local representation is reduced, there is a real risk that health inequalities become even less visible within the system, and we cannot allow that to happen.
The ambition to improve joined-up care and strengthen community healthcare is the right direction of travel. I simply ask the Government to keep a close watch on local representation and patient voice as these changes are implemented. Patient voice must not be lost and health inequalities must not increase. ICBs should not be used as a vehicle to reorganise NHS management structures.
Madam Deputy Speaker (Judith Cummins)
I will call a Member on the Opposition Benches, and then I will reduce the time limit to three minutes.
Saqib Bhatti (Meriden and Solihull East) (Con)
It is a pleasure to follow the hon. Member for Birmingham Erdington (Paulette Hamilton), not least because I agree with a lot of what she just said, especially around accountability and the impact on integrated care boards and Healthwatch. I will try to speak quite swiftly in the time allocated to me.
I campaigned for ICBs, because when I was a new Member of Parliament I had to deal with clinical commissioning groups. In summer 2020, the CCG that I was dealing with told me that I was going to get two new urgent treatment centres at the cost of about £1 million each, but I had a call with the same CCG a month later and it denied ever saying that to me. Luckily, one of my staff members had been on that call. I went to see the Health Secretary at the time, and I thought, “This is not possible.”
I am not a health expert, but I have been in business, and accountability and transparency really matter. That is why I supported the Health and Care Act 2022 and the introduction of ICBs. The consequence of the Act was much more local accountability and delivery. That is why, since 2020, we have seen the introduction of an urgent treatment centre at Solihull hospital, a locality hub, state-of-the-art surgical units with robotics, and the second-largest community diagnostic centre in the country. That was opened under this Government, but it was allocated and instigated by the previous Government.
I am a big advocate for transparency and accountability, which is why I have great concerns about the Bill. I have great respect for the Minister, but I hope she will appreciate that the cross-party concern on the legislation is very valid. There is a bit of a power grab going on here; the central pillar of the Bill is to centralise powers. Despite the Secretary of State—I would welcome him if he was in his seat—saying that the Bill is not about politicisation, it is inevitable that that centralisation of power will be a politicisation. In fact, the integrated care boards in the form that we created them reduce politicisation. I will not stress that point more than the hon. Member for Birmingham Erdington did, because I was in total agreement with her.
Moving on to Healthwatch, I will start with a compliment to the Department of Health, because I wrote to it last year on 12 September and had a response on 15 September. That is pretty good going—long may it continue—but my compliments will stop there, because I am greatly concerned about the abolition of Healthwatch. The Secretary of State kept talking about integrating it into ICBs, but the response I had from the Minister clearly says that the changes will close local healthwatch organisations. I do not agree with the term “integrated”; a new mechanism is being created that will take away patient voices and patient independence.
Healthwatch plays an important role in gathering local intelligence. The hon. Member for Birmingham Erdington talked about inequality, and I have great concerns about that. Two of the most deprived wards in the country are in my constituency, and Healthwatch also plays an important role in giving a voice to the voiceless. I was not reassured by the Secretary of State that that role will be preserved as those powers are taken into the ICB or centralised into the Department of Health, where the Secretary of State will be an important arbiter.
There was one question that I wanted to ask the Minister. The inequality I referred to includes huge amounts of digital exclusion, another area in which Healthwatch plays an important role. When I talk about the voiceless, I mean the people who do not have the strength or confidence to address those issues. What work has the Department of Health done regarding the digitally excluded? That is a really important question, and I share the concerns about accountability and transparency that have been expressed. I hope the Minister can address them.
Daniel Francis (Bexleyheath and Crayford) (Lab)
At the outset, I echo the comments of my hon. Friend the Member for Thurrock (Jen Craft). As fellow SEND parents, we both call for the measures that she has pressed for.
I declare my interest as chair of the all-party parliamentary groups for access to disability equipment and for wheelchair users. I wish to speak about some of those issues, predominantly as they relate to clauses 15 and 16 of the Bill and how ICB commissioning needs to be considered in relation to carers and disabled people. Last October, the APPG for access to disability equipment published a report entitled “Barriers to Accessing Lifesaving Disability Equipment”, which made recommendations that I believe need to be considered as the Bill progresses. Its main recommendation was that there be a national strategy for community equipment, ensuring consistent national standards and accountability at every level.
Disparities exist not just across ICB areas, but within them. In my part of south-east London, there are different contracts in Bexley, Greenwich and Bromley—three neighbouring boroughs within the same ICB, where people receive completely different service levels. My daughter is a wheelchair user. She is in a school class with children from the neighbouring boroughs that, despite being in the same ICB, have completely different commissioning contracts and different levels of service. That postcode lottery, both across ICBs and within them, is something we really need to look at.
Getting the commissioning of disability equipment right is crucial if we are to streamline processes, reduce delays and prevent unnecessary hospital stays. For instance, there is no timescale for equipment when it comes to hospital discharges. A timescale of 18 weeks for wheelchairs is set out in the national strategy, but not for disability equipment. That leads to delayed discharges, but also to operations that in many respects are unnecessary, such as for people with cerebral palsy who do not have the equipment they require. There is clear evidence, as we will see again in the months ahead, that providers of disability equipment and wheelchairs bid lowest for contracts, creating cash flow issues for them. They then have to slow down the ordering and provision of equipment, which has great knock-on effects on both operations and discharges for the NHS. That is why our APPG has called for a streamlining of communication channels between local authorities, health bodies and Government Departments to ensure a more joined-up approach.
I have very little time, but I want to mention the recycling of equipment. Often, one ICB will have the equipment that a patient in a neighbouring ICB requires, because it has recycled it, but it cannot pass that equipment on because the contracts are different. We saw that issue to a great extent last year in the area of disability equipment when the NRS Healthcare contract collapsed. I welcome the Bill, but I believe it can be strengthened to better address the needs of carers and the disabled.
Gideon Amos (Taunton and Wellington) (LD)
This Bill contains welcome elements, such as creating a single patient record and enabling integrated care boards to become commissioners across a wider area. However, I cannot support the weakening of patient voices, nor removing local authorities from oversight of health trusts. I pay tribute to Gill Keniston-Goble and her team at Somerset Healthwatch for all the fantastic work they have done.
In moving to a single patient record, we need to prioritise privacy and rethink putting the American firm Palantir in charge of our data, with its founders such as Thiel opposing democracy and denigrating our NHS as part of a “Stockholm syndrome”. My constituent, whose family member was brutally murdered, is rightly horrified that victims’ NHS records were shared unlawfully online with NHS workers—she called it “repugnant voyeurism”, and she was right to do so. I hope the Minister will echo the apology of the trust and condemn that kind of behaviour.
However, none of the reforms in the Bill will have a positive impact on patients or staff in Taunton and Wellington who use the maternity and paediatric department until and unless the promised new unit is brought forward. One of my constituents, Jeff, told me of their grandson Ryan, who was admitted to the ward a couple of weeks ago. The lack of air conditioning meant that temperatures there exceeded 30°C over the past week—no wonder medical staff have fainted in the heat while looking after mothers and children who are baking in single-storey flat-roof buildings—buildings that were put up for the United States army as a temporary measure during the second world war and never replaced.
As Jeff put it,
“Walking down the corridor of the old building is an embarrassment. There are literally sheets of plastic attached to the leaking ceilings running into guttering in the corridor”.
I do not need my architectural training to know that guttering should be on the outside of the building, not the inside. It is therefore unsurprising that the previous Secretary of State, the right hon. Member for Ilford North (Wes Streeting), when challenged on BBC Radio Somerset only a month ago, promised that he would speed up the Musgrove Park hospital project if he could. I hope the new Secretary of State will honour his predecessor’s promise to meet me to discuss that.
The Bill is based, at least in part, on the mission to move from treatment to prevention, which is of course the right ambition. Because of its major teaching hospital status, Taunton has a big medical community who know a thing or two about prevention, and I will highlight two areas in which this Bill should be going further on prevention. On prostate cancer, I hope the Government do not decide to hold back from widespread screening, as a recommendation to do so is before them. As a member of a family in my constituency recently hit by that disease told me,
“I am a recently retired doctor and I do not believe the statistics that have been published, with the emphasis being placed on over-investigating patients and the distress this causes. This pales into insignificance compared to a missed diagnosis.”
Finally, more should be done to reform the dental contract. Unless the Bill leads to more NHS dentists, social care reform and better prevention—
Sonia Kumar (Dudley) (Lab)
Today, we stand at a defining moment for our healthcare system. We face a ballooning NHS budget and a social care system in crisis. We ask ourselves what must change to reduce deep-rooted health inequalities, improve patient-centred care and remain financially sustainable. The NHS was designed to treat acute illness and provide healthcare free at the point of use, regardless of income, background or status. Medical and scientific progress has transformed healthcare—people are living longer than ever before, often managing multiple, long-term conditions that once would have been fatal.
The NHS was founded on the simple but powerful principle of equity, yet health outcomes remain profoundly unequal. Research consistently shows that where someone is born and the socioeconomic conditions they grow up in can determine how long they live, sometimes by more than a decade. The wider determinants of health—income, housing, education and employment—shape outcomes long before illness appears. Now we must embrace the global technological revolution; from artificial intelligence to robotics, we must harness it to improve patient-centred care. Used well, technology does not replace humanity in medicine, but restores it, giving clinicians more time to care.
Indeed, we should go further. AI and data analytics should be used not only to treat individuals, but to understand communities, designing healthcare around the real conditions in which people live. A true systemic approach means not just knowing that a patient has a condition such as high blood pressure, but understanding why: the environment that shapes us, rates of poverty or unemployment, housing conditions, education levels, access to green spaces, the density of fast food outlets or accessibility of affordable healthcare services per capita. The reality is that health inequalities are complex, interconnected and predictable. We require a whole-system approach, bringing together the NHS, local councils, hospitals, charities and grassroots organisations.
Having a way to fully map communities and what they look like would allow for tailor-made healthcare services to be delivered to the population. Healthcare and the NHS do not need reform; they need an ecosystem map. I want to call it the health biosystem. It would be a system where health is shaped not in hospitals, but in homes, schools, streets and workplaces. As Attlee once said, we have
“not been elected to try to patch up an old system but to make something new”.
Sir Bernard Jenkin (Harwich and North Essex) (Con)
I very much welcome the idealistic vision that the hon. Member for Dudley (Sonia Kumar) sets out for us, but I am afraid that it is far from what is in this Bill. Like my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), I shed no tears for the demise of NHS England; it was never an organisation independent of politics, but always looked upwards at the political leadership and did what Ministers wanted. It was created as an unnecessarily complex organisation. However, I ask myself whether reasserting the principle—unspoken in this debate—that somehow the man in Whitehall knows best is not reverting to the previous failures of the system, when we need to be looking for a much more organic and local system.
I speak in this debate to lament the demise of HSSIB, as proposed in this Bill. It is a profound mistake. It represents a downgrading of safety as a priority in this Government’s health policy, because HSSIB is the only organisation that can independently investigate safety incidents in the NHS and is not conflicted by any other function or role. It does not compromise any other functional role in the NHS, yet the Government have decided to get rid of it. It will not save any bureaucracy. This tiny organisation costs a few million pounds, yet it is pioneering a new system of safety management in the NHS that the NHS culturally barely understands.
We forget that NHS reform is really about people and leadership, not management structures and organisational structures. HSSIB was one of the catalysts that was beginning to transform attitudes towards safety. It was a safety valve for clinicians and patients and their families. It was the one place they could go to tell their story, without fear nor favour, in a safe space, and it was instructive.
Saqib Bhatti
My hon. Friend is delivering a passionate speech. Is he reassured in any way by the changes the Secretary of State alluded to that will help strengthen the patient voice?
Sir Bernard Jenkin
Well, no, and the abolition of HSSIB is an example of that. It was the one organisation that could independently hold any part of the system to account. If its functions are transferred to the CQC, those functions will be compromised in their independence —and they are explicitly intended to be compromised. The Government set great store by the Dash review, but it is a flawed and dishonest document that misleads the public by what it says. The Dash review is not about patient safety. It puts far more emphasis on quality. It elides quality and safety, which are not the same thing, even if many people believe them to be so.
That concern is reflected by the fact that there are too many recommendations flying around and too many resources being diverted to recommendations that the NHS does not want to implement. All those recommendations are coming from this plethora of public inquiries that Secretaries of State keep setting up. Surely we want to replace the public inquiry system with something much more effective, as we did for rail accidents. After the Ladbroke Grove rail crash, we replaced public inquiries with the rail accident investigation branch in the Department for Transport.
There has not been a public inquiry into a rail accident since the Ladbroke Grove inquiry, because we have the rail accident investigation branch. There has not been a public inquiry into an aviation accident since 1972, because we have the air accidents investigation branch. Why can we not have the same principle for safety in healthcare, instead of this ridiculous Dash review, which is full of falsehoods and misleading statements? I will give the House just one example of that. The review says:
“HSSIB was not able to retain the maternity programme because the Health and Care Act 2022 does not make provision for maternity investigations under HSSIB.”
That is wrong. It had to give them up, because it did not have the capacity to do them.
Lizzi Collinge (Morecambe and Lunesdale) (Lab)
First, I must declare that my husband works for NHS England, which is a bit awkward, if I am honest. Today I will speak to a few different aspects of the NHS modernisation Bill, including the single patient record, the independence of the Health Services Safety Investigations Body, or HSSIB, and possible changes to the make-up of NHS foundation trust boards.
I welcome the introduction of a single unified patient record, accessible to patients and clinicians in one place. Too often patients are forced to carry the burden of holding together their own medical history. I have heard the same story from countless constituents: they arrive at appointments with records that they have pieced together themselves, having to rehash their medical history over and over again to each new clinician. That clearly does not work for the patient, and it does not work for the clinician either, because when clinicians do not have access to the full picture, decisions are made with incomplete information, and the right diagnosis or treatment might be missed or, even worse, an unsafe care decision could be made.
The single patient record addresses long-standing issues of fragmented records and poor communication between NHS services, and this Bill is an opportunity to make things work that much better, but that needs to come with strong safeguards. People rightly want to know that their personal, private information will only be used for proper purposes and will be kept secure. I urge the Secretary of State to take full notice of the Science, Innovation and Technology Committee’s views on that. In other ways, the single patient record can make our data more secure. I recently received a letter containing personal information, and I had been sent to my last house but one. That is not secure at all.
I will talk quickly about the abolition of HSSIB and its responsibilities moving to the CQC. There is a fragmented and confusing patient safety and regulatory landscape, but independence and the appearance of independence in patient safety investigations is very important. I would like strong reassurances from the Minister that there will be still an independent investigative function that patients and staff can have confidence in. Harmed families have told us just how important that is.
Finally, I flag the changes to the make-up of NHS foundation trust boards. The Bill appears to remove the requirement for registered nurses and doctors to be represented on trust boards. I hope that is an oversight that can be examined and rectified in Committee.
For all its faults, the NHS is there for us right from the beginning and right to the end of our lives, and for the most difficult moments in between. From the birth of our children through to every broken bone and every anxious wait in A&E, we are supported by the NHS and its staff. If we want it to remain for future generations, we have to be willing to modernise it, reform it and make sure it is fit for how people live today.
Shockat Adam (Leicester South) (Ind)
We all cherish the NHS, and all of us in this Chamber have a duty to ensure that anybody who does not believe in the basic principle that care should follow need, not wealth, must be nowhere near the jewel in our crown that is the NHS. I begin with primary care—or, indeed, the glaring inequality in primary care. Practices in the most deprived areas carry, on average, 300 more patients per fully qualified GP than those in the least deprived. That gap has grown by 50% since 2018. In Leicester—my constituency and my home—there are 1,985 patients per GP, which is significantly above the national average. The Bill introduces a statutory duty to reduce health inequalities and, under clause 24, to produce neighbourhood health plans, but a plan without the workforce to deliver it is a plan in name only.
I must also declare my interest as a practising optometrist. Clause 14 gives integrated care boards new responsibilities over primary care services, and the Bill transfers commissioning of NHS sight tests from a national framework to individual ICBs. I completely understand the logic of localisation, but I have already seen what happens in practice. In Coventry and Warwickshire, a community urgent eye care service that was diverting more than 13,000 A&E attendances per year was withdrawn at the end of 2025. In Hampshire, community glaucoma schemes have been moved back into hospitals. This is the postcode lottery in action.
Glaucoma affects approximately 700,000 people in the UK, with about half of them walking around undiagnosed. It causes irreversible sight loss, it increases the risk of falls, and it carries serious long-term costs for both the NHS and social care, and we now have the technology to address it more efficiently than ever. The iStent inject device can be inserted during routine cataract surgery in a single procedure, treating both conditions simultaneously. This is exactly the kind of innovation that the 10-year health plan calls for, yet uptake is inconsistent because there is no national commissioning guidance. I urge the Government to ensure that the single patient record supports consistent clinical decision making across the glaucoma pathway, and that integrated care boards are required, not merely permitted, to commission those procedures.
The Bill also abolishes NHS England, and we have heard much about that. History gives us cause for concern, especially when it comes to private finance initiative arrangements, which have cost the NHS tens of billions of pounds over decades.
Let me end by saying something about the Palantir question. The creation of a single patient record is welcome, but the vessel matters as much as the vision. The £330 million NHS federated data platform contract, awarded by the last Government and inherited by this one, raises serious and unresolved questions, and it must be addressed.
Rachael Maskell (York Central) (Lab/Co-op)
The national must determine the “what”, and bringing NHS England into the Department is therefore the right decision. However, as many Members have said today, it is the “how”—how we do this at a local level—that determines the outcomes we see. Given the huge inequalities in our constituencies, which we have all spoken about today, the question of how we deliver, in particular, the third shift to prevention, is really important. The right integration, the right systems and the right focus will bring our health service together at a local level.
I agree that the accountability processes are not in the right place under the Bill, and I agree with the hon. Member for Runnymede and Weybridge (Dr Spencer) about the need to ensure that we in this place have that connection to the national and the local, while also integrating with those held publicly accountable in our councils and combined authorities. But the focus also needs to be there. It is because there is no coterminosity between commissioners and providers that people are looking in both directions in trying to bring about a system that cannot have the capacity to deliver in such ways. We need to see that bringing together of services to focus on a “population health” approach, but the Bill does not do that.
We need to think about what the outcomes that we want to see. I have lived through so many reorganisations, and I know that it is not reorganisations that ever deliver the satisfaction outcome. Given that ICBs have now been stripped back to such an extent—unable to communicate with us, as MPs, and not having the resources to make decisions—I fear that that delivering the “how” will become harder under this model. However, we also need to ensure that local accountability comes from our communities—and that leads me to the issue of healthwatch.
What we called community health councils were abolished in 2003. We replaced them with public and patient involvement forums, and replaced those with local involvement networks and then with healthwatch, which is soon to be scrapped. If it did not exist, we would invent it, because it has the independence that the new structures do not have, giving patients and people confidence in a system that enables them to raise their voices, and to be sure that their voices will be heard and systems will be held to account. I therefore oppose clauses 64 and 65, with the respective schedules 9 and 10, and ask the Government to reconsider and also to take on board the questions that have been raised about the systems that make it possible to hold investigations. HSSIB has done that well, and I think that its role should continue.
Given what has happened over a decade of raising concern in the House, I welcome the commitment of the former Secretary of State, my right hon. Friend the Member for Ilford North (Wes Streeting), to a public inquiry, but we do not have a chair and we do not have terms of reference. It is therefore really important that we put in place the right structures to hold the system to account.
Adrian Ramsay (Waveney Valley) (Green)
The Government present this legislation as technical, restructuring NHS England and reconfiguring integrated care boards. They also say that they want to devolve power from Whitehall and give patients more control over their care. However, there is a mismatch between this presentation and the contents of the Bill. While some responsibilities are being devolved, other powers are being drawn upwards to the Secretary of State, with greater control over spending, appointments and key operational decisions. There are serious concerns about how the patient voice is to be treated, and hearing that voice is essential if we are to address inequality and replace the negative health impacts of austerity, bad planning, poor housing, weak transport and divisive social policies.
With the Bill, we have the chance to address the totally unacceptable 16-year gap in life expectancy between different postcodes in the UK. I therefore urge Ministers to amend the Bill to include clear legal frameworks and a cross-Government strategy to mirror new duties on strategic authorities for tackling health inequalities—inequalities that I see in my constituency, where those without the means to pay for a private dentist endure horrible pain and suffering, and where children go without care; inequalities that mean men in the most deprived areas can expect to live, on average, 11 fewer years in good health than those in the least deprived areas.
It is a real concern that the Bill will permit the Secretary of State to vary the proportion of public and private provision of health services if they consider that to do so is in the interests of the health service. How might that power be used in the hands of a pro-privatisation Secretary of State?
As for the issue of patient voice, it beggars belief that, as drafted, the Bill abolishes the statutory duty underpinning local independent patient and public voice, including the entire network of local healthwatch organisations. That must be rectified. We need independent challenge, because without it accountability is at risk. Healthwatch Norfolk has pointed out that it has a legal power to visit health and social care services and see them in action, but the Bill does not mention that statutory power, or how it might sensibly become the responsibility of the ICB or the local council. What will happen to it? Healthwatch Suffolk has pointed out that recognition of an independent voice for patients has been a principle supported by Governments for 50 years, but if this Bill passes into law unamended, it will end that recognition.
Finally, ensuring that the different records in the health system are in one place so that patients do not have to repeat their stories is an important principle, but that single patient record must be safeguarded. I therefore urge the Minister to rule out awarding the contract for its development to Palantir, so that we can ensure that clear safeguards are in place.
Lewis Atkinson (Sunderland Central) (Lab)
The history of the NHS shows that there is no one way of securing improvement or accountability, and that a range of different mechanisms have a role. Patient voice, patient choice, performance management—including centralised performance management—planning, democratic challenge, competition and collaboration all have a place, and it is for the Government of the day to make a judgment about the right blend of mechanisms with which to pursue their objectives. Overall, I think that the Bill represents a good attempt to do that, given the NHS that this Government inherited and their ambitions, as set out in the NHS plan. There was undoubtedly duplication between the DHSC and NHSE, and returning to the situation before 2012, when there was direct departmental oversight of the NHS, is not a radical step.
There are, of course, costs to this transition. Unfortunately, in terms of morale, I think that these costs were somewhat exacerbated by the regretful manner in which the original announcement about NHSE abolition and ICB changes were made, which did not do justice to the commitment and professionalism of impacted staff. But that does not change the fact that the Government’s overall diagnosis is correct: since the 2012 reforms, accountability has been muddied, and a total reset of regulation is required to empower NHS providers to meet the urgent health needs of the population with the resources available. However, I agree that there are significant questions about the role of HSSIB, and I hope that this issue can be resolved in Committee.
The Government have been clear that they see the future role of ICBs as strategic commissioners. That capability needs to be developed, and I echo the point made by my hon. Friend the Member for Middlesbrough and Thornaby East (Andy McDonald) that it needs to be done with particular care in relation to specialist services. There also needs to be a resolution of how the development of neighbourhood health services will be strategically led. ICBs must retain the capacity to work at place level, and I join others in questioning the proposal to remove local authority representation on ICBs. Combined authority representation does not suitably replace that. Mayors’ responsibilities are entirely different and do not include anything to do with social care or public health that rightly sits with councils, and we need that to be hardwired into ICB membership.
I want to end on an area of healthcare that is the subject of a manifesto commitment that is not currently in the Bill: delivering parity of esteem for mental health. It is unconscionable that waits for NHS mental health services are significantly longer than physical health waits and that, as yet, there is no specific commitment to bring them down. The Health and Care Act 2022 introduced a duty on the Secretary of State to report annually to Parliament on NHS mental health spend. I wonder whether, as part of this Bill, there is scope to widen that duty to include reporting on the different waiting times for physical and mental health, and to make some progress on the very welcome cross-Government mental health strategy that has recently been announced.
Freddie van Mierlo (Henley and Thame) (LD)
All too often in my role as a local MP, I have been frustrated by the buck-passing in the NHS. My local ICB cuts a service, pleading no money, or refuses to fund a new one. It tells me to ask the Government, the Government tell me it is a local decision for the ICB, and the cycle goes on.
With this Bill, I welcome the accountability conferred on the Secretary of State, but I am slightly gobsmacked that he has agreed to it. Every Back Bencher should be rubbing their hands with glee. This legislation makes the Secretary of State personally responsible for commissioning arrangements in all ICBs. I look forward to sending him a letter on the day the Bill receives Royal Assent listing every change I want him to make. My ICB has one of the worst offers on IVF, it has been far too slow to adapt to new dynamics in ADHD and autism, it has left commissioning gaps in palliative care and closed down step-down beds, and now it wants to close down child and adolescent mental health services.
I make this prediction: the office of the Secretary of State for Health and Social Care will balloon under this legislation, because every Back Bencher will appeal to him to make sure that they get their local commissioning arrangements sorted. This reform is, of course, fully in line with the UK’s overly centralised Whitehall system, but it is not in line with the Government’s supposed devolution agenda. Mayors could be the answer, but the Government have been too timid about the role of mayors, who merely sit as members of the ICB. What of areas that have been slow to get mayors?
Although the Bill addresses ICBs, there is no reform of the sclerotically slow-to-act Joint Committee on Vaccination and Immunisation or UK National Screening Committee; they have been painfully slow to act on spinal muscular atrophy screening.
Although I welcome the single patient record, I would like to raise a serious concern. In my constituency, I was recently made aware of a case of a patient’s record being accessed multiple times, unrelated to their care. In fact, they were not receiving care at the hospital at the time; instead, they were campaigning on maternity care. Clinicians had no business looking at the record. Although a single patient record of this scope is welcome, it opens up the abuse of data privacy on steroids. What steps will be taken to protect data and confidentiality?
Finally, I want to discuss how the National Institute for Health and Care Excellence recommendations are implemented. Trusts have 90 days to implement NICE technology appraisals, yet this Bill confers on the Secretary of State the right to change that. How will that be handled? It should definitely be considered further in Committee.
Alex McIntyre (Gloucester) (Lab)
Since the general election, there are 10,000 fewer people stuck on NHS waiting lists in my constituency of Gloucester, we have the green light for two new NHS dental practices, and a new GP surgery is being built in Hucclecote. But now is not the time to pat ourselves on the back and say, “Job well done.” It is not even job half done. We must go further and start to deliver change at the pace that my constituents expect. Too many people in my city still struggle to see their GP or dentist when they need to, are placed on excruciatingly long waiting lists—particularly for mental health—and have to battle just to get a diagnosis. We have to go further.
I am pleased to see the creation of the single patient record. I hear time and again from constituents who are fed up with having to explain their story several times to different medical practitioners. Keeping records that do not speak to each other just does not make sense in the digital world in which we now live. It is inconvenient, frustrating and, most of all, it threatens patient safety. I am also grateful to the Government for taking the bold decision to abolish NHS England. It is clear that the model has not worked and does not provide the value for money that Gloucester residents deserve.
We are facing a health crisis in the UK, with significant gaps in life expectancy across the country. Someone from Gloucester who, like me, lives in Abbeymead is likely to live a whole decade longer than someone who lives just 3 miles down the road in Kingsholm. That is just not acceptable, and it highlights the entrenched health inequalities found in constituencies like mine up and down the country. Deprivation, poverty and a lack of adequate healthcare are harming life chances in every part of our United Kingdom. I therefore urge Ministers to meet the charity Health Equals, and to consider its proposal to strengthen the requirement for the Secretary of State to tackle health inequalities. The Bill should also introduce a duty requiring all Ministers across Government to consider the impact of major policy decisions on health inequalities.
Speaking of cross-governmental missions, I read with interest the report by Alan Milburn last week about young people not in education, employment or training. He sets out in damning detail the impact of the failure of the Conservative Governments to properly invest in mental health services. Today, mental health conditions account for 20% of all ill health in UK, but only 9% of NHS spending. Our Heath Committee has recommended making the mental health investment standard a statutory requirement, and the Government should make such a change.
I also ask the Government to consider amendments that confirm our commitment to tackling the obesity epidemic. I and several other Committee Members were concerned to read press reports that the Government are considering scrapping measures included in the 10-year plan to tackle the obesity crisis. Will the Minister confirm at the Dispatch Box that the Department of Health will not bow to pressure from the supermarkets and large food manufacturers to scrap our important work on obesity? We spend billions of pounds every year on tackling obesity-related illnesses, while food manufacturers and supermarkets lobby to avoid scrutiny. Of course we need to do more to tackle the cost of living, but the food lobby’s argument that we must choose between the cost of the weekly shop and tackling the fact that one in three children are overweight or obese is disingenuous at best.
This Bill is great, but there is more we can do to tackle mental health waiting lists, to tackle obesity and to tackle health inequalities in places like Gloucester.
Andrew George (St Ives) (LD)
It is an enormous pleasure to follow my hon. Friend the Member for Gloucester (Alex McIntyre)—I call him my hon. Friend as he is a fellow member of the Health Committee.
The 2012 Act was mentioned earlier, and I am one of the few Members who was in this House when it was passed. I was sitting on the coalition Benches at the time, but I eventually voted against the Second Reading and the Third Reading of the Bill because it broke the coalition agreement. We had agreed that there would be no top-down reorganisation, but it was the biggest reorganisation that the NHS had ever seen. Although the Liberal Democrats made the Bill significantly less bad—and I congratulate all those involved in that—there was still far too much that damaged the NHS. I welcome this Bill as it addresses some of those deficiencies.
On the points made by the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), I strongly agree about the abolition or the merging of the Health Services Safety Investigations Body into the CQC.
Sir Bernard Jenkin
Clause 59 states:
“The Health Services Safety Investigations Body is abolished.”
It is going to be abolished.
Andrew George
I am grateful to the hon. Gentleman, but the representations made by both the CQC and HSSIB itself seem to refer to its amalgamation into the CQC. The point is that, as he rightly says, a really important role is played by HSSIB, which could be lost as a result. It is a vital safety agency, and its independence is really important. There needs to be a safe space giving those working in the service the confidence that they can blow the whistle confidentially to that service to improve, protect and enhance patient care. There is a major risk, as the evidence has shown, that the protected disclosure of important legal information could in fact be compromised as a result.
Many Members have also referred to clause 4, on reducing inequalities. I entirely agree, but I hope the Minister will also look at geographical inequalities. In my constituency there are places where, as a result of clinical improvements and sub-specialty developments, services are moving further and further away for people facing emergencies. For example, in 10% to 15% of stroke cases, mechanical thrombectomies are required, but in west Cornwall, people need to travel 80 miles to Plymouth to get that service. That geographic inequality is reflected in other areas of sub-specialty too.
Clause 10 refers to not
“causing a variation in the proportion of health services provided by the public or private sector”.
I would be interested in the Minister’s explanation of whether that is to protect the public sector or the private sector.
Other Members referred to the federated data platform. My hon. Friend the Member for Newton Abbot (Martin Wrigley) made an excellent speech on that on 16 April, which I hope the Minister will look at.
Andy MacNae (Rossendale and Darwen) (Lab)
I very much welcome the Bill and the modernisation it will bring. To deliver the change needed requires a fundamental redesign of NHS structures and practices. Without a willingness to make the big changes, we will never deliver on the aspirations of the NHS 10-year plan.
At the same time, patients and NHS staff need to see change now. We cannot reasonably expect our residents and frontline workers to buy into this long-term vision of the NHS when they face so many issues with services right now. How will the Bill and the ongoing change process impact on some of the areas of most concern to my residents in Rossendale and Darwen? Top of the list for us is Blackburn A&E, which is one of the busiest in the country. I fully recognise the work being done by brilliant doctors and nurses to try to manage demand. None the less, the indignity of corridor care remains a blight. Almost every week I hear of patients spending hours and hours in the corridor, not knowing when they will be seen, often in discomfort, feeling exposed, anxious and unsupported. Ending that sort of experience is a crucial test for NHS modernisation. Only when we see the end of corridor care at Blackburn A&E and others will the residents of east Lancashire feel that something has really changed for the better.
As we have heard, the Bill is also about improving patient safety. It includes some significant steps, but, again, what about the practicalities? For years now we have been stuck in a vicious cycle of investigating shocking cases of patient harm and system failure, making numerous recommendations to improve safety and yet failing to implement them, and repeating the same mistakes. We must break the cycle. This cannot only be about simplification; it requires bold action as well. For example, as we have heard many times in this place, we have a crisis in maternity safety and soon Baroness Amos will deliver the report on her national investigation, which is likely to identify a requirement for some really fundamental systemic and cultural change. There will also be areas outside her remit that need to be addressed, such as the role of the regulators in a fit-for-purpose patient safety landscape. I therefore wonder if the Bill goes far enough and if there will be a need for amendment after Baroness Amos reports. Perhaps the Minister will share some thoughts on that.
Finally, I will touch on prevention. The move from sickness to prevention is one of the three big shifts in the NHS 10-year plan. It is surely the key to a health service that is sustainable in the long term. Although the Bill makes some reference to prevention, frankly, a lot of it feels pretty peripheral and leaves some key questions unanswered. For instance, how—in a practical sense—are we enabling ICBs to support prevention at a local level and at a scale that will make a difference? How are we driving the prevention agenda across Government Departments? Are we doing enough to ensure healthy lifestyle habits are developed in early years and at school? Why are we not putting the social prescribing of proven interventions, such as exercise programmes, on the same financial footing as pharmaceutical interventions? And so on and so on.
I suspect the Committee stage will be crucial in ensuring the Bill matches its aspirations. I look forward to the Minister’s thoughts on how we can balance long-term modernisations with delivering change today.
Martin Wrigley (Newton Abbot) (LD)
I will focus on two things: the changes in data privacy and access to support a centralised single patient record, and the abolition of Healthwatch.
Healthwatch is not the same as the other regulators and it should not be amalgamated. Regulators can be amalgamated only if they have a single purpose and a single viewpoint. Healthwatch today is not a regulator but a patient advocate and there are no others in the system. Without Healthwatch, the remainder of the checks and balances come from the medical profession and the health establishment—and we have seen cases where that goes wrong. Healthwatch guards against that. It is a vital body to speak up for the patient, rather than the NHS itself.
James Naish (Rushcliffe) (Lab)
I have had a look at the parliamentary record; Healthwatch has been mentioned over 100 times in the past five years. One key area of focus is its reporting and the insights it provides to Members of Parliament. Does the hon. Gentleman agree with me that whatever replaces Healthwatch must retain that research focus?
Martin Wrigley
I absolutely agree with the hon. Member. We heard earlier how Kevin Dixon of Devon gives us excellent reports of what is happening with Healthwatch.
The modern NHS must run on data, but critically, on data that carries the consent of patients. A single patient record is undeniably critical to see the data of patients all in one place, but it must be built from a patient’s point of view, not from a centralised data-analysis point of view, and with privacy by design from day one. We obviously need GPs to see hospital data and vice versa, and ambulances to see everything that they need to help, but we do not need the new regulation to do that.
The single patient record already exists in a federated model; in Greater Manchester, Merseyside, Shropshire and more, trusts already run interoperable access for care services, GPs and hospitals. The Government admit that but claim it is partial and fragmented. They also claim that the data will remain in the systems where it currently exists. However, with the Bill, the Government are asking to remove all protection of patient data—look at proposed new sections 250E(1) and (3) to the National Health Service Act 2006 as set out in clause 47(2) of the Bill. We are asked to trust somewhere below primary legislation that it will all be okay—we should trust the regulation. It is a big-tech approach to deliver an overreaching centralised system, rather than a distributed interoperable solution.
NHS England has ignored and discounted UK sovereign systems that can and do provide what is required along with patient trust. Systems built over years with focus on patient treatment and defined use cases could be rolled out today with no change required in law and privacy by design built in from day one. Greater Manchester and others have the single patient record capability and the hard-won foundation of trust.
I will be tabling amendments to remove the relaxation of data privacy from the Bill. The measures are unnecessary if NHS England does not follow the Palantir advice and instead follows what has been proven to work in Greater Manchester, Merseyside, Shropshire and many other places. Perhaps it is an example of something that has worked in Manchester that might work everywhere.
Mary Kelly Foy (City of Durham) (Lab)
The NHS needs reform, not least after years of Conservative underfunding, fragmentation and neglect. I strongly support the Government’s commitment to shifting the NHS from sickness to prevention. As co-chair of the APPG on smoking and health, I was proud to support the landmark Tobacco and Vapes Act 2026, but smoking still remains one of the greatest drivers of ill health and inequality. Prevention must be built into the machinery of the NHS, and that must apply to mental health provision too. My constituency office deals with huge volumes of casework involving people waiting too long for support, families in crisis, and vulnerable people being passed between services.
On the safety and voices of patients, we have seen the devastating consequences of failures in breast cancer care at County Durham and Darlington NHS foundation trust. I pay tribute to the brave women who have spoken out after unimaginable distress. Their experience was in sharp contrast to the excellent cancer care that I received only 12 miles away at a neighbouring hospital. I hope that clause 4 of the Bill addresses the postcode lottery in quality of care.
I think of a husband who lost his wife and two sisters who lost their mam after tragic failings in what should have been routine care. Their fight for justice continues. The Bill must not weaken independent scrutiny or make it harder to raise the alarm when things go wrong.
I briefly raise dentistry; as co-chair of the dentistry and oral health APPG, I know that access to NHS dentistry is one of the clearest examples of where the system is failing constituents. Dentistry is public health, and Ministers must explain how ICBs will be held accountable for NHS dental care.
Finally, on the single patient record, there is real potential for better joined-up care, but patients must have confidence that their information is safe, confidential and used in their interest. That means safeguards on NHS data, including the role of private technology companies such as Palantir, and transparency around access by private providers and consultant partnerships, including limited liability partnerships. The point of reform is not to move boxes around Whitehall; it is to ensure that when people in County Durham and across the country need care, they can access it, trust it and be listened to.
Brian Mathew (Melksham and Devizes) (LD)
All of us want to see a better NHS, but there is a profound contradiction at the heart of the Bill: the Government are handing ICBs more responsibility and authority with one hand while cutting them off at the knees with the other. ICBs are being merged, clustered and completely reorganised with no idea of what the landscape will look like in six months, let alone six years down the line.
In my constituency, the Bath and North East Somerset, Swindon and Wiltshire ICB is cutting 50% of its staff. In the midst of this, HCRG Care Group, a private equity-owned provider, has taken over essentially all community health contracts. It has arrived with a rapid programme of change, new technology and frontline staffing cuts, promising efficiency and ease of access, yet patients are facing new barriers, unanswered calls and a mounting backlog of referrals. The ICB is supposed to be overseeing and scrutinising all this while running at half capacity, mid reorganisation, with its own future uncertain. Can the Government assure us that no patient will be lost in the shuffle?
On the subject of robust scrutiny and oversight of our health services, I am alarmed at the proposed abolition of Healthwatch, which has been an independent champion of our patient care for more than a decade. Part of its function will be transferred to ICBs, to add to their ever-growing list of responsibilities. My late friend Anne Keat, a long-serving Healthwatch member, would be highly concerned at the prospect of the NHS being given the role of marking its own homework. Independent scrutiny is vital and healthy for the future of our NHS. Will the Secretary of State please reconsider this element of the Bill?
Dave Robertson (Lichfield) (Lab)
We are here tonight to talk about a very large piece of legislation, but I would like to focus my remarks on just one part of it, which is the changes the Government want to bring in around planning for the future in the NHS, which are so very needed. There is perhaps no better example of where that planning is going wrong than in Burntwood in my constituency.
Almost 20 years ago, a new doctors surgery was planned for the town. The NHS at that time was very good at knocking things down; however, when the coalition Government rode into town in 2010, all the funding for the replacement was cut. Here we are, almost 20 years later, with no replacement. That has been to the detriment of the town: for well over a decade, people in Burntwood have had to see their doctor in portacabins in the leisure centre car park. In all that time, nobody has stepped up to right that wrong.
We thought there might be light at the end of the tunnel in 2023, when we were promised a replacement by the end of last year. But before that happened, some pen pusher at NHS England decided that the existing surgery in that temporary structure had to close, which meant 5,000 patients distributed to other surgeries in the town. In a town of 30,000 people, that is a significant number. They were told simply to disperse them—“It’ll be fine, don’t worry. We’ll just disperse them.” That dispersal was so traumatic that an existing surgery has had to pick up the same temporary structure and is now operating out of there as well. There was also all the paperwork, legal matters and everything that went with that, because NHS England said that it could not extend for two years. I am very pleased to see the back of that particular quango, which so disadvantaged my constituents.
However, that structure is still being used because the replacement is still not here—it was not delivered by the end of 2025. We do not have the planning application yet. We have once again been promised that it will be here by the end of next month.
I am aware that the Reform-led county council inherited this situation and promise from a Conservative-led county council, but it has not sought to talk to the people in Burntwood. The council has not sought to explain why that promise was not going to be met; it just blew past it. It broke the promise with very little expectation. We now have another one, and that must be met, because so many people across the town have seen so many broken promises and false dawns that they are failing to believe that anything will actually come good.
This entire saga reinforces exactly why the Bill is needed and why these changes are needed. I do not want any other community in any other constituency to be overlooked and forgotten in the way that Burntwood in my constituency has been for so long.
Ian Sollom (St Neots and Mid Cambridgeshire) (LD)
Reducing duplication, streamlining priorities, and getting resources close to frontline care—these are reasonable aims. My concern is that in pursuing simplification the Bill makes a series of choices on patient safety that it is not clear have been fully thought through and that risk repeating mistakes that this country has paid a very high price to learn from.
Through successive inquiries, including Mid Staffordshire, Morecambe Bay, Shrewsbury, Ian Paterson—I could name more—Parliament has repeatedly recognised that the NHS cannot be relied on to scrutinise itself. Each found the same pattern: concerns present within the system but not acted on, problems developing in isolated services, and a culture in which those who raised concerns were treated as the difficulty rather than as sources of vital information.
Yet the Bill’s general approach is to remove independent scrutiny rather than improve it. I am not arguing that all the bodies that have been created—Healthwatch, the National Guardian’s Office, which has been absorbed into NHS England, which will now be abolished, and HSSIB—have worked exactly as intended. In fact, I have been working with families and others affected by failings at Cambridge University Hospitals trust. It has been suggested that the trust has not published independent information, commissioned by the trust, that found 32 missed opportunities to identify and address concerns about a paediatric orthopaedic surgeon between 2012 and 2024, and children were harmed as a result.
Sir Bernard Jenkin
I am most grateful to the hon. Gentleman for raising the HSSIB question. The Dash review accused HSSIB of exceeding its remit. That is completely wrong in law, and it was always intended to look at systemic problems across the system. The new investigation function in the CQC will not be able to do that, because it will not be independent.
Ian Sollom
The CQC and HSSIB themselves have expressed concerns about how those two organisations might be brought together. The AAIB is separate from the Civil Aviation Authority, and that model was created for a good reason. The hon. Member made good points about the statistics on that earlier.
Returning to the case I was talking about, a clinician at the trust who did raise concerns formally in 2015 was simultaneously subjected to disciplinary proceedings and told by the trust that they did not want to hear any more complaints. I wish I could say that I had not heard similar stories from NHS staff several times in a little under two years as an MP.
Just because there are some flaws in those independent systems for the NHS, it is not a reason to remove the independence. That would represent a return to conditions that so many of the inquiries warned us about, and I think that patients would rightly question whether lessons have really been learned.
As the Bill proceeds to Committee stage, I urge the Government to ask a simple question about each body that it proposes to absorb or scrap: not just whether the function will still be performed somewhere but whether it will be performed with genuine independence from the organisations that it scrutinises. That independence has been hard-won, and I hope that Ministers will reflect on that carefully before legislating to remove it.
Several hon. Members rose—
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. Interventions are going to make it very difficult for everyone to speak in the debate. I call Dr Beccy Cooper.
Dr Beccy Cooper (Worthing West) (Lab)
I will try to keep my remarks brief. The NHS is one of the most unifying institutions in our country today. It is a huge employer, a major source of pride, and a safety net for us all at our moments of greatest need. We all know that it has been creaking under significant strain for some time now, so it is good to see new life and new energy in the 10-year plan. I welcome this Bill as a response to some of the purpose outlined in the strategy.
A lot of the detail in the Bill has been covered by colleagues already and will doubtless be covered further in the Bill Committee, so I will limit my remarks to single patient records and the role of public health in the Bill. I am fully supportive of a single patient record finally being realised. Our health and care system should revolve around patients, rather than patients revolving around it. It is over 20 years since I was a junior doctor, but I still remember my and my patients’ frustration when I once again had to ask them for their clinical history after they had already told it to the GP, the paramedic and the triage nurse.
This endeavour has been tried several times before. The financial cost of NHS Digital and the litany of platforms, software and systems that have been tried and abandoned provide a wealth of lessons learned to ensure that it is successful this time—which, let us face it, is long overdue. Public trust is very important for health data systems. We could consider new safeguards such as a public interest test for sharing data or bringing back requirements to report to Parliament. The NHS must ensure that the technical know-how is sound, as well as being fleet of foot.
I turn to the role of public and population health in this NHS Bill. Public health must be front and centre to provide the right health services in the right place at the right time. At an ICB level, there is now an explicit requirement for population health considerations to be understood. Integrated care boards will be responsible for commissioning the vast majority of our local NHS services, so they need to know the population health need.
That has been demonstrated in my ICB area of Sussex over the past couple of weeks. In the discussions about proposed sites for neighbourhood health hubs, it became clear that the population needs of my constituency of Worthing West had not been entirely understood when considering sites: there is a large area containing several villages with an ageing population and limited access to transport, whose requirements had not hit the radar of the ICB.
To be clear, this is not about blame—anyone who thinks that planning for population health needs is straightforward is welcome to sit the public health exams in epidemiology and statistics. Expertise is there to be used, and we should draw on it. I therefore suggest that we require a statutory appointment of a lead director of public health to represent the area covered by each integrated care board.
Finally, to guard against a focus solely on reorganisation, alongside this NHS Bill and as a key focus of the 10-year strategy we must have a whole of Government approach that recognises health as a strategic and shared asset—
Navendu Mishra (Stockport) (Lab)
I declare my interest as chair of the all-party parliamentary group on cancer and the donations made by trade unions to my constituency Labour party.
I welcome a Bill to modernise the NHS, but our local hospital in Stockport, Stepping Hill, needs a lot of modernisation. The building is quite old and lots of problems have presented themselves over the years. I am grateful to the Minister for meeting me a few weeks ago to talk about Stepping Hill. The former Health Secretary and I had several conversations about the Stepping Hill estate. I urge the Government to work with me and other Stockport MPs on a long-term solution for Stepping Hill. I am very grateful to all the doctors, nurses and volunteers at Stepping Hill hospital.
I want to mention ICBs, as they feature quite a lot in the Bill. My experience of the Greater Manchester ICB has been quite poor. I thank the British Fertility Society and the charity The Fertility Alliance for all they have done on protecting access to in vitro fertilisation. I also thank in particular my local councillor Karl Wardlaw and his late wife Jodie, and place on record my gratitude to them for all the work they did on protecting access to IVF.
The Greater Manchester ICB consulted on levelling down the offer for NHS-funded IVF treatment across Greater Manchester to just one cycle in each borough, including Stockport; 74% of respondents completely disagreed or disagreed with that proposal. The ICB did the consultation—I am not sure how much time and money it wasted on it—but then proceeded with the levelling down offer of just one cycle of IVF. My experience of the ICB is therefore very poor.
Many constituents have written to me about their concerns about Palantir and access to their data. I know that Unison has also raised significant concerns about the damage done to public confidence by Government data initiatives and the use of organisations such as Palantir, the spy tech firm.
I have limited time. On a more positive note, as we are talking about the NHS, I am always keen to encourage more people to donate blood; I have been donating blood myself for almost 10 years. I place on record my thanks to everyone at the Plymouth Grove donor centre in Manchester. In particular, I thank Connor, Phil, Vivian and Dorcas, who always look after me. May I ask the Government to do more to promote blood donations?
I welcome the Government’s reforms to bring more democracy and accountability to the NHS, but we must ensure that health inequalities are addressed and reduced. In the richest part of my constituency, people can expect to live almost nine years longer than those who live in the most deprived part.
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I know of a quite frail diabetic patient with cancer, who underwent several operations as well as complicated chemo in London. He eventually decided that he was well enough to take a short holiday, so he went to Cornwall on the train. Unfortunately, shortly after arriving he was found in a state of collapse by his daughter, and taken to the nearest hospital late on a Saturday night. The doctors had no access to his medical notes, and no answer when they called the hospital in London, so they were puzzled. That situation is familiar to doctors. Patients are incredulous when they are told that we are unable to see all their medical records: “Surely everything is on the computer?”
As a surgeon before becoming an MP, I worked in at least three different hospitals. There was no compatibility between the records, which meant that transferring care was complicated and hazardous. I would be asked to advise on a patient from another hospital, relying on a dictated note from the referring doctor, but I could not access the clinical records, the results of investigations such as the pathology test, scans or, crucially, the operating records. Consultations were delayed as I stared at creaking computers, with numerous software programmes, each individually protected by ever-changing and forgettable passwords, that slowly booted up. That obviously needs to change.
I would link the NHS number to an unique single patient record. I would give ownership of the record to the patient, and let the patient be the custodian and the gatekeeper. That is the truly revolutionary idea. If someone could easily look at their medical record, with appropriate physician safeguards, they could monitor everything—blood pressure, heart rate—and perhaps there would be an incentive for them to look after their health a little better.
Let us imagine for a moment the power of anonymised medical data for a population of 70 million people. The NHS is perhaps the largest complete set of health data on a whole population in the world. That is a huge resource for informing health policy and medical research. By tracking the health outcomes of millions of our fellow citizens, we can sort out all kinds of diseases, such as heart disease, cancer and mental health disorders. I can think of no greater innovation, or more helpful measure to improve the health care of this nation, than a single patient record.
Martin Wrigley
All the features that the hon. Member is asking for are available to people within the Greater Manchester area. Exactly those things are there and work today, even down to the remote monitoring he mentions.
Peter Prinsley
I am grateful for that intervention, and I am aware that in various bits of the country such systems do exist. I would like to see a single patient record that is genuinely single, so that when my hon. Friend the Member for Stroud (Dr Opher), who is sitting next to me, writes something in the record, I can see it, and when I write in my record, he can see it, and no letters are passing back and forth between us. That is why I am sure that legislating for the mandatory single record is what we must do, and as a surgeon who has worked for 40 years in the NHS, I will do everything I can to help.
Dr Simon Opher (Stroud) (Lab)
It is a pleasure to speak in support of the Bill, which I believe has the power to transform patient care in the NHS. Particularly after the remarks of my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley), the House will be aware that I also have a vested interest in this, as I have been a working GP in the NHS in Stroud for at least the last three decades. Indeed, I did a surgery last Friday, and I excitedly told the other doctors that we are going to have a single patient record. Instead of being excited, they said, “It’s about time.”
Those of us working in the NHS have been calling for a single patient record for years, so it is about time that a patient can tell their story just once, and about time a GP knows what a consultant is saying and the consultant knows what the GP is saying. It is about time that, when a patient gets admitted to A&E, the doctors know what the GP has already done, and that, when a patient gets referred to a psychiatrist, they know which antidepressants have been taken. As my hon. Friend said, patients struggle to understand how all the doctors do not know what is going on. We got rid of the fax machine in our surgery only last year, so we are fairly behind on communication, but the Bill lays the foundation for that to be remedied.
The benefits of the Bill for patients are huge—their medical knowledge at their fingertips, just as they are for clinicians and for integration. We cannot have integration without a decent single patient record. On research, our data is a national asset. I fear that a company such as Palantir owning our data is a derogation of our duty, and that we should use that data as a fantastic resource. I am also worried about Palantir’s involvement with death in Gaza and the infringement of civil liberties under the Immigration and Customs Enforcement agency in America. Also, at the Chelsea and Westminster hospital, it seems that the benefits that Palantir said it would bring to the operating theatre were not provable. The data is owned at the moment by GPs, and if there is a spillage of data, GP practices are unlimitedly liable. We must change that; otherwise, no one will become a GP partner. We must also be careful, because excessive and over-the-top safeguarding could obstruct the single patient record, and that would harm patient care.
Peter Prinsley
Does my hon. Friend agree that we must have a single patient record, not simply federated records from other sources?
Dr Opher
I do agree, although that is a much bigger job. At the moment, mental health uses a different system from the hospital, and it would be great to unite them. I agree with that, but whether it would possible in the next couple of years, I am not so sure.
Let me quickly go on to NHS England. The administrative burden on GP surgeries from NHSE has been huge, as my hon. Friend has mentioned, and it will be fantastic to get rid of that. When GPs undergo CQC inspections we have to do pointless protocols to fulfil the criteria, and they involve weeks of work. I want to make a little bid here for a much more supportive, lighter touch approach when looking at proper data around GP surgeries, which we would not have to prepare for. That would be very popular with GPs.
I warmly welcome this Bill. It is about time we reduced the ridiculous administration around patients and allowed clinicians to properly care for patients, and it is about time we had a single patient record.
Liz Twist (Blaydon and Consett) (Lab)
First of all, I very much welcome the Bill. It has been designed to deliver and work with our 10-year plan in that bigger picture.
I will touch on three issues raised with me by my constituents in Blaydon and Consett. The first is the single patient record. Of course it makes absolute sense for everyone to be able to access up-to-date records when a patient is admitted. I think of the groups I have worked with who have rare conditions, for example, who find that when they are taken into a different hospital, the doctors there are unable to access the records of their specialist treatment. That is the first thing, although there is also a good deal of concern among my constituents and others about how that will be managed and brought about, and how the data will be handled and the contracts awarded.
The second issue I wish to raise is Healthwatch. I understand that the Government’s real intention, through the Bill, is to strengthen the patient voice and the ability to raise issues, but there is real concern that an organisation inside the Department of Health and Social Care will not provide that independence. Will the Minister commit to looking again at how that independence can be built in and linked with the ability to pull the levers that Ministers have talked about, in order to make a real difference for patients? It is about getting that balance right.
Finally, I want to talk about parity of esteem for mental health services. As we move from treatment to prevention services, we need to use this legislation to reinforce parity of esteem for mental health services, including in the ability to access them. We need to build in preventive measures and access to those mental health services. I would just like to comment on the point made by my hon. Friend the Member for Worthing West (Dr Cooper) about building public health issues into the overall health framework. We need to look at re-establishing that public mental health function within DHSC under the new arrangements, and indeed within ICBs. We need also to link this to our mental health strategy, which we are expecting in the very near future. I welcome the Bill greatly and look forward to seeing those issues addressed in Committee.
Josh Fenton-Glynn (Calder Valley) (Lab)
This Bill has to be set in the proper context of the mess that we are clearing up from the previous Government. The Darzi report laid bare the crisis in the NHS. We must learn from that Government’s disastrous reorganisation, because we cannot afford to make those mistakes. I approach the Bill as a critical supporter of the changes that we have made and that we seek to make.
I have not always given my right hon. Friend the Member for Ilford North (Wes Streeting) the easiest time, but I pay tribute to his leadership, both on this Bill and in the NHS more generally. Waiting lists are down, treatment is up and we are seeing a real shift to the priorities that we need—from sickness to prevention, from analogue to digital, and from hospital to community. We have seen an overall reduction in NHS waiting lists of more than half a million since July 2024.
I welcome the new Secretary of State to his place. He has a famed eye for detail, which this job demands, and I hope that his background in local government means that he will take seriously the need to get to grips with social care.
Clearly, there is a real problem that needs fixing. Over the past decade, the centre of health policy has increased: staffing across DHSC, NHS England and local commissioning bodies has doubled since 2013, from 20,000 to 40,000. The Lansley reforms were one of the most high-handed acts of sabotage that a Government have ever committed on the health service. They were meant to reduce bureaucracy, improve efficiency and save money, and they achieved none of those things.
Some concerns about the Bill came up in a recent sitting of the Health and Social Care Committee. I am curious as to how, in practice, the merger will be able to concurrently reduce headcount from NHSE, DHSC and ICBs by 50% without causing unintended consequences. I am concerned about that and want to see more detail on it, particularly given the scale of the changes that we are trying to make in the NHS. A report published in 2012 by the Institute for Government entitled “Never Again?”, which looked at the Lansley reforms, warned against making redundancies that are quickly undone as organisations recognise that essential roles have been lost and end up rehiring the same staff. The cost of redundancies under the Bill is estimated at about £1 billion. The cost of the Lansley redundancies was about half that, but one in five of those staff ended up being re-employed by the same organisation. The Select Committee heard before the recess that some areas of the NHS are under-managed, and I do not want clinicians to take on those roles.
Overall, I support the Bill, but we should be clear that a reorganisation of the centre at this scale is not simple. It has to be properly planned, co-ordinated and communicated. I welcome the new Secretary of State, but I hope that the Bill can make the changes we need.
Sojan Joseph (Ashford) (Lab)
We have already seen the difference that a Labour Government can make in improving our NHS. That is the result of the difficult choice that this Labour Government made to prioritise investment in the NHS and our other public services, but I know from my 22 years working in our health service that investment on its own is not enough. That is why I am pleased that this Bill will reverse the legislation passed during the Conservative and Liberal Democrat coalition, which made NHS overly rigid and too prescriptive, increasing bureaucracy and weakening accountability. The Bill is an important part of delivering a reformed NHS by implementing the elements of the plan that require legislation.
I particularly welcome the parts of the Bill that will amend the National Health Service Act to make provision for the establishment of a single patient record. Patients too often receive care that is not as co-ordinated as it could or should be, meaning that they must repeat their story each time they see a different medical professional. From my experience in mental health services, I know that mental health patients go to A&E, explain their story to the doctors there, explain the same story to a mental health worker, and then explain the same story the next day when they are admitted to a mental health ward. That is very challenging for professionals and patients. The single patient record can therefore be very useful.
We also have patients coming from other parts of the country. For example, a patient from Manchester could be admitted in Kent, where the doctors and medical professionals will, in some cases, be unable to access that patient’s records for many days. That delays the treatment, so it will be a big step to have a single patient record.
The other area I welcome is the abolishment of NHS England. During my time in the NHS, I saw layers and layers of management structures and scrutiny by different organisations, which caused lots of repetition, so I welcome the abolishment of NHS England. I would like to see that money go to the frontline, so that we can recruit many more nurses for hands-on patient care.
Finally, I would like to raise the issue that many other colleagues have raised: parity of esteem for mental health services. I would like to hear from the Minister that the single record system will be implemented not just in other parts of the health system, but in mental health services.
Josh Newbury (Cannock Chase) (Lab)
Before becoming an MP, I worked in communications in our NHS. Combined with numerous stories from my constituents, that gives me a view of the NHS at its best, but also where things do not work as they should. Very few of our constituents think about the structures of the NHS. For them, whether it is working right comes down to whether they can see a GP and how long it takes to get a diagnosis and treatment. I welcome the Bill because all of us have constituents who have had to give the same information over and over, wasting their time and their clinician’s time and undermining trust in the fundamentals of a unified national health service.
A member of my team told me about one of her family members who suffered a stroke two years ago. He got to A&E at 11 am, was diagnosed after several hours and then at 6 pm, after several scans, was told that he needed to travel to another hospital to see a specialist. When he got there, he was told that the data had not been passed across, so all those scans and tests had to be done again. Stories like that demonstrate why the single patient record made possible by this Bill is so vital for patients, who should not have to repeat their symptoms, and for clinicians, who want to focus on care.
On the abolition of NHS England, the Government are right to shift money currently tied up in monolithic bureaucracy to frontline services. But as one of, I assume, very few former NHS communicators in this House, I want to dedicate the time I have left to them.
The abolition of NHSE comes at a time when ICBs are shedding half of their staff and are busy clustering. It is a time of immense change and anxiety for staff. I have recently seen a slew of posts from brilliant NHS communicators who are signing off for the last time, or posting bittersweet celebrations of securing a role while many colleagues are leaving. Some see NHS communications jobs as a “nice to have”, but the reality is they are the people who ensure that patients, from general practice through to discharge, know how to get the right care at the right time. They are the ones who spring into action when the phone lines go down. They tell the stories of real people working and getting treated in our NHS, which is so vital to encouraging others to spot early warning signs and come forward.
Comms in the NHS literally saves lives, and that is why when I see comms professionals leaving the NHS, I fear that we could be throwing the baby out with the bathwater through this important and justified process of change. I pay tribute to every NHS communicator, and I hope the Minister will say a little about how these legends will be valued and retained. The Bill will do so much to improve the NHS for millions of people in our country, so I will proudly support it, but let us ensure that we know the value of everyone who makes our NHS world-class.
Luke Murphy (Basingstoke) (Lab)
I welcome the NHS modernisation Bill as the next step in improving our NHS. When I was elected as the Member for Basingstoke, access to GPs, dentists and mental health services was not good enough. There were unacceptably long waits for elective care and at A&E, poor conditions of our hospital building and an overstretched primary care estate, so I welcome the progress made since my election, nationally and locally, through the investment, reform and hard work of NHS staff. We have seen 3,500 fewer people waiting for healthcare at Basingstoke hospital under a Labour Government, more GP appointments delivered across Hampshire than ever before, money to upgrade the practice at Chineham surgery from the Government’s upgrade fund and, after significant pressure from my office, the local council providing developer contributions of nearly £1.4 million for the same surgery. But we do need to go further; we have made progress, but there is so much more to do.
I particularly want to recognise in the Bill the importance of bringing about the single patient record. Before my dad died at the end of last year, he spent many days, weeks and months, over many years, in hospital, including in diabetic foot clinics and dialysis units, and in far too many intensive care units and wards. While the single patient record will bring about safer and more efficient care, the most important thing for me, as many other Members have mentioned, is the reduction of the burden, anxiety and stress placed on both the patient and their carer. When my dad was in hospital, I remember vividly that my mum carried around several sheets of A4 paper with his medical history and medications written on them. She did not just have to present that record to different parts of the NHS—she often had to present it to different units within the same hospital. Rather than worrying about my dad, she was worrying about whether she had brought that record. Clearly, that record should be held by the NHS. I know that many patients will recognise what an advance that will be both for their care and for hospital efficiency.
I recognise that the streamlining and abolition of NHS England will put more services on the frontline. As I said earlier, that is still badly needed in Basingstoke. It will help to improve GP access, deliver the health centre at Winklebury, ensure that there is a neighbourhood health centre across the constituency and further improve the A&E wait, for which there is plan in place.
Jessica Toale (Bournemouth West) (Lab)
In his opening remarks, the Health Secretary set out our record in office on waiting times, patient experience and investment. My local area has benefited from this record level of investment. The BEACH—births, emergency and critical care, children’s health—building at Bournemouth hospital opened in March 2025, improving maternity, children’s and emergency care services. Poole hospital will this year become the largest planned care hospital in the country.
Over the past month, I have been to the opening of two new mental health facilities, representing a £70 million investment in the local area. One of them, the Seastone building, is a high-intensity unit for young people, the first of its kind in our region, and it will stop young people from being sent to Manchester or Newcastle from Dorset or the south-west. I am particularly proud of the commitment to get Winton health centre back open, and we have now secured £1.3 million in investment to do that. It will open in the summer and will bring care closer to my community and alleviate pressure on our local GPs.
I have not met a person in the health system, in education or in the community who does not agree with the NHS 10-year plan’s ambition to move the health system from treatment to prevention and to get more care into the community. The Bill helps us to get closer to delivering this ambition for all people. I want to talk in particular about three often vulnerable communities. My hon. Friend the Member for Thurrock (Jen Craft) spoke eloquently about the experience of children with SEND and their parents, so I ask the Minister to reflect on how the Bill helps with joined-up services and access to specialist care for those young people.
HealthBus, a local charity that I support, brings direct nurse-led care to people experiencing homelessness. Their core ask has been to have access to system 1 records and local NHS historical records to better help their patients. I am grateful to the civil servants who have been helping them to date, but I ask that particular attention is paid to ensuring that the single patient record is rolled out to benefit communities who struggle to engage and get support from existing structures.
We must support our elderly population to get the care they need. I met staff at Lewis-Manning hospice care this week. They have done an incredible amount of work on the number of hospital admissions that people have in their last 12 years of life. They are proposing hospice at home hubs to ensure that up-front investment can help people to spend their last days in dignity. Will the Minister provide reassurance that any frontline services that become available are put into end-of-life care as well?
Finally, when this Labour Government came into office, the fundamental promise of the NHS, that it would be there for us when we need it, had been broken by decades of under-investment, by bureaucracy and by ditching reforms that had been made under the last Labour Government. I am proud of the progress to date, and I support the Bill to improve the patient experience, to put more resources into frontline services and to deliver our NHS 10-year plan, getting care closer to the communities who need it.
Several hon. Members rose—
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. To ensure that the final four speakers can get in, the speaking limit will become two and a half minutes.
Anna Dixon (Shipley) (Lab)
I welcome the Government’s plan to make it easier for doctors and clinicians to share critical information in a single patient record, but I would like the Minister to confirm whether access to patient records could be extended to carers, giving them the ability to access information concerning the person they care for. The NHS often fails to look after our amazing carers, so I am keen for ICBs to have a duty to identify and support the health and wellbeing of our fantastic unpaid family carers, and give them the right to a break.
Our health service needs to do a better job of identifying the next of kin of people who die in its care. There are currently 4,000 public health funerals each year for people whose loved ones cannot be reached, including Ken Bower, a friend of my constituents Cathy and Richard. In his memory, they launched the “Next of Ken” campaign. I invite the Minister to meet me and my constituents to see how this could be embedded in the patient record.
Ministers should promote integration between local authorities and the NHS, and I urge Ministers to implement a stronger duty to integrate health and care services. I welcome the duty to reduce inequalities in access to care, but the Bill needs to go further. I echo calls from colleagues for a cross-Government duty to have due regard to health inequalities.
Finally, as an officer of the APPG on patient safety, I know that the relevant Minister has received many representation on the issue of patient safety, not least from the hon. Member for Harwich and North Essex (Sir Bernard Jenkin). I hope the Minister will provide reassurances that when harm occurs, there will continue to be fully impartial investigation by HSSIB and clinicians will be able to speak openly about safety incidents.
The Health Bill is a comprehensive and ambitious piece of legislation, but I hope that, on the matters I have mentioned, changes will be considered in Committee. Our ambitions must be bold, our delivery must be rapid, and our NHS must be renewed.
Jim Dickson (Dartford) (Lab)
I warmly welcome the priority and the additional investment in our NHS over the first two years of this Government. In my constituency, we are seeing positive change with our newly opened North Kent community diagnostic centre, which is delivering vital tests and results for residents in a few short days from a great building with amazing staff.
On top of that, we are seeing major investment in our local Darent Valley hospital, with £27 million being spent on a new intensive care unit. That said, there is still a long way to go to reduce the length of waits in A&E, and the hospital remains in a building that is prone to problems, as illustrated by a recent water outage that lasted several weeks and affected patient care across half the hospital.
Above all, we need Kent and Medway ICB to recognise the speed of population increase and ensure that there is new primary care capacity to meet it so that GP practices such as Swanscombe health centre are able to cope with patient registration numbers—an extraordinary 38,000 in its case. Health infrastructure must be properly planned alongside new homes, and a test of the powers for the ICBs in this Bill must be that this happens.
I also warmly welcome measures in the Bill to provide a single patient record. This new information must drive fully integrated care, the absence of which is causing worse outcomes for my residents. One of my constituents, Frank Fitzpatrick, suffers from severe coronary artery disease and a separate condition that affects his oesophagus, and he has also had a stroke. He has recently received severely disjointed care, including discharge without medication or a letter, unsafe transport, and a lack of co-ordinated follow-up to provide physiotherapy or monitor his range of conditions. The result has been a major worsening of his health and quality of life. We must urgently bring in proper patient-centred care for Frank and so many others.
I have two final concerns. The winding up of NHS England must ensure that more resources are available and that decisions are made at or near the frontline. With the abolition of Healthwatch, independent scrutiny must not be lost. We will need to be convinced that the patient experience directorate, alongside the local service user voice, will genuinely hold the system to account.
Amanda Martin (Portsmouth North) (Lab)
I do not think there is a single person who thinks the current recording system is working. Navigating this system, whether as a patient, a family member or indeed an MP on behalf of constituents, is a nightmare. When it comes to safety and accountability, it is not transparent, and the experience is made harder for people who regularly move, so I would like to speak about the single patient record and what it will mean for the tens of thousands of people in my city who serve or have served in the armed forces.
Thousands of serving personnel, veterans and their families call Portsmouth home, and many more pass through it at various points in their careers, because one of the defining features of military life is mobility. Serving men and women move regularly at short notice, sometimes across the country and sometimes overseas and back again, and often their families move too. Every new posting means a new GP practice—starting from scratch with a folder of letters and a bag of medication boxes, hoping that the new surgery can piece together a medical history from scraps of paper or that the patient themselves can remember every diagnosis, allergy and procedure. For young families, those expecting a baby or those waiting for a diagnosis or tests, it is stressful, but for someone managing complex or chronic conditions, it is dangerous.
Veterans in Portsmouth have also described to me the exhaustion of having to re-explain their medical history every time they register with a practice, including mental health histories that are deeply personal and difficult to revisit. That is not good enough, and this Bill will help to put it right. The single patient record will mean that when a family moves from Norfolk or Plymouth to somewhere near Portsmouth, their medical records will move too. However, it will not work for those who move from Scotland to Portsmouth, so I urge the Government to work cross-border to rectify that situation.
I also want to acknowledge what the single patient record means for mental health. The mental health needs of veterans are well documented and often unmet. Continuity of care is critical for those managing post-traumatic stress disorder, depression and other service-related conditions. Losing that thread every time a file fails to transfer or a referral gets lost between trusts could cost lives, and the single patient record can hold that thread together.
Military personnel already sacrifice an enormous amount in service to this country. The least we can do is ensure that their health service keeps pace with their demands and those of their families. I am proud to say that this Labour Government are delivering a Bill for our armed forces, and I am proud to say to those people: we see you and we see your family, and your health matters to us.
Sureena Brackenridge (Wolverhampton North East) (Lab)
Given the lack of time remaining in this debate, I will focus my remarks on the long-overdue move to a much-welcomed single patient record.
Many Members will have had constituents get in touch with casework, raising blunders and delays that stem from fragmented patient records. When they have been in severe pain or at their most vulnerable, patients have been asked to repeat the same medical history again and again to different clinicians, whether in hospital or in the GP setting. It is frustrating, and in some cases distressing, especially if the patient is elderly or with neurological conditions such as dementia. A single patient record will ensure that clinicians have the right information at the right time, including on allergies, medications and previous diagnoses, so that they are better placed to make the right decision quickly. Today, we have heard of surgeons who have had to cancel operations because patient histories were incomplete or did not arrive quickly enough. There is consensus that a single patient record will make a significant difference in A&E, for paramedics at the roadside and even in routine care, where small details can have significant consequences.
I must, however, also make clear the concerns of many of my residents in Wolverhampton North East. Bringing together such large volumes of highly sensitive personal data into a single system will inevitably raise questions about cyber-security and data protection. We know that patient data in the UK would be extremely lucrative to some, and many will be acutely aware of international interest in getting hold of our data-rich NHS in order to profiteer. As such, can the Minister set out in more detail the safeguards that will be built into the system from the very start to guard against cyber-attacks and unauthorised access? How will this be controlled, and what oversight will exist to ensure that public confidence is maintained if threats evolve?
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Before I start, I must declare an interest as an NHS consultant paediatrician, a member of the British Medical Association and a member of the Royal College of Paediatrics and Child Health, as well as someone who has been moved to the back of a waiting list, after asking for a consultant review for the third time, and finding that I still do need it but it will have to wait a bit longer.
Churchill once said:
“Healthy citizens are the greatest asset any country can have”.
Good health is perhaps the most important asset that any individual can have, and I am sure that across the House, we all want the very best healthcare and the most efficient NHS for our constituents. As such, I am confident that this Bill has been brought before the House with the very best of intentions, but does it achieve its goals?
In general, organisational restructure involves some sort of assessment of where we are now, followed by a vision of what the future should look like, and then a focus on how to get smoothly from A to B. The Government started with a review of the current system. They called it the “Independent investigation of the NHS in England”, although the House should note that it was independently conducted by a former Labour Minister. In his report, Lord Darzi said that
“a top-down reorganisation of NHS England and Integrated Care Boards is neither necessary nor desirable”.
The then Secretary of State, the right hon. Member for Ilford North (Wes Streeting), seemed to agree. In September 2024, he was reported as saying that a top-down reorganisation was the “last thing” he wanted to do. Within six months, he seemingly changed his mind, which he is allowed to do, but it is regrettable that, having begun the last thing he wanted to do, such little progress has been made on his promised first acts, such as the roll-out of fracture liaison services. So many other promises are delayed, undelivered or, in the case of the promise to double the number of medical school places, somewhat bizarrely denied.
Another of the Government’s stated objectives is improving the patient experience. At the moment, we have Healthwatch—an independent organisation that listens to patients and provides feedback. More than 300,000 people a year share their experiences with their local Healthwatch to improve services, and that feedback has led to positive change. The Government cited Healthwatch data in their King’s Speech publication. Against the backdrop of rising clinical negligence claims, concerns about maternity care and even reports of abuse in hospitals, it is clear that more must be done to listen to patients and address the problems, but this Bill abolishes Healthwatch England and effectively ends local Healthwatch organisations. The Government plan to replace it with a patient experience directorate within the Department of Health and Social Care. As Councillor Dr Wendy Taylor of the Local Government Association has warned that this
“risks organisations being seen to mark their own homework.”
There is another concern. Facts are stubborn, but statistics can be pliable. How can the public ensure that they are getting reality and not spin from the Government? Ministers keep celebrating falling waiting lists, when in fact patients are being removed from the list without treatment because their appointments have been cancelled, because they missed an appointment they were not told about, because they have not filled in a form, or because they were called several times asking if they still needed an elective operation and agreed to see a consultant to check.
My hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) made a passionate speech about the importance of HSSIB. This Bill seeks to abolish the Health Services Safety Investigations Body. It provides a safe space, modelled on air accident investigations. Through the avoidance of blame and liability, it can get to the truth and prevent future tragedies. The Bill abolishes HSSIB apparently to simplify the patient safety landscape and reduce the number of organisations. In response to criticism, the Government have attempted to provide reassurance by saying that HSSIB will retain autonomy within the CQC, but the Government cannot have it both ways. Is HSSIB being abolished, or is it being hidden within the CQC?
Either way, the new unit within the CQC will face a number of challenges, such as the undermining of confidence in safe spaces, because it will be within a regulatory body. Its independence will be undermined, because Ministers have now signalled their intent to direct the vast majority of investigations and because the national quality board will prioritise any recommendations that they make. We will also have a CQC board without full oversight of what it is accountable for and, somewhat bizarrely, a risk that if the regulatory part of the CQC wants information from the safe space, and the other part of the CQC does not want to publish it, we could see the CQC suing itself. We have all this upheaval to have one less—or at least the illusion of one less—organisation. How on earth does that improve patient safety?
As many have said, including my hon. Friends the Members for Runnymede and Weybridge (Dr Spencer) and for South Northamptonshire (Sarah Bool), the single patient record is a good idea in principle. Patient information is currently fragmented across different parts of the healthcare system, and bringing it together could save lives, save time and improve prevention. However, the introduction of such a system must be well executed.
First, there are practicality concerns. Do patients want their full medical records, including sensitive conditions and perhaps including sexual health records, visible to every health professional? The hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) talked about the difference between a single patient record that is all of the same type and one that is part of a federated platform. The Secretary of State talked about linking up people’s ability to see the current system, but there is huge variety in systems. Even within one hospital, there might be a different system for maternity, A&E, blood results, historical notes and current clinic appointments. Will NHS staff be required to learn all those systems for all over the country, or will data be transferred to a new system? Either move has its downsides, but I am not clear which the Government intend to do.
Secondly, there are security concerns. As has been said, the NHS has the most valuable health dataset in the world. The Government must provide clarity in relation to who controls the data, who is responsible for maintaining its accuracy, and how it will be kept securely. Hackers are already trying to gain access to it, knowing that even if it is encrypted, quantum computing will be able to unpick encryption in the years to come. The Government must ensure that they are quantum-ready. What role is the National Cyber Security Centre playing in this regard?
Life, in all things, is a balance. If arm’s length bodies are in control of things for which Ministers are nominally responsible, we have a democratic deficit, and it is understandable that the Government want to recoup that, but, as we heard from my hon. Friend the Member for Meriden and Solihull East (Saqib Bhatti), the powers in the Bill for them to take control of everything risk the creation of a politicised service in which those who shout the loudest get preferential treatment. Those with very rare conditions such as corticobasal degeneration, Wiskott-Aldrich syndrome, Lafora body disease, Friedrich’s ataxia and many more such conditions may not have as well-funded or celebrity lobby groups acting on their behalf as those with other conditions. How will the Secretary of State ensure that clinical need drives the provision of services, rather than the resources of lobby groups or access to Ministers or, indeed, the Secretary of State?
As the NHS is undergoing a massive reorganisation, I am mindful of what the Minister once said:
“The reorganisation of health services always distracts from people’s jobs, destroys morale and wastes money”.—[Official Report, 22 September 2022; Vol. 680, c. 809.]
It also stalls progress and takes a lot of staff time, which may be why we have a 10-year health plan that took a year to write, why the workforce plan has still not been produced, why the so-called “rapid” national maternity investigation has not been completed, why waiting lists are up for patients referred for admission in several specialities, why we have a glacially slow roll-out of fracture liaison services, why the mechanical thrombectomy service promised for stroke victims by April is not available, why there is no response to the Hughes report, why there is a denial of the promise of an increase in the number of medical school places, and why doctors have announced their 16th strike, costing millions of pounds in appointments. The Government promised results, but all they have delivered is disruption, delay and disappointment.
I feel for the current Health Secretary. His predecessor was more focused on unseating the Prime Minister, and he is left to pick up the pieces. However, despite our political differences, I do have hope. Previously, he insisted that trans women were women, but I understand that he has now changed his mind. He has listened, and he has accepted that biological women are distinct and require single-sex spaces, in line with the law, biology, and common sense. I am therefore hopeful that the new Health Secretary will also listen to concerns about the Bill, and that we can work together in Committee to improve it. As I said at the beginning, we all want the best possible health service for our constituents.
The Minister for Secondary Care (Karin Smyth)
I was going to say that sometimes it is the hope that kills you, but instead I will say that it is a pleasure to close the debate on behalf of this Government.
Let me begin by commending the many fantastic speeches that we have heard this evening. My hon. Friend the Member for Middlesbrough and Thornaby East (Andy McDonald) made some excellent points about spinal cord injury and specialised commissioning. His comments apply to many people, and I take them on board. My hon. Friend the Member for Beckenham and Penge (Liam Conlon) talked about the experience of Alex Savage and his work with the Tessa Jowell Foundation; we thank Mr Savage for that, and mourn his passing. The Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), made a number of valuable points, and I will continue to engage with her and her Committee. I also note the points made by my hon. Friend the Member for Calder Valley (Josh Fenton-Glynn). My hon. Friends the Members for Thurrock (Jen Craft) and for Bexleyheath and Crayford (Daniel Francis) talked about the experience that they bring to this place in relation to SEND, supporting disabled people—particularly children—and joining up services. My hon. Friend the Member for Dudley (Sonia Kumar) drew on her experience of designing services for the future around people and patients.
As ever, I thank my hon. Friend the Member for Sunderland Central (Lewis Atkinson)—another excellent manager from the service—for the expertise that he brought to the debate. My hon. Friend the Member for Cannock Chase (Josh Newbury) made some excellent points about professionals in NHS England, and about communications professionals as well. We know that it is difficult, and we want to use their expertise as we go forward. My hon. Friends the Members for Gloucester (Alex McIntyre), for Rossendale and Darwen (Andy MacNae) and for Stockport (Navendu Mishra) talked about mental health, obesity prevention and their local services. I thank the former Secretary of State, my right hon. Friend the Member for Ilford North (Wes Streeting), for his support for my work in presenting the Bill, and I am relieved that he is still here in support this evening. That is good to know. A week is a long time in politics.
As I often tell people—you have heard it before, Madam Deputy Speaker—I have Lord Lansley to thank —or blame—for my being at this Dispatch Box. I left the NHS and stood for the Bristol South constituency because I could see the coming catastrophe of those coalition reforms. In 2010, patient satisfaction was an all-time high; in 2024, it is at an all-time low. In 2010, the last Government inherited the shortest waiting lists in history; in 2024, they left the waiting lists at record highs. In 2010, the NHS was efficient and delivered value for money; by 2024, we had dropped down international rankings despite a massive increase in headcount at the centre. That is the scorecard that the last Government left for the 2012 reorganisation.
In preparing for this debate, I have looked through my past comments since becoming an MP. In 2016, I said that despite being a non-executive director and manager in the NHS, I could not easily navigate the plethora of bodies in the health and care field. From 2016, it got worse. Each crisis or scandal brought more so-called independent bodies, but no more efficiency, effectiveness or, crucially, safety. We on the Public Accounts Committee were desperately trying to get clarity on accountability for spending, but we did not get it. In 2019—this is on the record—I did an interview with the Health Service Journal in which I highlighted how the role of Parliament in nodding through the estimates bore no relation to financial accountability or spending in my local NHS, and how it was impossible to follow through on funding allocations for facilities for my constituents, or even to understand the decision making of local commissioners, trust boards, regions, NHS England, the Department or the Treasury. When I sat on the Opposition Benches, I watched Tory MP after Tory MP chastise their own Government about what was happening in their constituencies, which was met with a shrug of the shoulders to say, “It’s all down to NHS England.”
The Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), talked about ICB accountability, but there is none. Many MPs come to me and say that they cannot get a response from their ICBs. At the moment, some people cannot even get a response to their emails. It is shocking, as my hon. Friend the Member for Lichfield (Dave Robertson) outlined so clearly. The Conservatives’ approach was to hand £200 billion of taxpayers’ money to one body, and more taxpayers’ money to a host of others that were charged with delivering, monitoring and checking a health system in which there is a lot of monitoring, a lot of checking and no end of tick boxes but, crucially, too little delivery of the high-quality services that the British public deserve and the staff want to give.
That cavalier approach changed with this Labour Government, why is why we are bringing forward this Bill. We are abolishing NHS England, devolving commissioning budgets to ICBs, putting patient voice at the heart of the new directorate, and making local commissioners in councils and ICBs embed patient voice and experience in their commissioning, rather than outsourcing their responsibility and then ignoring it. The system does not work, and Members know it. Patients deserve better.
This is the biggest transfer of power to local systems that we have seen. Most significantly, this Government are delivering on giving power to patients, who are frankly astonished to find in 2026 that their records are not joined up in the NHS. My hon. Friend the Member for Portsmouth North (Amanda Martin) made an excellent point about the impact that that has on veterans. Although we have a patchwork of local workarounds that benefit a few people—in Manchester, Bristol or the north-east, for example—patients across England have the right to their own record, and for their clinicians to have access in order to deliver the care they need. That point was well made by my hon. Friends the Members for Glasgow South West (Dr Ahmed), for Ashford (Sojan Joseph), and for Bury St Edmunds and Stowmarket (Peter Prinsley), all of whom gave us real examples of patient experience. As my hon. Friend the Member for Stroud (Dr Opher) says, it is about time that we had single patient records. We heard about the impact on patients from my hon. Friend the Member for Basingstoke (Luke Murphy), who spoke about the sad passing of his father.
A lot of questions have rightly been asked about the single patient record and data, including by the hon. Member for South Northamptonshire (Sarah Bool), my hon. Friend the Member for Morecambe and Lunesdale (Lizzi Collinge), the hon. Member for Newton Abbot (Martin Wrigley), and my hon. Friends the Members for City of Durham (Mary Kelly Foy), for Worthing West (Dr Cooper), for Bournemouth West (Jessica Toale) and for Wolverhampton North East (Sureena Brackenridge). We want to make sure that we get this right. They should know that although the Bill establishes the legal framework for the SPR, much of the detail will be in secondary legislation. I can assure the House that all Members will have a chance to scrutinise the regulations in due course. However, we firmly believe that pursuing a single patient record is the right thing to do. We have found that patients and staff support it, as long as it is built with the strongest safeguards for security and privacy. We hear their concerns, and we will make sure that those safeguards are built in.
The single patient record will protect personal data by default. It will be considered critical national infrastructure, with the highest standards of cyber-security and information governance, so that only the right people can access the right information at the right time and for the right reasons. There will be audit trails of who has accessed a patient’s data, and UK GDPR and the Data Protection Act 2018 will apply. The Bill does not create new legal gateways for purposes other than direct care. It does allow data to be used for research, population analysis and service improvement, but only where there is a separate legal basis for doing so.
Let me pick up on the issue of accountability, which is very important to me personally. I agree that it is important to get this right, and we need to work both nationally and locally. I am old enough to remember the world before 2012. For 60 years, the Secretary of State had overall responsibility and accountability for this service. I think the comments about local accountability were well made by the hon. Member for Runnymede and Weybridge (Dr Spencer) and my hon. Friends the Members for Birmingham Erdington (Paulette Hamilton) and for York Central (Rachael Maskell). Let me be clear: the Bill puts more power, not less, in the hands of local organisations. ICBs will be responsible for commissioning a wider range of services, including primary care, and they will hold a large proportion of the NHS budget—over £179 billion, as before—but at the same time the public expect Ministers to be accountable for the NHS they pay for.
Therefore, Ministers should have the tools to hold ICBs to account and direct the system where necessary. That is why the Bill provides the Secretary of State with a power of direction, but with important safeguards on appointing specific individuals and directions to intervene in decisions about services provided to a particular person. If a NICE recommendation on a drug or treatment exists, this takes precedence over a direction. The powers in the Bill will ensure the Secretary of State is able to create the conditions for ICBs to succeed with effective and proportionate forms of intervention, where necessary.
Another major point made this evening was about Healthwatch. I think there is an important philosophical point about independence, the perception of independence and effective decision making, which we will discuss in Committee and it will be important to do so. However, as the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), outlined very well, we have had these bodies for 50 years. Patients are saying that the system does not work and are not reporting to it, so the system does not work. I listened carefully to the hon. Member for St Neots and Mid Cambridgeshire (Ian Sollom) and my hon. Friends the Members for Blaydon and Consett (Liz Twist) and for Dartford (Jim Dickson) about getting the balance right, and we will discuss those really valuable points.
Currently, the patient voice sits isolated in separate organisations, which criticise the status quo but are not able to change it. That is why we want a new director of patient experience in the Department to ensure that voices are heard as part of every decision. Locally, it is the job of the commissioner—and I have been a commissioner—and of a good commission organisation to include the patient voice and experience in all its decision making. That is where the difference is made, and such organisations should not be outsourcing those decisions. That is the difference, but a debate is to be had, and we have to assure people on the perception issue. We want to ensure local ICBs incorporate the patient voice and experience appropriately—including digitally excluded people, as the hon. Member for Meriden and Solihull East (Saqib Bhatti) said— into their decision making. How that happens is not set in stone. It is our job to set the destination, not exactly how we get there. If an organisation can provide a good service locally for the patient voice and experience, the ICB could continue to contract with it.
Briefly on HSSIB, I hear the points from the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), whom I have met, and my hon. Friend the Member for Shipley (Anna Dixon) and other Members have raised these issues. The Dash review is very clear—I recommend Members to read it—and it is why the new CQC will combine its regulatory functions with the depth of HSSIB’s investigatory capability to the benefit of both. As was rightly raised by the hon. Member for St Ives (Andrew George), the safe space is important to enable people to share concerns in confidence, and that is safeguarded in the Bill. I understand that there is a perception issue, but we must ensure that that is real. The CQC has also raised some operational issues with implementing the integration of HSSIB, and we are working with it to ensure that, when passed, the measures concerned will be implemented effectively.
To conclude, the Bill is only one part of our modernisation agenda, but it is a crucial one, because for decades Governments have failed to grapple with this fragmentation. Like capital and the workforce, the problem was put in the “too difficult” box and left to this Government to solve, but solve it we will. The single patient record will finally mean patients get the joined-up, proactive care they deserve. By voting for this Bill, we can have a fresh start in NHS history. I commend it to the House.
Question put and agreed to.
Bill accordingly read a Second time.
Health Bill: Programme
Motion made, and Question put forthwith (Standing Order No. 83A(7)),
That the following provisions shall apply to the Health Bill:
Committal
(1) That the Bill shall be committed to a Public Bill Committee.
Proceedings in Public Bill Committee
(2) Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 16 July 2026.
(3) The Public Bill Committee shall have leave to sit twice on the first day on which it meets.
Consideration and Third Reading
(4) Proceedings on Consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.
(5) Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.
(6) Standing Order No. 83B (Programming committees) shall not apply to proceedings on Consideration and Third Reading.
Other proceedings
(7) Any other proceedings on the Bill may be programmed.—(Jade Botterill.)
Question agreed to.
Health Bill: Money
Monday 1st June 2026
(1 month, 3 weeks ago)
Commons ChamberRead Full debate Health Bill 2026-27 Read Hansard Text
Health Bill (Second sitting)
Tuesday 16th June 2026
(1 month, 1 week ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 16 June 2026 - (16 Jun 2026)
The Chair
We will first hear oral evidence from the NHS Alliance and the Royal Berkshire NHS foundation trust. We have until 2.30 pm for this panel. Gentlemen, I will be grateful if you would be kind enough, from left to right, to introduce yourselves for the sake of the record.
Sir Ciarán Devane: I am Ciarán Devane, chief executive of the NHS Alliance.
James Blythe: I am James Blythe, chief executive of the Royal Berkshire NHS foundation trust.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Q
Sir Ciarán Devane: First of all, the ICBs have had their 50% cuts and they are in the middle of reorienting themselves and joining up, so there has been a degree of distraction. The second thing, though, is the idea that the ICBs should be strategic commissioners, working well to commission plans that genuinely reform services. I think we all support that, and the move to give them GP commissioning, pharmacy provision and so on. All of that is good.
The challenge will be that the baseline for the current year is not necessarily the outturn of last year, because there were some one-off savings in that, so our members across the NHS are saying that this is the year when the trade-offs have to be made. Some of those trade-offs will be good, in the sense of we can reconfigure this service, move some services into the community and do some good things—I am sure we will hear about some of those—but some of them will require difficult decisions to do with whether we shut down the service in this hospital and double down on the one over there. Making those decisions will need political cover locally as well as nationally, so we are in a tricky place.
What we are saying is that we all understand the state of the public finances and suchlike, but we need some capital to allow places to reconfigure and redesign their services, whether that is new IT, AI or diagnostic services. Those are the things that will allow the transformations to take place, which is where the productivity and the money will come from. What we and chief executives, finance directors and chairs across the NHS are saying is that there is only so much heavy lifting that asking people to run around the hamster wheel a bit quicker can do. We have to make some of those big decisions.
Dr Johnson
Q
Sir Ciarán Devane: We are unclear and concerned about what the nature of those interventions could be. In theory, we fully understand that the Secretary of State and the Government need the ability to say, “In the unlikely event an ICB goes rogue, we have to have the right to sort it out,” but we need to guard against the alternative of a Secretary of State who is intervening too much and making decisions on particular services, commissioning decisions or reconfigurations. We want the legislation to prescribe the circumstances in which the board of an ICB can be overruled. That should be transparent, it should be published, and intervention should be rare. We recognise that that backstop needs to be there for the sake of good governance, but we need checks and balances. The powers are needed if somebody is operating outside their licence, but we need to guard against the Secretary of State or the regions or the new departments reaching in and second-guessing local decision making. If this is really about empowering strategic commissioners to do what is right for their populations, working closely with local authorities, interventions that second guess their decisions need to be very rare.
Dr Johnson
Q
James Blythe: Councils of governors across the NHS have added significant value since they were instituted and brought into foundation trusts. The foundation trust councils of governors play two roles. The first relates to the appointment and holding to account of the non-executive directors on the board. The second relates to securing public and patient involvement and voice in the organisation and the management of our services.
Since councils of governors were instituted, we have developed increasingly sophisticated ways of getting public and patient voice into services. If you look at innovations such as maternity and neonatal voices partnerships, which really involve service users in how services are developed on the ground and are very close to the teams that are running them, that gives us different ways of involving patients and the public in services where possibly councils of governors have not been able to do in the past. Councils of governors have played a really important role in foundation trusts, but certainly in terms of that patient and public voice function, we have moved on as a system and developed more sophisticated ways of doing that.
The Minister for Secondary Care (Karin Smyth)
Q
Sir Ciarán Devane: The biggest difference should be that the local providers and ICBs are incentivised to get together to make collective commissioning decisions. That means that, whether you call it a neighbourhood, footprint or local authority area, they make those decisions based on population evidence, which is why the single patient record is important, and they have the autonomy to do that with a lighter-touch centre that is set in guidance saying, “Look, this is broadly what we’d like you to do.” That guidance should be developed in conjunction with the people who have to do the job on the ground. That is what it should be; if the Bill allows that, that is fantastic.
The second bit is that the mechanism—it is not necessarily a legislative thing—by which the NHS is managed day-to-day will still need to exist. Who is going to be keeping an eye on things 24/7, 365 days a year? What happens if there is a fire—maybe even a literal fire—in a hospital? How is the NHS going to be corralled and brought in to help out a trust where something like that happens? That management function—the day-to-day operational management—needs to remain strong enough in the target operating model, as it is called, in the Department. If it is not, that could prove very difficult. Not necessarily day to day or in the short term, but in the long term, that bit has to be got right. One of the big risks of the legislation—there is not a legislative solution to this risk—is how day-to-day management works. We all have views on the relative strengths of the regions, of NHS England and so on, but how is that going to work in the new world? If one loses “grip”—that word is used a lot—then the risk to service delivery is quite high, and the risk to financial control is even higher.
James Blythe: Put simply, as an NHS organisational leader I think there are always a lot of things from which you can take your guidance on what you should be prioritising and focusing on as an organisation. If the result of this legislation is that we as organisational leaders have a really tightly defined set of priorities to deliver, articulated as far as possible as outcomes for local people and our population as a whole in terms of waiting times, quality and improving population health, I think that will allow us locally to get on with the partnerships that we already have as a day-to-day part of running local public services. We can focus on that very small set of things and do them really well.
Over the last year, there has been a sense of increasing clarity about those priorities as NHS England and the Department of Health and Social Care have worked more closely together. The NHS has delivered on those priorities to a large degree, but it all comes down, as my colleague says, to how senior officials and Ministers operate the system, because there is to be significantly more freedom to set priorities, and to design and run the system that essentially delivers them for the NHS. How that is done, retaining clarity about the things that we want to have delivered through the system and empowering local systems to do them will be really important.
Karin Smyth
Q
Sir Ciarán Devane: No, we are not.
Karin Smyth
Q
Sir Ciarán Devane: Yes, completely.
Karin Smyth
Q
James Blythe: I think the single patient record offers enormous opportunities to improve patient care. We know that we see patients every day whose quality of care and patient experience would be improved through having access to a continuous record that ran through primary and secondary care, mental health care and other services. To my mind, having had experience of working with systems that have introduced to some degree the single record or a single care plan, it will be extremely important that we take the time to train our clinical staff and adapt our operational systems so they use a patient record productively and consistently in the interests of better patient care. If we just put a single patient record into clinical settings without doing anything with the staff or services to make it useful, at best it will be inconsistently used and sometimes it will just be missed altogether. If we are going to invest, which I think is right, in a single patient record, we also have to invest in those systems and human factors around it, and make sure that we train people to use it well.
Helen Morgan (North Shropshire) (LD)
Q
Can I ask about Healthwatch? We heard this morning that ICBs will be taking on a chunk of the current operations of local healthwatches, but that they will not have any additional budget to enable them to do that. In fact, we know that their budgets have been significantly reduced. Could you elaborate on how you think that will work, and will it be as effective as the current system?
Sir Ciarán Devane: The ICBs have a capitation fee of £19.40, which they have to do everything out of. This is an additional duty placed on them. They will have to work out how to do it if there is no extra money coming, but it will be pressured.
I hear the argument that local healthwatches were variable. This function has been slightly outside and independent, playing back into decisions; we have to ensure that the level of independence remains somehow in how this is constructed, but that the variability is not just transferred from local healthwatches to how it is done within or across ICBs. Again, the implementation will need to be done well. That leads into the question about local authorities and the connection with them, making sure the democratic voice is brought in and equally the local voice. The legislation does not stop an ICB doing this well. Therefore, without the legislation, part of what we can be doing collectively is trying to make sure that what was good about healthwatches is preserved and is understood by ICBs. There are only 25 of them, so it should be a manageable task for the rest of us.
The effectiveness comes back to whether you believe this is a good thing. One of the things we have to do is secure that the benefits of having the patient voice in there, along with the clinical voice and the voice of the manager, at the same time, so that it is not a case of saying, “Oh, now we’ll go and consult the patients on the font size of the report,” but is authentic. That puts a lot of work on to the ICBs and on to those of us who believe passionately in engaging with the patient voice, but there is a risk because of that pressure. Done well, it will enable strategic commissioning and ensure the quality remains, but they are starting, if maybe not from scratch, from a new place.
Helen Morgan
Q
Sir Ciarán Devane: According to the ICBs we are talking to, which is all of them, they are saying that they believe in local authority engagement. We will be saying, “You may not be told you have to, but we would encourage you to do it.” I am sure that should be coming from the Department as well.
The witness to my right is an example of that; we know that when the NHS has really good local connections, you can get things done in the interests of your patients much more easily. The belief is there, but we need to make sure that the legislation is not seen as a signal that this is unimportant. That is a risk. As a representative organisation, we have to say to people, “We hear you saying that you really believe in this. Therefore, you need to demonstrate, not least to the Secretary of State, that you are following it through.”
I have a small additional point about mayors in unitary authorities being able to appoint somebody who is both the chair of the ICB and the local health commissioner. That should help. Those individuals will have to work out how to serve two masters, but that is okay—other people learn how to do that, too.
James Blythe: I would focus on a slightly different part of the Bill in terms of how this needs to work. There are 25 ICBs; that is quite a large footprint. From my experience of delivering meaningful collaboration and joint working between health and local government, I think it tends to happen at a more local level than that. The neighbourhood health plan in the Bill becomes extremely important. As a system, we should be very ambitious for those neighbourhood health plans. They should go a lot further than just describing what should happen in terms of improving health outcomes at a local level.
We should set an aspiration as a system that there should be a responsibility on health bodies and local government bodies to describe how changes will be made. The role of ICBs is to enable groups of providers and other organisations in local areas—most ICBs will have several places—to come together and not just work out what a local population needs, but actually do it. That will mainly be about relationships on the ground between an acute hospital team, a community services team, a mental health team and a social work team.
The role of ICBs is very much to give the contractual tools and mechanisms to local NHS organisations to work effectively with their local authorities so that there are really good neighbourhood health plans. Most importantly, they should not just write them but actually see them through.
Liz Twist (Blaydon and Consett) (Lab)
Q
Sir Ciarán Devane: I go back to our having to convince people. Many people are convinced—that is probably the first thing to say. But we have to convince people of the benefit of doing this. Delivering the ambitious neighbourhood health plans that James describes will happen only if everybody is in the room and doing it.
I do not necessarily think that the legislation can mandate that belief or the way to do that. However, it can set an expectation for the ICB that, in developing its plans, it should be able to demonstrate that it has engaged with the local authorities, patient organisations and the public local to it. The legislation can set an expectation that the ICB is using population evidence to make the right commissioning choices and that, if reconfigurations, which may well be locally contentious, are to happen, engagement happens beforehand. As elected Members, the Committee will know that those conversations should start early and that local populations should not just be bounced into something.
It will be incumbent on the new department to set those expectations with the ICBs about the new way of working. That is the only way we are going to create an NHS that will be able to cope with the number of frail, elderly people with multiple morbidities. Those people are a consequence of the success of the NHS over decades. People are living longer with cancer; the prevalence of cancer—the number of people alive with cancer—has doubled in 20 years. But that means that there are four million people who are not necessarily well. The only way to cope with that is to make a significant and radical change to the neighbourhood health plans and bring the public with us. That will happen only with proper patient and public engagement.
Liz Twist
Q
Sir Ciarán Devane: Yes, I do. I was in Epping recently, at St Margaret’s. I talked to the lady who runs the patient engagement: she is a volunteer and is a patient herself. They are a very good example, because they have said, “If we want to provide good services and avoid people turning up at the A&E in Harlow, we can do a neighbourhood diagnostic service.” The patient representatives got in very early. They ran some public meetings ahead of it and said, “We are thinking of doing this: what do you think? We’ll feed it back.”
Everything good is happening somewhere. It is the variability that is causing the problem. We need to make sure that good practices are deployed across the sector. That has to be the expectation: if this reform, which is huge, is to deliver value, that is the value that it has to deliver.
Gregory Stafford (Farnham and Bordon) (Con)
Q
James Blythe: With a lot of foundation trusts, as the NHS has moved into a period of increasingly tight financial control and as we have needed to recover from the covid pandemic, far closer working has been required between all NHS providers and the centre, to manage both the financial implications and the pandemic’s implications for patient access and patient quality.
Having recently moved from a senior leadership, board-level role in an NHS trust to two roles as chief executive in a foundation trust, I do not feel that in the day-to-day relationship with the centre and with our local and regional representatives there is an enormous difference in how we balance quality, finance and performance now. Those foundation trust freedoms were most relevant when we were in a system in which expenditure on health could grow and we were not trying to recover from the challenges that we have had recently.
Day to day, the relationship between NHS trusts and foundation trusts feels quite consistent now, so I am not sure that the changes proposed in the Bill will necessarily make a huge difference. As I said in response to an earlier question, it depends entirely on whether the provisions of the Bill are used to set a small number of priorities and let NHS organisations get on with delivering them, or whether they are used more regularly to intervene more directly in our day-to-day operations. A lot comes down to how the regime is operated.
The Chair
Sir Ciarán and Mr Blythe, thank you very much indeed. Sadly, we have just about run out of time for this session, but we are most grateful to you.
Examination of Witnesses
Sarah Tilsed, James Cooper and Professor David Croisdale-Appleby OBE gave evidence.
The Chair
We will now hear oral evidence from the Patients Association, Together for Short Lives and Healthwatch England. We have until only 3.10 pm for this panel of three people. Would you be kind enough to introduce yourselves for the record? Let us start from the left.
James Cooper: Hello. I am James Cooper, associate director of external affairs and membership at Together for Short Lives.
Sarah Tilsed: Hello. I am Sarah Tilsed, head of partnerships and involvement at the Patients Association.
Professor Croisdale-Appleby: Good afternoon. I am David Croisdale-Appleby, chair of Healthwatch England.
Dr Johnson
Q
James Cooper: I think that there are both opportunities and threats for families of seriously ill children and the professionals and services that provide them with palliative and end-of-life care. When we talk about seriously ill children, we mean children with life-threatening conditions, life-shortening conditions and severe medical complexity. They have a range of emotional, psychological, social and physical needs that need to be met across health, education and social care services.
Part of that care involves specialist children’s palliative care, which is predominantly provided at a regional level by teams led by specialist paediatric palliative care consultants. They often have Grid training, and there are not many across the UK—there are only about 24 whole-time equivalents. They are often based at children’s hospitals or children’s hospices and are often co-located across both. These specialist teams also comprise senior nurses and other specialists involved in emotional, psychological and practical support for families.
Our issue is that these services are often quite patchily commissioned at the moment; even though there has been a specialised children’s palliative care specification from NHS England since 2012, we think that money and commissioning has flowed to these services to only a very limited extent. For example, we have a successful service in the east of England, which provides 24/7 end-of-life care at home for seriously ill children, supported by nurses and these specialist consultants. But the provision is really patchy across England.
The Bill presents some opportunities through the additional powers for the offices for pan-integrated care board commissioning—the OPICs—to mandate ICBs to work together to commission these services. We would like to see that. However, because of the small numbers but highly complex needs of these children, the services often need to be planned and funded at a regional level, although they often are not.
We are concerned by the increased devolution to ICBs because of the extent to which other children’s palliative care services—the core services—are being commissioned at the moment. We have a range of evidence that shows that it is possible in some areas for that care to be commissioned well—for example, 19% of ICBs currently commission end-of-life care for children at home 24/7, provided by nurses and specialist consultants. However, at the moment ICBs are not taking on their full functions and implementing national guidance.
I would like to see much more rigour and accountability from the centre, the Government, to make sure that such specialised commissioning works for this particular group of complex children and families.
Dr Johnson
Q
Professor Croisdale-Appleby: Obviously, I am not here to speak on behalf of the CQC, although I am a non-executive director of the CQC. You are quite right that it has been in a challenging position, from which it is taking very substantial steps to recover, principally in changing back to a system of having chief inspectors who are very knowledgeable about their particular area of expertise that they can apply. The Department has asked the CQC to take on additional responsibilities in its regulatory capability and, to some degree, in an inspectorate capability. I cannot really agree that it is too much for the CQC to take on, but a substantial amount of work is certainly being added to the CQC.
Dr Johnson
Q
Professor Croisdale-Appleby: It is quite interesting to think that we have had 52 years of independent organisations representing the patient voice, as well as that of the carer. I think everyone here will be aware of it, but there was a step change in impact after the Mid Staffs situation, when Healthwatch—both Healthwatch England and the 153 local healthwatch bodies—was set up. We have produced over 20,000 reports; if anyone is interested in accessing any of them, we can certainly provide access by the end of the week.
Since I joined Healthwatch in 2023, in my view it has been very successful in reaching out to those communities often referred to as “difficult to reach”—diasporas and so on, where we all know the health inequalities are often the deepest. I think Healthwatch has been very successful in ensuring that we have not just listened to the easy-to-reach groups but deliberately sought information and views from those other parts of our society, which form an increasing part of it.
The research being done with those communities has recognised that there is quite often an investment of some six months for one of our people go into a particular community—whether a cultural community or an ethnic community—and win the confidence of the people so that they actually talk to us about the problems. I have to ask how that depth and focus is to be replicated under the arrangements suggested in the Bill. That is my extended first point about Healthwatch.
I think we have had a lot of impact, and I use the word “impact” as a researcher myself. Impact is measured by the change that you make. When we produce reports, whether national or local, we include recommendations. The important thing is that we always follow up on those recommendations and ask, “Are they being implemented? Are they being listened to?” Each year, we produce a report that says, “What change has occurred as a result of the recommendations that we make?”
I think that is extremely valuable, because it is about independence and holding organisations to account. Clearly, those organisations report in line function to the Department of Health, NHSE or local authorities, but we are not only the ears of the patient and the carer; at times, we hold feet to the flames over whether something sensible is being done. We do not give up on this; we pursue it down the rabbit hole.
The Chair
Q
Sarah Tilsed: Professor Croisdale-Appleby said absolutely everything that I was about to say, so I will make just a few points without going back over everything.
The main thing is that we need to make sure that this does not divert attention from the main priorities, which obviously relate to patients: timely access to care, clear communication and involvement in decisions about their treatment. As the professor said, we need a truly independent patient voice. Abolishing healthwatches creates a fragmentation of patient engagement responsibilities across ICBs and local authorities. The evidence we see every day consistently shows that patients are not feeling informed, involved or treated as equal partners in care.
We need to ensure that any replacement model is, as Professor Croisdale-Appleby said, genuinely independent, transparently accountable and resourced equally across the country, to ensure that we do not lose sight of the people it is supposed to serve. Trust is really important here, and patients trust independent organisations. I feel that that trust might be lost in local communities.
Lastly, this is, as Professor Croisdale-Appleby said, about reporting. We need to consider the way that patient feedback data is reported, and ensure that that is not getting lost. Themes and demographics still need to be included to make sure that we know who we are listening to, and that services are provided for those who feed back and those who do not—usually, it is those who are not feeding back who we really need to consider.
The Chair
Thank you. Those opening comments were extremely helpful, but I now ask for brevity in your answers, as several Members wish to put questions to you.
Karin Smyth
Q
Professor Croisdale-Appleby: Sorry, I had some difficulty in hearing the question, but I hope I heard it correctly. Was it about the patient record?
Karin Smyth
Yes.
Professor Croisdale-Appleby: Fine. The Government’s move to the integrated patient record is absolutely excellent. Most of us have wanted that for a very long time, but we also recognised the IT difficulties in doing it, as well as the question of security. However, as digital has advanced, we have nutcrackers that we did not have before to crack that particular nut. I can but support that move.
From the point of view of the things that really matter, the ability of a person to feel that they can tell their story once—not time and again—comes up all the time in our research. With great respect to everyone here, we are very capable of standing up for ourselves and insisting that we get answers, but the people I deal with and have the privilege of representing are often not in that position at all. They are overwhelmed when they are repeatedly asked the same question, often in a language—medicalese, if you like—that they do not really understand and feel threatened by. The single patient record is going to go a long way towards helping with that situation. It is not the complete answer but at least it does the hygiene part, as opposed to the motivator part, very well.
Sarah Tilsed: It is an excellent initiative—1as the professor said, we have been calling for it for such a long time—but we really need to consider the consent and data elements. A lot of pieces of work that we have done with patients shows that people are happy with their data being shared for these electronic records, as long as they are transparent and patients know what is being done with their data—that is a really important point.
The care.data initiative and general practice data for planning and research—GPDPR—were great, but unfortunately, because they did not have genuine patient involvement right from the beginning, they failed. We need to ensure that the SPR does not fail. In terms of reaching underrepresented or less-heard communities, we need to ensure that we hear from those people straightaway. How do they want this to work? Do they want to know how their data is being used? How can we ensure that people who do not use the NHS app are involved and that their data is being shared? How do we approach people who are understandably very hesitant about digital technology and electronic records?
Helen Morgan
Q
Sarah Tilsed: I said a lot about that earlier, in response to a previous question, so I am not sure how much more I have to add. I think my main point is that we must not divert attention away from the urgent priorities that patients are facing at the moment, ensuring there is a truly independent patient voice and trust—there is a lack of trust among patients, as I keep saying. How are we going to ensure that the reporting system is there for this?
Ultimately, patients need reform to lead to better care, not simply to different structures, which I fear is what often happens. Sir Robert Francis said, following the Mid Staffs situation, that patients must come first. Throughout the passage of the Bill, the Patients Association question will remain simple, and we will ask it time and again: will these changes actually help patients to receive better care, and how will we know if they do? That is the first principle to come back to. When everything is happening—all this restructure—how are patients going to be affected and involved in it?
Helen Morgan
Q
Professor Croisdale-Appleby: Thank you for that question. One of the reasons there is a difference or variation among the 153 is that the amount of funding is very different. Some of them get 10 times the funding of others, which makes a difference to the scope of what they can do. What it does not allow—and I think Healthwatch England has an important contributory role in this—is a change in the quality of the way in which the research is done.
One of the things that I have encouraged very strongly—although it happened before I joined Healthwatch—is the use of qualitative as well as quantitative data. The system is awash with quantitative data, but that does not necessarily cut through to the way that people are, the way they think, the lexicon they use, the concepts they use in communication etc. One of the great strides that Healthwatch England and our 153-member network have made is the intelligent use of qualitative data. That is an art in itself—I would like to think that is a science, but it is certainly an art.
It would be easy to remedy that, in the sense that if the funding were more equitable, some of that variation would disappear, but the variation is not in the quality, the effectiveness of the listening or the ability to look thoroughly at the impact, and it does not affect the fact that the organisations concerned are held responsible for what happens to the recommendations in terms of implementation. That is uniform across the system—it is just the amount of it that will vary naturally, because of the differential funding.
Laura Kyrke-Smith (Aylesbury) (Lab)
Q
James Cooper: There are some big opportunities in the single patient record, with the caveats that Sarah mentioned on data governance and consent. For families of children who are seriously ill, it presents huge opportunities, as I said earlier, because of the complexity of their needs. Often, huge amounts of information need to be conveyed to any professional who the children come into contact with, wherever that is across health, education or social care.
Many professionals have a long-standing relationship with such families, whether they are NHS community children’s nurses, consultants with a speciality in the child’s condition or children’s hospice teams, but families often need to access emergency unplanned care, perhaps in the middle of the night or at weekends. In those instances, when they speak to paramedics and emergency doctors, it is imperative that they can convey the information as quickly as possible. In those instances, I can see huge benefits.
With issues such as advanced care planning, to reflect the needs and wishes of those families, in particular as the child is coming towards the end of their life, I think it is critical that the whole range of professionals involved in the care of children has access to that information. I will welcome much more clarity from the Government about when the families will benefit from that particular initiative.
Professor Croisdale-Appleby: May I add a short comment?
The Chair
By all means.
Professor Croisdale-Appleby: We have to recognise that a tremendous amount of work is done in the health and social care system with people who have multiple comorbidities—not just one thing, but a number of things that often interact together. Without a single patient record, we can find that a consultant or a GP has access to only one part of that multiple comorbidity, as it were. That can lead to all sorts of unforeseen errors. I think that that is an important point to make about the great advantage that we can get from a single patient record.
Joe Robertson (Isle of Wight East) (Con)
Q
Professor Croisdale-Appleby: You make a pivotal and focused point. The independence is vital, not just because of the quality of what Healthwatch produces, but because of the confidence that it gives people that they are speaking to an independent organisation. In the background, some communities distrust being critical about the care that they receive in case it rebounds on them. If the same organisation is responsible for marking its own homework, as you put it, that problem will be much greater than it has been in the past. In terms of what to do about it, I think that you stick to some basic principles. If we are moving forward positively, we have got to be locally driven. We must reach out to communities. They will not reach into us; we have to reach out to those communities and the individuals within them.
I mentioned the value of qualitative evidence. It is not always easy for big institutions to go through all the work of evaluating qualitative work. It is easy to look at quantitative statistics, but the patient voice must be highly visible and central to policymaking. That was the basic idea behind the Bill: it would be about the patient and the patient voice, putting the patient right at the centre of the multiple discourses. As my colleagues have said, we should be totally transparent about priorities, impact and holding people to account. If all five of those principles are followed, it will work. If they are not followed, it will not.
Sojan Joseph (Ashford) (Lab)
Q
After each incident, there is a recommendation or an action plan, but clinical staff or patients do not have much involvement with those and do not see any difference. Healthwatch helpfully finds the issues, but it may not actually go back and see what changes are made following its recommendations. The CQC physically goes into clinical areas to see the difference, and has the power to take action against those responsible, so is it not a good change that more accountability will sit with the providers, and the CQC—or local authorities and ICBs—can take action against them?
Professor Croisdale-Appleby: Forgive me; you asked several questions. Which would you like me to start with?
Sojan Joseph
I asked whether it is not a good change to streamline these bodies so that fewer of them have powers to take action like the CQC?
Professor Croisdale-Appleby: There is always a danger, if I may say so, in the use of the word “streamline”. We have to think what is lost in the streamlining process. I do not want to repeat what I have said and waste your time, but one thing that is important is whether there is a golden thread running through seeking out and listening to patients’ views, putting those together in a coherent form, making recommendations for improvement—that is what we do all the time at Healthwatch—and then holding people accountable for that. I remember Penny Dash saying that one of the points of the Bill is to bring this closer to those who commission and those who deliver. I am not sure that it necessarily takes it closer to that simply by embedding it—as a colleague asked earlier—within the formal structure. There is a danger in that that the patient voice is often a spiky voice. As a former chair of hospitals and so on, I know that patients do not always say things that are convenient. That point about independence is vital. If I may, sir, I take slight issue with your term “streamlining” and would try to take that apart into the different components that might comprise it.
Sarah Tilsed: I cannot comment too much on the CQC, but on the point about a rise in complaints but nothing seems to be happening, we are finding that patients do not want to complain any more because they are finding that they are getting a worse service of care. That might be a slightly separate issue, but considering that there are so many complaints and that patients are not wanting to complain because they are scared, I do not think that streamlining is the right way. We need an independent voice that will focus solely on the patient voice, which I think we are completely losing at the moment.
Gregory Stafford
Q
Professor Croisdale-Appleby: If we talk about money— I will be quantitative here—Healthwatch England currently costs £3 million per year and the network receives £25 million per year. To people like me, £3 million and £25 million is a lot of money, but in the greater scheme of things it is not a significant amount, particularly when you think what is being produced for it.
I cannot speak appropriately, in my role as chair of Healthwatch, about Government policy. It is not my job to do that; it is the Government’s job. If you want to ask me a question on a purely personal basis so I can step outside of that role, I will be happy to answer, but I always have to draw a very distinct line on anything that I say. Everything so far has been said in my formal position as chair of Healthwatch as opposed to any personal views, because I certainly do not want to comment on Government policy.
The Chair
Let us see if either of your colleagues would like to be less cautious. Mr Cooper?
James Cooper: The key here is making sure that the independent patient voice is well-resourced, is held accountable for doing its job and works particularly for those the system finds it hardest to reach. Families of seriously ill children definitely fall into that bracket, so the interest of Together for Short Lives and the children’s palliative care sector is certainly in making sure that those structures do that.
Sureena Brackenridge (Wolverhampton North East) (Lab)
Q
Sarah Tilsed: I disagree with that. It is fine for ICBs to be involved, but it is all about local partnership working—bringing in the voluntary sector and really going into the community, and doing it in partnership. That is the only way of doing it. If you are bringing it into the ICB, consider how much funding there was when Healthwatch was doing it and—I do not want to repeat this point, but I will—the fact that it will be marking its own homework. For me, it is about partnership working going from the community—not within the system and not within the NHS, but going out to the community and feeding inwards.
Edward Argar (Melton and Syston) (Con)
Q
As a Minister, I was on the receiving end of some quite sharp recommendations from Healthwatch, but they were always constructive. Whether right or wrong, my fear is that this measure risks a perception among patients that it will be down to NHS managers and ICBs essentially to make recommendations that reflect their priorities, rather than the priorities and voices of patients. Professor, even if the principles that you have enunciated that might mitigate that risk were applied to the new model, are you really confident that they could mitigate the risk to patients’ confidence that their voice is genuinely and independently heard, loud and clear, however unhelpful it is perceived to be by bits of the NHS?
Professor Croisdale-Appleby: I cannot be confident of that, because we are in the foothills, not up the slope, and the details have not been given. ICBs have received something approaching a 50% cut in their running costs. I will not comment on the appropriateness or otherwise of that, but one has to be realistic and think about how high a really informed patient voice—particularly one that seeks out the views of both communities and individuals where the health inequalities are the greatest—will be on the priority list. I would question that, but I will leave it there.
Liz Twist
Q
James Cooper: It is key that ICBs are given that support. In the conversations that Together for Short Lives and the services we represent have with ICBs, we certainly get the sense that they want support. They want to know how much they should be funding certain services, and they want to know how to plan. A lot of guidance is already out there, particularly in children’s palliative care, where we have service specifications and NICE guidance and quality standards—there is even a legal duty to ensure that ICBs commission palliative care for children and adults. That accountability and support from the centre, and making sure that resource is there, is key.
The Chair
Q
Professor Croisdale-Appleby: I just want to reassure colleagues here that Healthwatch England and the Healthwatch network are still fully functional—I think that is important for you to know. Although we are sensibly on a reducing trajectory in line with the Government’s abolishment plans, we will maintain that full functionality and the ability to meet our formal mandate right through until the Bill is enacted, and until the guidance that will probably follow is in place. I just wanted to reassure the Committee of that.
The Chair
Thank you very much. On that note, Mr Cooper, Ms Tilsed and Professor Croisdale-Appleby, thank you very much for attending, and for your guidance and wisdom—we appreciate it.
Professor Croisdale-Appleby: Thank you for the opportunity.
Examination of Witnesses
Councillor Megan Wright, Sally Burlington and Maria Higson gave evidence.
The Chair
Good afternoon. We shall now hear oral evidence from the Local Government Association, the Association of Directors of Adult Social Services, and South East London ICS. We have until 3.50 pm for this panel. Could you identify yourselves for the benefit of the record, please?
Maria Higson: My name is Maria Higson. I would like to state for the record that I am here to bring to the panel the experience of a director of transformation within the South East London ICS. I do not represent the organisation, but hopefully I bring that experience.
Councillor Wright: I am Councillor Megan Wright. I am the vice-chair of the Local Government Association health and wellbeing committee.
Sally Burlington: I am Sally Burlington. I am chief executive of the Association of Directors of Adult Social Services, which represents directors of adult social care in England.
Dr Johnson
Q
Councillor Wright: I assume that was directed at me, as I am a representative in local government. We feel it is going to weaken it. Having someone on the ICB is useful to help shape health strategy and ensure that the wider determinants of health are taken into consideration when planning health. We would like to see some kind of structure where local authorities and other partners involved in determining health from a wider perspective have a voice within the NHS delivering health locally.
Dr Johnson
Q
Maria Higson: Whenever we introduce these changes into the system we have to remember that we are talking about a group of professionals who are trying to deliver for the NHS, citizens and patients. This Bill was first announced back in March 2025. It would be fair to say that since then, for an awful lot of people, there have been organisational and personal unknowns. The best intentions to deliver against the agenda and the three shifts can be hindered by that uncertainty. As with everything, implementation is absolutely critical.
Dr Johnson
Q
Sally Burlington: The better care fund is a really important source of funding for statutory core services. It funds about 80% of social care—in terms of the use of the better care fund by social care, 80% is statutory. While the ability to use it differently could be really valuable, we would be worried about diverting it from those core services into other functions. We have also benefited from the fact that the better care fund is uplifted at the same rate as NHS funding. If we lost that, it would be significant, because social care is systematically less well funded over time compared with some other services.
Dr Johnson
So you are losing a protection with the Bill.
Sally Burlington: Exactly.
Karin Smyth
Q
Councillor Wright: The main problem the abolition of NHS England has caused is upheaval and uncertainty with our health partners. Many of the health partners at our health and wellbeing board meetings or our place committee meetings are almost saying to us, “I don’t know if I will be here at the next meeting.” Such turmoil in the changeover creates instability from a lack of being able to plan what will happen next. That is one of the challenges that we feel. We are working with our health partners and getting assurances that there will be continuity, but it is quite hard when the person we are working with is changing.
We are really excited about neighbourhood health sitting under health and wellbeing boards. We love the idea of neighbourhood health looking at the wider determinants of health and having a very localised health response to the issues that that community needs to help it. One of our anxieties is that a lot of ICBs have become bigger and have less connection with the place. They are also shrinking; I think NHS England is losing 30%—
Maria Higson: Larger geography, fewer people!
Councillor Wright: Exactly. We have had a letter from our ICB giving us the heads-up that they might not be able to guarantee that they can send the right person to our health and wellbeing committees, which will obviously make it difficult to plan neighbourhood health.
The other challenge we find in neighbourhood health is that local authority boundaries might not necessarily match neighbourhood boundaries. I will give an example from Bracknell, where I live. Bracknell is very clearly a neighbourhood, but the south of the borough, which is within the Bracknell Forest council area, probably sits within Bracknell and Wokingham and a little bit within Reading. It will be hard to bring in true neighbourhoods with the current structure, but that is something we are working around, and we are hopeful that we will be able to sort it out.
Karin Smyth
Q
Sally Burlington: Health and wellbeing boards will probably become even more important following the removal of local government representation from the ICB. It will be the only place we have NHS and local government partners with the specific statutory responsibility to work together on social care. As others have noted, they are at place level and will therefore be crucial for connecting with the neighbourhood.
The other factor that is helpful to note is that there is a huge amount of pressure on systems at the moment, and the cuts to ICBs are having a profound effect on the relationships they have with local government partners. We are hearing from our members that continuing healthcare is a real point of concern, with reviews leading to the withdrawal of that care, placing challenges on local authorities. In that context, making sure that we are supporting health and wellbeing boards to be as effective as possible for neighbourhood health, and in that strategic joining-up role, becomes even more important.
Karin Smyth
Q
Sally Burlington: Neighbourhood health is a really important vision that we strongly support. In a way, it is obviously the right thing to do to move services closer to the people they serve and to work very closely with communities. Health and wellbeing boards have an opportunity to drive that neighbourhood health agenda because they are responsible for neighbourhood health planning and have the connection to local government, to the voluntary sector in many cases, and to the NHS. It feels like that is a real space of opportunity to drive neighbourhood health and realise the benefits that it could offer.
The Chair
Q
Maria Higson: A couple of things. One is that it is not possible to overstate the importance of the partnership working between the NHS and local authorities. If we want neighbourhood health and the shift to prevention more broadly to be successful, working closely with local authorities, including the public health teams—which were not in the question but deserve a mention—is imperative. I am sure we will come to the question about the relationship with the mayoralties. There is something about that geography question. The insight and experience that local authorities bring is really important. That is the one thing that I think ought to be mentioned.
Helen Morgan
Q
I am really concerned that that will become even more problematic because they cannot work together, given that we are not a combined mayoral authority, that we will not have a mayor sitting on our ICB and that our ICB merged footprint does not fit with our local authority geography. How can the health and wellbeing boards work between the two organisations to deliver good social care?
The Chair
Let us start with our councillor in the middle.
Councillor Wright: It is a challenge. I completely hear that; continuing healthcare is a really difficult one. It is right to say that residents are seen as a financial burden, which should not happen. That is why we need strong health and wellbeing boards. We need strong, honest conversations between local authorities and the NHS for ensuring that good continuity of care.
Obviously, I think the overall aim of the 10-year health plan is to move much more to a model of prevention and treatment in the community, where we hope that we could intervene earlier and set up good standards of care before it gets to a stage where it becomes so adversarial. That is what we are aiming for. We have challenges in our local authority and have had to push back on a few cases where we felt the NHS should be helping those people.
Sally Burlington: The problem is getting bigger over time. We did some joint work last year with the NHS Confederation to look at those difficult issues on the boundaries between health and social care, including continuing healthcare and mental health aftercare. That identified some good models. We see arrangements for joint commissioning of continuing health care, which can work well. We have seen a little bit of withdrawal from that by some ICBs.
Part of the issue has to be that we are seeing a real intention to cut costs, and that leads to lots of reviews taking place that do withdraw continuing healthcare. We have seen that trend while the demographics are pointing to potentially more demand, not less. I do not think there is a substitute for better relationships. The legal framework is pretty clear. A helpful way into the problem would be to find a way to have a set of conversations at a national level about what the right solution for people is—start there and then think about whether the reviews are right in the ways that they are taking place.
Maria Higson: The only thing I would add is that it is tricky when we apply a broadbrush approach of, “Well, it’s going to be about the mayoralty and so on.” In reality, certainly within London, we can describe ourselves as a system of systems. We work with six local authorities across one ICB, now partnering with south-west London as well. It is not as easy as “one approach fits all”. As this Bill goes through implementation, it will be important to be conscious of that to get the best out of those relationships.
Helen Morgan
Q
Councillor Wright: I chair a health and wellbeing board, and everyone comes to those; there are really good conversations and really good reviews of what is happening. I think they are in a really good position. What I worry about is how much influence they will have over NHS wider strategy.
I was at a King’s Fund day, and someone said something that I thought was so true: the Health Bill and the NHS 10-year plan is the NHS 10-year plan. The NHS will be judged on how it achieves what it is meant to achieve. Although, as local authorities, we want to help with prevention and those wider determinants of health, ultimately the responsibility sits with the NHS.
It is about trying to work out how we have better conversations with the NHS, to say, “We have done neighbourhood health for years; this is what we do as local authorities. We look at all these things and we use public health and our adult social care system to create healthy environments. We need you to be on board with us.” I therefore think there is something about the power dynamics regarding health and wellbeing boards and how we address them. But overall, I feel that they are the best way of ensuring community health.
The other thing is about geographies. Health and wellbeing boards might not match neighbourhood health geographies, so there are also some challenges in working out how that will work.
Edward Argar
Q
I was the Minister who created ICBs, and I sat on that Bill Committee with the current Minister for Secondary Care. I am getting a sense of déjà vu—we are on different sides of the Chamber now, but we sat through the Committee stage of the Health and Care Act 2022 together. I deliberately created ICBs to match the geography of upper-tier authorities because health and social care is essentially one system. If one bit does not work, the other bit does not work.
Since then, we have seen significant mergers and larger areas, further removing them from that direct relationship and read-across. Although the good ones do, I fear that a lot of NHS ICBs do not fully reflect the intention behind their creation, which was to see them as a genuinely collaborative exercise with equal voices in the room.
My question is: if we see ever-larger areas or fragmented areas, whether through neighbourhood health plans or mergers and acquisitions among ICBs, how do we maintain genuine local accountability and the relationships that underpin any structure written in law, on a piece of paper or in guidelines?
Notwithstanding what is being done about the health and wellbeing boards’ increasing involvement, do they actually have the teeth they need? In my experience, however good the collaboration, it is within the ICB boardroom that the decisions are actually made. However well things have been discussed beforehand, the ICBs will make their own decisions based on their own priorities. Does the removal of that voice from the ICB strengthen or weaken the ability to see this as one local system and to deliver a genuinely holistic local solution?
Councillor Wright: It will probably weaken it, unless we are given more say in our local health and wellbeing board. Our Thames Valley ICB has one director of public health. Thames Valley ICB I think has nine local authorities, and one chief executive and one director of public health sit on the board, so already the voice on it is quite small. If we lose that voice, where would we have those conversations? That brings me back to the whole thing about health and wellbeing boards needing to be stronger, definitely.
Sally Burlington: We would agree with that. If you take away the voice that is able to speak on behalf of social care, public health and wider public services, it will be harder and an additional job to bring in that consideration. It will be even harder to expect there to be notional teeth in that relationship, so we have concerns about that.
Maria Higson: It is also worth recognising that the delivery of any strategy or plan will require partnership working with local authorities, so whether or not they are in the room, they will be needed for delivery, and the proof is always in the pudding. For me, the partnership is somewhat non-negotiable in order to achieve delivery.
Sureena Brackenridge
Q
Councillor Wright: At the LGA, we are arguing for a single person record, so that we have a single patient record that brings in social care providers, or at least the local authorities’ social care statutory provision, too. Someone discharged into the community would therefore still have access to records and know what was going on, while others would know what has happened to that person and what they need. Yes, we agree: we hope that a single patient record would make things as smooth as possible from hospital discharge to home and would help when someone comes into hospital, so that the clinicians have a better idea of what the patient’s quality of life was like, what treatments they were on, and so on. We are definitely in support of the single patient record for that, and we would like it to become a single person record.
Sally Burlington: We are supportive as well. The Bill itself is unlikely to solve all the problems in this space. A huge number of practical cultural system problems exist in data sharing, so the regulations that follow the Bill will be important to enable that to work for social care providers and commissioners. It is worth noting that there are thousands of social care providers, so the implementation of the Bill and subsequent regulations will be important. We are keen to ensure that any approaches are co-produced with the social care sector, as well as the NHS. It will be a lot of thinking, a lot of planning and a lot of hard work to get it right, and social care providers will need lots of notice to upgrade their systems in the right, consistent way to enable them to speak to each other, if we are to see the vision of the single person record delivered. I guess it would also be helpful to think about the role of carers as we move into that space, because we know from covid that data sharing among carers was one of the issues that came up.
Gregory Stafford
Q
Maria Higson: Any time we go through an NHS reorganisation, it is distracting—that is the reality of such situations. It is unfortunate that, over the past 15 months, this has been a large distraction for people who are genuinely trying to deliver the three shifts—prevention, digital and neighbourhoods. It is true that it has been a distraction. I am not sure that this Committee is the right space to go into these, as I am aware that we are here to discuss the Bill, but there are probably opportunities to go further on some elements, which may help us in future.
Gregory Stafford
Q
Maria Higson: To take one example, I would love to see an NHS where we step away from short-term activity metrics, and towards outcomes—that is mentioned in the Bill. The constant firefight on activities is quite challenging, so how can we move that dialogue to ensure genuine transformation? That is an example of where we could potentially go further than the Bill suggests, but I am conscious that I am supposed to comment on the Bill, not give my own random thoughts.
Jo White (Bassetlaw) (Lab)
Q
The Chair
I could not hear the question from this end of the room; I do not know if our witnesses could.
Jo White
I was talking about bed-blocking in hospitals and how neighbourhood health plans can work more cohesively with hospital trusts.
Councillor Wright: I think we can answer this together. The whole point of neighbourhood health is to bring in everyone in the voluntary sector, your patient transport and all that, so that your joint strategic needs assessment has a good understanding of what is available to someone in the community when they come home. We talked before about having a strong single patient record so that good communication is there, and neighbourhood health is able to strengthen that. Neighbourhood health should be not just about shifting the need from hospital to community, but about reducing that need in the first place so that fewer people need to go to hospital. At the same time, we are seeing some good developments in the NHS, such as frailty teams and hospital at home teams, all of which help to prevent people from being admitted to hospital in the first place, and to ensure that when people come home, there is a team to visit them.
You are right about the communication issue, although it has not been an issue where I am, as we have very good communication with our local ICB about the people being discharged, to make sure that someone is there to meet them and that nurses come out to see them when they come home—I cannot remember the word for that. We have the right systems in place and they are working. I do not know how neighbourhood health will work everywhere, but in our borough we have a step-down unit called Heathlands, which people quite often go to when they come out of hospital and which does quite a lot of rehabilitation. That already starts the plan to get them home: to go from hospital, to the step-down place and then to home. It is about having good systems in place, all of which should hopefully be supported by neighbourhood health, which should have a good knowledge of what is available locally.
Sally Burlington: It should definitely help, if it works well; we should see more capability and capacity available in the community, closer to where people live, to help them when they come out of hospital. There is a lot of good practice and understanding about good discharge and how you plan from the point that somebody is admitted to when they come out of hospital. The emphasis on integrated neighbourhood teams will be important. It would be helpful if we could all remember that those must include social care and wider local government services and connections in to those, not just integration within NHS teams. It is definitely a positive step forward and, if we can try to make sure that the relationships between health, social care, public health and wider services are brought to life in neighbourhood health, that will help us in this way and in lots of others.
Janet Daby (Lewisham East) (Lab)
Q
Sally Burlington: As I understand it, the safeguards around data sharing remain in place under the Bill—they do not change. The part of the single patient record that is really attractive to our world is that people will not have to repeat themselves to every professional they meet; they will not have to tell their story again and again or be retraumatised by explaining the detail of what they have been through.
The potential advantages are there, but there are obviously concerns about data protection and how data is used. It is incumbent on us all to take those seriously, think them through and make sure that safeguards are appropriately implemented locally and in all the institutions that have access. That is probably a matter less for the Bill and more for the implementation and supporting regulations, but we and other partners will be keen to be a part of that process to make sure that the safeguards are appropriate.
Laura Kyrke-Smith
Q
Maria Higson: I think we are all agreed that working at the neighbourhood level is absolutely the right way to go about that. That is where health inequalities can best be addressed, because that can be most nuanced and tailored. Working on that smaller footprint is really important. You mentioned voluntary, community and social enterprise organisations, and I think that is a hugely important part that has broadly been missed out from the conversation around these changes. We work closely with VCSE partners and we know they deliver huge amounts for the communities and understand the communities in which they are embedded very well, so making sure that the VCSE voice is part of those neighbourhood teams will be important for that nuance and tailoring in the local element.
Councillor Wright: I agree entirely. Local authorities are in a good position to engage the voluntary and community sector. But again, we are fighting for a voice with the NHS and they are fighting for a voice with us, so we need some honest conversations with ICBs, and a real strategy looking at those health inequalities and what is driving them. It will not purely be access to hospitals; it will also be access to meaningful employment, housing, transport, mental health or social isolation—there will be so much driving those wider determinants of health that are affecting healthy life expectancy. Local authorities are in a prime position to do that, and they need to be listened to. I think the challenge will be how we collectively say, “What needs to be done, other than implementing the Bill? How do we look at the whole health inequality picture and address it?”
Sally Burlington: I would agree with the others: tackling health inequalities is really difficult. Doing it the same way in every area would not work, particularly in a world where there is not enough resource to do everything we would all like to do. You have to tailor how you approach local service delivery and what is needed locally according to local needs, the local community capability, how people work and what their preferences are locally, and the neighbourhood health agenda is our best shot at tailoring in that way.
I think you will come on to Healthwatch, but we would have concerns that, in separating the Healthwatch duties to look at NHS and social care, we risk missing some of those who are most likely to need both, and that that could exacerbate health inequalities rather than make them better.
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
Q
Councillor Wright: That is quite interesting; I was at a session this morning looking at communities, and there was a comment that for the NHS communities are about buildings, whereas for the local authority they are about people. I think it would be the ICBs and whoever they commissioned to provide neighbourhood health centres. I hope there would be enough input from the voluntary sector, the local authority, adult social care and public health—from everyone—but I see the ICBs as the commissioners and the people who organise them.
Peter Prinsley
Q
Maria Higson: If we want to be as open to change as possible, my argument would be that that should be decided locally. Would it not be fantastic if, for example, some of them were led by VCSEs that worked in close partnerships and had clinics where GPs came in? You can envisage a whole number of different scenarios, led by local communities and local organisations. This plays back to the health inequalities point, but that is how you do it, although it relies on you being open to different models and not trying to do a one-size-fits-all, which is really tricky when you are trying to implement.
The Chair
Last word, Sally Burlington.
Sally Burlington: I strongly agree with that. If you were asking who is best placed to run them, the answer would be that it probably looks different everywhere, because it will rely on local leadership and local capability and capacity, which varies across all our sectors, so this is a really good opportunity to make the most of that leadership ambition and skills and capacity locally.
The Chair
Thank you, ladies. The Committee is most grateful to you.
I will just explain now, while we are changing over witness panels, that after I introduce the next panel there are likely to be—in fairly short order, because the Minister is on his feet—four Divisions in the House. I shall suspend the Committee from as soon as the first Division is called until 10 minutes after the start of the last Division, when we will start again. I hope that is clear. It does mean, I am afraid, that we will have to ask our witnesses to be very patient. It is extremely tedious and very discourteous, but that is the way this place operates, I am afraid.
Examination of Witnesses
Emily Holzhausen, Paul Farmer CBE and Kath Abrahams gave evidence.
The Chair
We will now take evidence from Carers UK, Age UK and Tommy’s. Could you introduce yourselves for the record, please?
Paul Farmer: I am Paul Farmer. I am the chief executive of Age UK and also the chairman of the Richmond Group of Charities, which comprises 15 of the larger health charities as members.
Kath Abrahams: I am Kath Abrahams. I am chief executive of Tommy’s, which is the pregnancy and baby charity looking to stop the heartbreak and devastation of baby loss and make pregnancy and birth safe for everybody.
Emily Holzhausen: Hello, everyone. I am Emily Holzhausen, director of policy at Carers UK, representing England’s 4.7 million unpaid carers. I also have lived experience as a carer.
Dr Johnson
Q
Paul Farmer: From the perspective of older people and people with long-term conditions, the single patient record will be, broadly speaking, welcomed. I will explain very briefly why. If you are an older person with multiple long-term conditions and you find yourself in hospital, you often have to explain your experience and health needs, time and again. That is often because of a lack of join-up between the current data systems. Single patient record means the individual patient does not need to repeat their stories or lived experience—and, more importantly, it allows clinicians to have a clear overview of an individual patient’s health records. There are issues that need to be considered, particularly around making sure that people are not digitally excluded, and I am sure that we will get into those, but at a high level we would welcome the introduction of a single patient record.
Kath Abrahams: There are some very similar themes for us. A lack of shared patient record is a particular issue in pregnancy and maternity. You are being seen by your GP, early pregnancy unit and maternity unit. You might have other conditions that affect pregnancy or could affect the outcome of your baby being born. At the moment those systems are very disjointed. The other piece in maternity, which will not come as a surprise to you, is that, if you have lost a baby, you end up having to retell your story over and over again and that can be very traumatic. Sometimes that can lead to people disengaging from care, but also in many cases being retraumatised.
We broadly welcome the single patient record, but with lots of caveats around people feeling able to trust the data and trust that their data is safe. Overall we are very supportive.
Emily Holzhausen: Again, similarly to my colleagues, we are supportive. When we ask unpaid carers what matters to them, sharing of information is really critical, but we have a slightly different perspective here.
First, carers would like to have access to the record, with the right permissions. That is not on the face of the Bill, but it is suggested that that may be covered in regulations, and we would like to see some assurances of that. It would change things, again, because of not having to retell information, which carers call “triggering” and “exhausting”. They will be more able to spot errors or things that are not quite right, which is important for the person they are caring for. As an unpaid carer, when you are responsible for caring for someone, that is a huge weight on your shoulders and you really want to make sure that it is being done right. Finally, most of us care remotely—we do not all live with the person that we care for. This could really help to transform carer’s lives and the pressure they feel.
I have one statistic for you: just under one in eight carers spend over 40 hours a month on NHS admin. If the NHS app and the single patient record can reduce that, that would change things. The only other point I would like to make is that where this tips over into social care, this is something that we need to build with social care and all those people who go across all these different services.
Dr Johnson
Q
Emily Holzhausen: Yes. That is a lot of different questions. It has to be done with the right permissions, with the patient being in control of their data—that is a very strongly held principle within the NHS. There will be situations where people do not have capacity and their primary carer, who might be their partner, their son or daughter, might need access. We have lasting power of attorney in England, which could be used as a mechanism, or other assurance mechanisms.
As for digital access, that is an issue that I am sure Paul will want to come on to. Especially when digital access costs money and we have people in poverty, we have called for that to be supported by Government to ensure that everybody has digital access. People have to feel confident about it. While we have seen a doubling in the number of carers using the NHS app to manage their own health and care in the past two years, there are key groups that are being excluded: older carers, people on lower incomes and people who feel less confident with technology, for a whole range of different reasons.
Some of this stuff is delivered very well through voluntary and community services—I know that Age UK has helped my family locally, for example, but I will stop there, because I am sure Paul will want to come in on that.
The Chair
Paul Farmer, you have been given the floor.
Paul Farmer: I would very much like to come in on this subject. We see probably the greatest risk and the greatest opportunity here, in the context of digital exclusion and digital inclusion. The risk of digital exclusion is that older people in particular, although it is not exclusively an older people’s issue, will lack the access to their own care record, as it is electronically based. We need to bear that in mind when we think about the roll-out of that and the availability of the content of that patient record to people who are digitally excluded.
I do think, however, that this is a significant opportunity. It is part of a much broader question about digital inclusion more generally, and inclusion into accessing public services more generally, which is a key theme of the work we are doing at Age UK. We had funds from DSIT to support the work of our local Age UKs, where we run a number of digital champions programmes—Members are very welcome to come and visit them at any time. We worked with 8,000 older people in a two-month period; we engaged more than 1,000 of that group into our digital champions programme, and two thirds of people took up the offer of engaging in a training module on accessing the NHS app.
In particular, we were able to enable people who are partially digitally excluded. We are publishing a report later, which we will share with the Committee in time, about the opportunities for people who are not fully excluded, but partially excluded. We think people are able to go on that journey, but it does need support. We encourage the Government to think about putting a really thorough programme of digital inclusion alongside the implementation of the single patient record, to support older people, people with long-term conditions, people with learning disabilities and other conditions who might need extra help and support to access the NHS app. There is a risk here of people being excluded, but also an opportunity for inclusion.
Mrs B, in Lincolnshire, was helped by Age UK Lincolnshire. She was a carer to her husband, who has had a stroke; she had a home visit from the local Age UK and they were able to set up the NHS app for her. She said she would not have been able to do that without that extra help and support.
Dr Johnson
Q
Kath Abrahams: On digital exclusion, the same risks apply, although there is a different age demographic. If you have somebody who has a particular disability, has English as a second language, or has difficulty reading, we need to ensure that alongside the single patient record we are not excluding people without meaning to. Having said that, there are real opportunities to reduce inequities as a result of this change, such as by ensuring that everyone’s information is there, and that people do not have to retell their story if they find it difficult to speak to their clinician.
What the single patient record will not do is solve all the problems found in the national maternity and neonatal investigation. An action plan will come out of that investigation, and it must be looked at really seriously. A single patient record does not replace compassionate care or somebody really being looked after well, but it can potentially provide a safer environment—I am very happy to go into detail on that.
The national maternity ambitions have expired, but we are pushing very hard for them to be restated. There is potentially an opportunity to use the data at a broader level to measure progress. If it was possible to use the single patient record to understand how things were going towards improvement, that could be very helpful.
Karin Smyth
Q
Kath Abrahams: Right now, the situation is really tricky and people are being failed in their pregnancy and maternity care. Women report constantly having to retell their story—highly sensitive or traumatic experiences of loss—and that repetition can happen across the early pregnancy unit and maternity services. There is a common misconception that the NHS is one system, so when they find that people in another bit of the system do not know something, that can be really frustrating and annoying, because they assume that it exists.
There is also a lack of continuity. A clinician can be completely unaware of a sensitive or traumatic experience that somebody has had, and there can also be genuine dangers in outcomes. We know from the reports into Morecambe Bay, Shrewsbury and Telford that the lack of joined-up sharing of information and good communication between different parts of the system has led to some really difficult outcomes, particularly if somebody also has gestational diabetes, for example, or another condition and they are taking a particular medication that could cause harm to an unborn baby.
There are lots of situations in which not having the complete history is preventing people from getting not only really good, compassionate care, but the safe care they need. If someone is in an emergency situation and they are bleeding out, or their baby is not moving as much as they should, there is not time to start from scratch; they might not be in a position to explain what is happening to them and what their history is. They might not even know all the relevant bits of their history. Having that complete record, if it was done really well, would give clinicians the information that would allow them to make really timely decisions. Maternity can often be high risk—I do not need to say that to you; you know that—but these are often fast-moving situations where time is absolutely of the essence.
Emily Holzhausen: To build on what I said earlier about the amount of co-ordination and admin that people do, I will just refer to some carers’ words. One said that if they had to phone, they would end up in a long waiting queue or having to travel to the GP in person. There are people juggling work and care, so this has real, everyday impacts on their lives and their time.
When I refer to errors, I mean things such as medication errors or diagnosis errors. When you care for someone with very complex conditions, you can have health appointments every week—sometimes twice a week—and it is so hard to stay on top of it. When I say it is so hard, and talk about unpaid carers, we know that caring is a social determinant of health: in itself it is a single factor for poorer health outcomes. We know that 600 people a day give up work to care.
We have done a report on the tipping point: what tips carers out of work? One such thing is social care; another is how they are treated in the health system. If we reduce the pressure on carers and put information at their fingertips to help them to manage care, we improve outcomes for everybody: the health and wellbeing of the carer and the safety of the person that they care for. People are trying to do their best in quite a difficult situation.
One of our members, Norman Phillips, has talked about that a lot. He was in contact with more than 24 professionals, knitting up care around his wife who had advanced multiple sclerosis and dementia. That is an incredible amount of co-ordination of care. You can see how a single patient record, as it is envisaged in the future, could really help to support people who provide care. It is critical, given that we have an ageing population, that we recognise and support families in what they do.
Paul Farmer: I would start by talking about people with long-term conditions. Let us bear in mind that by the time we are 65, 82% of us will have one long-term condition, and half of people aged 70-plus have more than one long-term condition. Most of those long-term conditions are diagnosed within primary care, but of course they have a huge impact on access to secondary care services. For a clinician not to be able to see that whole picture and for the individual to have to explain again and again their physical health issues, and potentially their comorbid mental health issues, creates a huge challenge for people in getting access to the right help and support in a timely manner.
I would build on that to think about two areas that particularly affect older people: frailty and dementia. In this context, we know that assessment for frailty can make a big difference to ensuring people receive the right kind of help and support. That should be done in primary care, but often, sadly, people with frailty will present in hospital with a range of conditions. Understanding the frailty assessment score and what help and support is needed is key. For people with dementia and their family carers, having access to the right information for the clinician and for the individual concerned can make a huge difference. A disjointed experience just exacerbates what can often be a very challenging time.
Helen Morgan
Q
Paul Farmer: Listening to patients is an incredibly important part of any health system. It is necessary to make sure that the right mechanisms are in place at both the individual and the systems level. The aspects of the Bill that cover patient experience need careful consideration.
Many people were fans of what Healthwatch delivered, and others were not, but it had a clearly established system and mechanism in place to ensure that patient voices were heard. It is important that clear systems are established to ensure that that patient experience is heard. I have operated around the health system for a number of years, seeing a number of incarnations of patient voice organisations and representation; you really have to think about it from the individual and the whole-system level—from top to bottom.
It is important that the Committee looks at the provisions in the Bill in that context to make sure that where there are good supports, they not only are preserved but can be built on. For example, how do you make sure that patient voice is heard at ICB level, in providers and, in particular, in the new world of neighbourhood health?
Kath Abrahams: Helen, it is a great question. Clearly, the Bill itself, and certainly the single patient record, are never going to replace wonderful, kind and compassionate care where people feel they are listened to. As I have already said, but I will say again, a combination of people not being listened to at all, despite knowing their own health better than anyone else, or having to retell their stories has very challenging consequences. Both leave somebody feeling that nobody really cares or understands them.
I spoke to a supporter of Tommy’s this morning who has had five miscarriages. She was saying it appears to be quite a small thing, but every time she went to see a clinician, they said, “Oh, you’ve had four losses” or “You’ve had three losses.” It was about them not understanding, and her having to correct her records and getting letters through. It is about that sense of not being listened to.
As we develop the Bill, women and birthing people, from a maternity perspective, should have the opportunity to contribute to the way something like the single patient record is shaped. You could have a digitally accurate system that did nothing to reassure women or help them feel looked after or listened to, or you could have a beautiful system where the information was recorded in such a way that it really helped.
Alongside that, clinicians need to continue to receive the right sort of training. They need to have enough time. As Paul said, you need those patient voices involved in overseeing how things are going, and able to contribute and help. The Bill itself, as a mechanism, will not do enough. This is about designing it carefully with patients in mind and, in the case of maternity services, involving women right from the start.
Emily Holzhausen: There are provisions in the Bill that transfer responsibilities from NHS England to the Secretary of State in relation to involving patients, and it is very explicit that this also involves carers. It is very important that explicit Healthwatch duties to involve carers have been transferred into the Bill in relation to integrated care boards. That matters because their portfolio of commissioning different services is increasing, as is that of local authorities.
Those are strategic duties. The reason why that is important, to be very specific about carers, is that they provide £152 billion-worth of care. They outnumber staff three to one. They are experts in care over time and they want to be involved. Of course, what colleagues have said about good practice is critical to look at.
The changes to Healthwatch—others have raised this—do not consider the person’s journey across different services, health and care. There is an independent voice that we do not have, and will not have, in quite the same way. A very small proportion of carers felt that, if they raised a complaint, it would be acted on. That kind of independent voice is actually very important.
As Kath said, those duties are really important, but we need top-to-toe listening to patients. We also need to be explicit about listening to carers, not just on behalf of the patient, but by asking, “What is your experience as a carer of managing this care?” because that is very different. To be honest, I do not think we have the right data flows behind that to collect and understand people’s journeys and improve things. I hope that that is also something that will be looked at.
The Chair
I do not think there are any further questions. I am sorry to have kept you waiting so long for what has been a relatively short period of time, but it was important that all Front Benchers, and any other Members who wished to do so, had the opportunity to question you. Thank you all very much for being so patient and for giving us the benefit of your thoughts and wisdom.
Examination of Witnesses
Dr Michael Cocker, Dr Towhid Imam and Dr Nicola Byrne gave evidence.
The Chair
If everyone is ready, we will proceed to the next panel; as you will see, one of our guests is on the screen. We have Dr Michael Cocker, from East Lancashire hospitals NHS trust, Dr Towhid Imam, from Croydon health services NHS trust, and Dr Nicola Byrne, the National Data Guardian for Health and Social Care. We will get through this as reasonably swiftly as we possibly can without cutting corners, if that is all right. I will try to bring this to a logical conclusion within—[Interruption.]
The Chair
For the sake of the record, starting with the two people in the room, will you identify yourselves, please?
Dr Imam: Hello, I am Dr Towhid Imam. I am a consultant geriatrician, working in Croydon university hospital, where I set up the front-door frailty service. I am also a clinical lead in South West London ICB and an adviser to NHS England.
Dr Byrne: I am Nicola Byrne, the National Data Guardian. I am also still a practising clinician, as a consultant psychiatrist in south London.
Dr Cocker: I am Dr Michael Cocker. I am a consultant obstetrician in the north-west of England, in Burnley general hospital. I am the clinical informatics officer for maternity at my trust.
Dr Johnson
Q
“rather than data being transferred from where it exists at the moment to a new system, it will remain where it is—in GP surgeries, hospitals and so on—but it will be linked up so that one person, including the patient, can see all that data”.—[Official Report, 1 June 2026; Vol. 786, c. 890.]
How easily will that work in practice? In the trust that I work in, we have different systems for blood results, results, tracking patient appointments, maternity and A&E. Is it realistic to expect someone to be able to log on from one part of the country and to understand all the different systems in all the other parts of the country, or do you think that it needs to work in a different way?
Dr Imam: About a month ago, we published some NHS England guidance on best practice for frailty. Included in that are examples of shared care records, where people who are living with frailty who have been assessed by health services can actually view one record. The way those work is to take information from multiple different records and place it into one shared care record, in order for clinicians from various different backgrounds and multidisciplinary teams to work together.
Dr Johnson
That would be moving it on to a new system.
Dr Imam: That is in a separate shared care records system.
Dr Byrne: As I understand it, the architecture is not yet decided, so how we solve those technical challenges will be determined by the choice of architecture.
Dr Cocker: Similarly, I believe that the technical solution for how that will be delivered has not been finalised. When we did the maternity-based pilot in the north-west, the wireframe prototype that was developed pulled information from all the separate systems—the maternity system, the hospital central electronic patient record system, the GP system. The pilot was based on pulling it from each individual system into one place where it can be viewed, but that is a future aim. The focus is on phased implementation, so it would not all be immediately available like that, but that is the vision.
Dr Johnson
Q
Dr Cocker: That is a pertinent question. I know that that has been the focus of a lot of concern since the Bill was publicised. I believe that the structure of the SPR would be recognised as a critical national infrastructure-type of project, so it would have access to more resource to protect it. But there will always be inherent risk, when you have something centralised, that it is a single target rather than multiple targets that could be attacked—for example, in a cyber-attack.
Role-based access would be important—for example, having an understanding that the information should be accessed only for the provision of clinical care. How it would be delivered on a technical level would have to be finalised; that was not the type of the prototyping work we did, because it was more about a proof of concept than those more minute technical challenges.
Dr Byrne: I am glad that Dr Cocker took that question first, because he has given you a helpful technical answer. As National Data Guardian, my mission and concern is primarily around public and professional trust. Trust in whether this system can be relied on in terms of people’s confidentiality is something that concerns me very much, as well as people’s trust and confidence in secondary purposes, how the system will be used and what the safeguards around it will be. I would be happy to answer from that perspective when it comes to people’s confidence.
I think you have heard a lot about the potential benefits of this system, but it is important to bear in mind that if people do not trust it, the programme will fail, however great the potential benefits are. As a clinician, I would share the excitement, and I am very supportive of the ambition, but people will not trust it if they perceive the risks to the security of their data and confidentiality to be too great.
With that in mind, I want to draw attention to two things that concern trust. I want to emphasise that trust is not simply important—I know that the word “trust” has come up repeatedly today—but absolutely foundational to the success of this. The question about how demonstrably trustworthy the system is should be the primary foundational question; all other questions, including the technical ones, flow from that one question.
On the confidentiality aspect, I think there is a provision under clause 47 that potentially has very significant unintended consequences. I understand that that is not the intention of the drafting, but I have concerns about it and I have a potential solution to suggest. In clause 47, proposed new section 250E(3) creates the power for the Secretary of State to remove the duty of confidentiality for any processing in the SPR in line with regulations. I need to register my concern about that wholesale lifting of the duty of confidentiality from the entire system.
At a system level, there are two risks. One is to patient and professional confidence in the confidentiality of the data once it is accessed or in a system. Confidentiality is absolutely the cornerstone of all clinician-patient relationships. It means that people are comfortable to share the most sensitive information about themselves and often loved ones—it is not just information about ourselves on our records; it is often also information about our loved ones. If people do not trust that that confidentiality is a constant ethical constraint for anyone accessing the record further on, they may be less able to share information about themselves or their loved ones. Clinicians may also be less likely to document that information if they have ethical concerns about who may access it further on if it is particularly sensitive. That will negatively impact on care and the quality of data for any secondary purposes in future.
The second point I will make about that confidentiality provision is that I understand that the drafting intent is to remove any ambiguity in terms of people’s concerns about duty of confidence when allowing access to their data at an organisational level. However, as currently drafted, the provision could be interpreted to remove the duty of confidentiality for not just direct care but secondary purposes. Secondary purposes in future could be dealt with by regulations. That lack of clarity poses a risk.
The solution I suggest is to redraft that provision, drawing on the precedent already set in the Health and Social Care Act 2012. Section 259 prevents disclosure of data from an organisation from being a breach, so people could allow access at an organisational level with confidence. You have removed that ambiguity, but it does not remove wholesale that duty of confidence—that ethical safeguard for the data in the system itself. I think that that is important for people’s own direct care, and, as I said, it is particularly important if there are any questions around secondary uses in future.
Dr Imam: That was a comprehensive answer; I have nothing to add.
Dr Johnson
Q
We keep hearing that it is difficult for people to have to repeat their story. I understand that stories can be traumatic and repeating them can be unpleasant, particularly if it must be done many times, but is there sometimes a clinical value in asking people to go through their story? If so, what is it?
Dr Imam: My specialty is frailty, which is a medical condition characterised by a loss of independence. Although it is associated with ageing, it is not an inevitable part of ageing. The treatment that I deliver as a clinician is called a comprehensive geriatric assessment. It is evidence-based and we know that it improves patient outcomes and maintains independence. What it describes is a multidisciplinary team approach to a holistic assessment that focuses on what matters most to the patient.
One of the issues that we have right now, however, is that the NHS does not consistently identify people who are living with frailty right across the system from community to hospital. If we are identifying people and diagnosing them with a condition, you would expect treatment options to be offered, yet we do not consistently do that across the country. That is essentially driving ineffective and inefficient care. Sometimes, therefore, when a crisis sets in—we have seen this in other reports around corridor care—that can ensue in older people living with frailty.
In my day job, where I look after people in a busy A&E department, I see people who have may have had a fall or become confused, or where there has been a breakdown in their social situation. My practitioners and I are spending hours trying to piece together information from multiple different sources. Those could be paper-based, digital or telephone—we could be trying to phone people to get up-to-date information. As you can imagine, sometimes they do not pick up the phone, so we are sometimes working from incomplete information and things that are not up to date.
Once we have done that, we try to create a care plan for a patient that allows them to be looked after in the community. However, that care plan may not follow the patient, because everyone uses different electronic patient record systems. Some important partners in that care, like social care or ambulance services, cannot actually see the care plan that I have developed for my patient.
Unfortunately, if a patient with frailty then succumbs to a crisis of some kind, the default setting is, in many cases, to trigger an admission to hospital. If a patient does not need to be in a hospital environment and they are frail, they can end up becoming more frail and weak, and lose their independence. That means that they will need even more social care than would otherwise have been required.
Where the solution comes in is that a nationally rolled-out single patient record system could fundamentally reshape this form of care, because we would be moving it from the fragmented, reactive model that I just described to one that is proactive, co-ordinated and truly centred around a patient. Another thing about frailty is that there are so many different people involved in that person’s care, so we need to try to restore the continuity of care for that type of patient, which has become eroded over time. The SPR addresses that with a single up-to-date view of a patient. It enables earlier risk identification, faster clinical decision making and that whole-system integrated response I have been describing, which is lacking at the moment.
There is often duplication; one of the other issues is that assessing patients in this manner can take a long period of time—up to two and a half hours is often quoted by the British Geriatrics Society. You can imagine that if you had an electronic record that could be auto-populated or could rely on the most recent, up-to-date plan done by someone else, that would avoid reassessment as we would be working from contemporaneous information.
Over time, you can see how, for frailty and many other conditions, that could lead to a more preventive approach that is more community based, that reduces the need for admissions, and that provides a better overall experience for staff and patients. Importantly, there needs to be a shift towards neighbourhood working on frailty, and this allows the multidisciplinary team to work towards one plan. You have also heard today about patient voice and carer voice, and this type of care plan also gives them the opportunity to become partners in looking after themselves.
Dr Cocker: The brief answer to the original question would be that communicating and getting a history from a patient are the cornerstone of the patient-doctor relationship. I do not think that the SPR is ever intended to replace that. Where I see its value within maternity, although I am sure that this is the same across all specialties, is that it would form a reliable means of cross-referencing information and being able to get information that—as we have alluded to previously—is often held on many separate systems. As a clinician, you will often not have the ability or the credentials to access that.
For example, in maternity care at my trust we use a certain piece of software. If you do not work in maternity, although you might be able to get generic access to it, you might not be able to navigate that system. The idea of the SPR is that it would pull out those key bits regarding current concerns about the pregnancy or what follow up has been arranged—all those kinds of things. That would not rely on the ability to use lots of different systems; instead, the information would be available. If there is information that requires cross-referencing or checking, it would also give you the ability to do that rather than replacing the process of taking a history and working out what is wrong with someone.
Dr Byrne: It is a terrific question. Healthcare is a relationship; it is not simply a transaction of facts. At its best, it is a working relationship between a clinician and a patient, but that is also why it is so hard sometimes. Our stories are a combination of two things: the facts and the interpretation of those facts. We heard a moving example earlier of someone saying that they had had five miscarriages and those facts were then not known and how distressing it was that they were not. That is a good example of why getting the facts from conversation to conversation could be really helpful.
Our life story changes over time, however, as does the interpretation that comes up in a conversation. As a doctor in the moment with a patient, I am sometimes as interested in what they are choosing not to tell me at a particular time as what they are choosing to tell me. For all of us, the story changes and is fluid. I think that is a potentially helpful distinction to make.
Karin Smyth
Q
Dr Cocker: Having seen the maternity-focused prototype that NHS England developed in the north-west, we learned that it is technically difficult because there are lots of systems. There needs to be a level of interoperability that allows you to pull the data or it is not going to be much use as a reliable system.
The other thing was about trying to ensure that we design those systems for the patients most in need. That might be social or medical need, and there are many different facets to that. That was one of the other challenges. A lot of the focus went into trying to determine a set of theoretical patients who were very high need, and ensuring that you have encompassed all those possible needs, so that if you design the systems for those in most need, they will cater for as many people as possible.
Dr Imam: To expand on Dr Cocker’s point about the identification of problems, people living with frailty often have multiple under-identified issues. In the prototype we have been shown, the SPR has the potential to analyse the wealth of data on a person and summarise it in a manner that makes sense to the clinician logged into the record. It can also piece together a timeline of what has been happening with a person.
As I said earlier, we often follow a manual process to try to understand what has been going on recently for a person. The SPR will not only enable the automation of that process, but give us the ability to know who the key individuals involved in that person’s care are, so when that person is in a crisis or emergency situation, we know exactly who to call and who the last person to touch the patient was.
There are other important functions. It is not only about sharing information across an entire pathway and having the whole-system approach that I described—from community to hospital, and vice versa. Importantly, many people living with frailty require multiple different referrals and the involvement of multiple different people in their care. The SPR will be able to streamline some of those processes and make recommendations for certain referrals that a clinician, who, under an earlier version, would have logged into the record, may not have otherwise thought about, so it may even improve outcomes for patients by providing solutions to improve their care that we would not have come up with otherwise.
Karin Smyth
Q
Dr Byrne: You have to show that you take the risks and people’s concerns seriously, and give a credible analysis of the risks. The key thing is to engage with the risks meaningfully. You should then think about what safeguards you could put into the Bill and future regulations that would actually be effective and be seen as credible, depending on what risks you are trying to address.
I know it is difficult to get into the detail on the primary legislation at this stage, not least because you are trying to sequence things when we do not yet know what the SPR will be, which I appreciate is a further constraint. I would suggest that you consider putting in the Bill one particular safeguard relating to secondary purposes. People have concerns around two main things: confidentiality and their privacy, and secondary uses—who might access their data in future, and why and for what purpose, other than for their direct care. Focusing on that second factor, there are lots of things that might come up that you could do in regulations, but right now, I would suggest that you could build in the safeguard of an independent oversight mechanism for how decisions are made on who gets to access the data and why. In that, you can involve public and layperson representation to bring in that consideration of the risks that matter to the public, alongside the potential benefits.
That could be helpful for two reasons. First, it would be a safeguard against having any unchecked decision-making power on access, whether now or in future. Secondly, it recognises the reality of human systems and organisations. No one expert or small group of experts, however wise or whatever their integrity, can see the whole picture and have a 360° view of what matters to the public. It would be a meaningful way to give the public agency and representation in that decision making—a meaningful exercise of citizen control, if you like. As humans, we are at our best and our decision making is at its safest and strongest when we get a diversity of perspectives involved—as, indeed, the Committee is doing right now. In this context, that should involve patients and the public.
My second point, which is perhaps germane to your wider discussions around the Bill, is that no one organisation can effectively and consistently scrutinise and challenge itself. That goes for questions around data use and access—and wider, as well—in your considerations.
Helen Morgan
Q
Do you have any advice for us on the development of that single patient record and how we make sure that the data is clean and consistent between trusts and different systems, so that the single patient record is actually meaningful? I will ask Dr Cocker first, if he is the technical expert.
Dr Cocker: I would not go that far—my involvement in this whole project is clinical, rather than having any sort of particular technical expertise. I think that is a pertinent issue, however, because, as has been discussed previously, if an error enters the SPR—say, a code is incorrectly followed through into the system—that error can then perpetuate. That is the risk of a single record: a documentation error can ripple out, rather than being contained within the system it originated in.
Does safeguarding that involve putting requirements on the providers of systems to mean that data can be exported in, maybe not a standardised format, but a set of formats that the SPR recognises? It is a technical question that I do not know the answer to, or the possible solutions to, but that would be one of my suggestions. Rather than having hundreds of different systems that all require slightly different solutions in order to be fed into the SPR accurately, there could be some sort of framework setting out requirements on the providers of the software products used by all the different organisations that will feed into the SPR.
Dr Imam: Like Dr Cocker, I am not technical but, from previous pieces of work that I have been involved with, some of it is to do with the data architecture and making sure that you can agree on the fields being used across the various systems. On frailty specifically, we have had the question of, “If we have multiple source systems that have the same field, which one should we be showing within the single patient record?” Our thinking at the moment is that we would show various entries, with who they have been done by and at what time, so that the clinician could decide how to interpret that data.
Helen Morgan
Q
Dr Imam: That is a really important question; it is something that needs to be thought about very carefully when it comes to the implementation. From my previous NHS England experience, where we have had digital innovations implemented in the older age group, or among those who are perhaps traditionally digitally excluded, that has included partnerships to enable people to have the option of someone coming around, and there has been a thought process regarding people who perhaps cannot engage with technology as easily. That could involve people from the voluntary, community and social enterprise sector—for example, we had Age UK in the previous panel. There are lots of good examples of that type of work to ensure that people are not disadvantaged.
Dr Byrne: There is an opportunity here in the context of digital exclusion. In a digital-first NHS, it is really helpful to think continually about what the analogue version of the system is in the event of further cyber incidents and outages of the system. We need to continually build and maintain a resilient system for the times when digital-first is not available. It is an important opportunity to do so if we think about that question of exclusion.
Sojan Joseph
Q
Dr Byrne: Those things are very important, yes. There are some technical solutions. Again, the SPR is an opportunity to look at that across the system, because systems vary greatly in the sophistication of their audit function, for example. Even when there is an audit function, if someone has legitimate access through their role as a doctor or a nurse, it can be difficult to know whether their access in any particular case is legitimate. These are not common occurrences, but it is extremely distressing for patients if their confidentiality is breached for any reason.
It is not simply a matter of technical controls. We need to look at how we build stronger, more effective deterrents across the system by having effective sanctions when incidents do occur. I am keen to look at that and delighted that the Department of Health and Social Care and NHS England are, I think, very interested in having that conversation with me. At the moment, it certainly seems that there is a variable response across the system to inappropriate access.
Looking ahead to the SPR, we need to look at that make improvements, so that the public can have faith that, given the harm that it can cause them, it will be taken very seriously if anyone does access their records inappropriately. There are technical, cultural and system aspects to think about here. The SPR is definitely an opportunity to do that, and I am very keen to work with other stakeholders on that.
Peter Prinsley
Q
Dr Byrne: It is an interesting idea, but I am not sure. I heard your question earlier about data controllership specifically in this regard. You will not necessarily like my answer. There are two ways of answering the question; perhaps straightforwardly, legally, but also clinically. I will start with the legal answer, which in some ways is easier. Data controllership in data protection law is a very technical term; it is determined by who is making the decisions about processing the means of the data. An organisation running and controlling an electronic patient record would be the data controller. Obviously, this is ultimately a question for the regulator and the Information Commissioner’s Office to determine, but that would be the legal position, nevertheless.
Clinically, we have to come back to thinking about what a patient record is for. Primarily, it is to provide good care in the context of the clinician-patient relationship. If you prioritise the needs of either side of that relationship, I think it is problematic; the needs of one must not outweigh the needs of the other.
The clinical record is there to enable clinicians to record what someone is presenting with, the difficulties they are having, what investigations are appropriate, the findings and what the plan is. It needs to be there for that tool to work. To take you on a slight thought experiment, if it was entirely held within a patient’s control—however loosely we use that term, legally or otherwise—and we could all amend, correct, change or add our diagnoses, findings and treatments, that might be clinically problematic. That may not be the answer you want, but it is the straight answer, if I am honest, from both a clinical and legal perspective.
Peter Prinsley
Q
Dr Byrne: I totally support that ambition. Patients and the public having more agency in their care, strengthening that relationship, and them being able to access their information through the NHS app is a great thing. That is hugely helpful, and there is real potential with the SPR to strengthen that. We have landed on agreement.
Dr Johnson
Q
Dr Byrne: At the moment, I think it is too early to say. Those are absolutely important questions that will have to be addressed in the design. At the moment, I am not sure how the programme intends to deal with those questions, but clinically, that needs to be thought about. There are complications that need to be thought about very carefully in terms of the record and the access. Sometimes that is clinically complicated, but I am not aware of what the plans are for that.
Dr Johnson
Thank you. You are nodding, Dr Cocker.
Dr Cocker: I was just going to say that we did do some exploratory work in relation to safeguarding, because that is quite a key part of safe maternity care, but because of the issues with confidentiality for other involved parties—say, a mother’s partner or someone else in the family—and the risk of that information being pulled through to someone else’s single patient record, it was felt that we could not include any information that contained information about anyone else. That aspect has been considered, but as Dr Byrne said, it would need careful consideration of all those different sources and whether there would be any option to change what feeds in. The only one I am aware of that we have looked at specifically was safeguarding, and it was primarily due to confidentiality issues for other involved parties.
Dr Johnson
Q
Dr Cocker: Yes, and those are concerns with the existing systems. There are multiple sources of information we record on a clinician-facing basis that might be deemed sensitive or confidential that are not available from a patient-facing perspective. It might be sexually transmitted infections or previous pregnancy history that a mother does not want someone else to be able to access on the patient-facing aspect of the record. Being able to provide that is very important in realising the end product of the SPR.
The Chair
Dr Byrne, Dr Imam and Dr Cocker, thank you very much indeed for your patience and for affording us the benefit of your experience and wisdom. The Committee is most grateful to you.
Examination of Witness
Jon Restell gave evidence.
The Chair
We will now hear oral evidence from Managers in Partnership. We have until we have exhausted ourselves—I will say that for the moment—for this session. Would you be kind enough to introduce yourself for the record?
Jon Restell: I am Jon Restell, the chief executive of Managers in Partnership.
Dr Johnson
Q
Jon Restell: There are lots of different ways to answer that. Obviously, some functions of NHS England moving into the Department, with powers going to the Secretary of State, feels like a centralising measure. I know that the ambition of Government is to give local NHS bodies more freedom and autonomy, but the Bill is very careful and goes into a lot of detail to leave powers with the Secretary of State to intervene in the running of those local bodies. On the whole, it is probably more of a centralising measure.
Another way that some changes outside the Bill process are centralising is through the merger of ICBs and, arguably, quite a lot of providers. Whereas before you might have two or three ICBs covering an area, you now have half the staff covering much bigger geographies. I would argue that that centralises decision making to a higher level than formerly.
Dr Johnson
Q
Jon Restell: This, for us, is the crux of what is going on. The Bill is the Bill, but there is a finite management resource in the health service. I think that, internationally, it is considered to be quite low. Certainly, Lord Darzi, the Institute for Government and Institute for Fiscal Studies have all pointed to a shortage of management being one of the potential weaknesses of the NHS, so what is going on right now is knocking another big hole in an already limited resource of managers in the health service. That has the potential to create very large workloads for people in the new system, such that, inevitably, certain things will not get done or will not get done well enough. It certainly feels like we have gone into an environment where we are cutting a management cost without thinking about the management capability the health service needs to innovate, deliver reform, and do basic safety and resource management.
Dr Johnson
Q
Jon Restell: Our members have been on a bit of a journey on this one. I think that they would broadly support the regulatory proposals that the Government will bring forward after the consultation. I think the real impacts will be very limited, covering a relatively small number of people and being used in very exceptional circumstances, so I do not think that they will transform management culture and deal with the management capability issue we have. They are a very personal form of professional regulation that will have very limited impact.
Dr Johnson
Q
Jon Restell: That is probably driving most of the anxiety and uncertainty that people are experiencing, and it is why, for some members, this is becoming psychologically very difficult. You have a change programme that started in March last year with the announcement by the Prime Minister of the abolition of NHS England and the halving of the staff of NHS England and ICBs. For 18 months, that process has dragged on, with lots of design decisions still to be taken about how the organisation will look, what functions it will have, what will be going to the Department and what might be going elsewhere, and what will potentially go to trusts from ICBs and from ICBs to regions. Despite all that uncertainty, people are being told to make decisions about voluntary redundancy and the future where they do not understand where that future potentially sits for them. That is undoubtedly driving a lot of people to feel psychologically unwell and distressed, and they are leaving. People are beginning to leave, because they need to protect themselves.
There is another part to this. Obviously, that is a very personal issue for our members, but the other thing is that they are really worried about the service to the public, the safety of the changes and what will happen to various functions that they are responsible for, if teams get halved and responsibilities are taken to a higher level in that more centralised model.
For example, we have a lot of members working in ICBs who have really hands-on roles in the care of individual children, particularly where providers fail. Those kinds of concern are not being properly addressed in terms of risk and continuity of service to those people. We are going to survey our members—we will share the results with the Committee—in the next week or so about what specifically is worrying them about the way that change is being managed. With due respect to the Minister, this was all announced without a plan, and we are now waiting for a plan to emerge, 18 months into the process.
Dr Johnson
Q
Jon Restell: Obviously, we have the 10-year health plan, which most people broadly see as a good vision for the service, but there are too many key design questions around the new department, the role of the department’s regions, what ICBs will be doing and what trusts will take on as part of this reorganisation. Behind it, there is a lot of capacity and resource organisational memory being taken out of the system.
We do not talk nearly enough about the work of the commissioning support units staff, who are providing internal consultancy and a huge range of business services to the health service, including overseeing child immunisation programmes in some cases. It is really unclear what the future of those functions is. We are taking out a lot of staff who have skills, expertise, organisational memory and commitment, but we do not quite know yet what the precise form of those organisations will be. It is a very difficult change to manage.
Karin Smyth
Q
We had a lot of change with the Health and Social Care Act 2012, and the Bill seeks to reverse that in terms of the architecture of the NHS. We absolutely appreciate as a Government that that is very difficult for staff working in it. I appreciate that the operating model and so on is coming forward, but could you say a bit about people’s feelings about the Bill? There will be more clarity to the centre and the role of providers is not changing, while the real change is around commissioning functions and, as you said, commissioning support organisations. We heard earlier that everything is being reorganised. That is not true, but there is a big change in the geography and the functions of ICBs and commissioners, and the Secretary of State’s role will clearly be different. What might people’s approach to that be?
Jon Restell: Clarity, definitely. No one wants to start with the system that came in in 2011 and 2012. Successive Governments started to correct it almost as soon as it was put in place. I think most people would welcome sorting out the clarity around commissioning there, but I do not think that is the same thing as cutting 50% of those organisations’ staff and running costs. You are clarifying the relationship between the centre and ICBs, commissioning and providers. You still need enough managers with enough skills working in the right system to deliver. That is the nub of what we are doing.
For us it is not really about how the Bill will eventually pan out; it is about the cut and how that is being administered by NHS England, the Department and ICBs. The whole system of management is under strain across the health service. You say that providers are not changing but they are also being asked to take out quite significant amounts of management resource. They are merging to form bigger, potentially more centralised units that may be less responsive and less innovative. I think that organisational form is really important, even if the headline of the Bill might tidy up and clarify those relationships, which would be welcome.
A point made by a lot of members, particularly those in ICBs, is that they do not think that the model design—where we started with ICBs, then went to regions and we are eventually going to get to the target operating model for the Department—is being done at a time where you can see the proper connections that need to be made between those organisations. When the system is up and running, how well will it work together to share information, share risk and so on? It feels like the Bill is very high level and the detailed design of the organisations is being undertaken in a completely fragmented way. People see that as potentially requiring the next round of reorganisation. You are a former NHS manager, Minister; you know how often reorganisation is reached for as the solution. I genuinely feel that people have got to the point where enough is enough. That kind of continual change will create more and more problems for doing the things that the public actually want to see: innovation, improvement in the quality of service and happier staff—all the things that managers should be focused on, not the merry-go-round of organisational change.
Helen Morgan
Q
Jon Restell: It certainly needs to be clarified. Whether it needs to be clarified in legislation, I do not know. Leaving aside the fact it took a very long time to get permission to move forward with their consultations, ICBs were thinking about what they needed to do around May or June last year. They will have made a lot of decisions and a lot of staff will have gone already based on the then understanding of what an ICB was supposed to be doing, based on the ICB blueprint that was published by NHS England, so I think that resource has gone. The people who may be connected with the functions that you are talking to have also gone in many cases. The question for me is: if the ICBs are to get more things to do, what is the implication for their running costs? As you know, they are currently capped at about £19 per head. If they get more functions, will they get more resources to do that? Will there need to be other ways of delivering those functions? I do not think that a lot of them can stop doing statutory functions, but that means all the good stuff that we want to see done in health systems—the innovation and the discretionary stuff, much of which is already on hold—will probably be the stuff that goes while they deliver their statutory obligations.
On the providers side, we need urgent clarity about what is going to go to the providers’ responsibility because they are taking out a lot of costs. I do not think that all, or many, providers know that these plans are afoot for them. That will create quite a shock. Again, they are choosing people to go now based on their current understanding of what is needed.
Helen Morgan
Q
Jon Restell: A lot of the concern is to do with the political make-up of mayoralties in the future and what that might mean; if mayors have an ever-growing responsibility and say in the who, what and where of health services, that is probably different from the more representative, advisory function that they have had. That really needs to be thrashed out: is that the new democratic accountability for health services, or does it remain, as now, with the Secretary of State, accountable to Parliament, making provision for healthcare? It feels a little unclear how much decision-making power those new local government voices will have on ICBs. Have people raised that as a concern? Of course they have; it is uncharted.
Helen Morgan
Q
Jon Restell: I cannot comment specifically on the BCF, but a general theme coming out of what our members are telling us in surveys, and in the regular surgeries and meetings that we have with them, is the sense that policy at the moment is trying to get you thinking in terms of your own organisation again, and thinking less about system-wide transformation, innovation or co-ordination. ICBs are getting bigger and providers are getting bigger. It is some of the system stuff, where I think a lot of our members would say the innovation will come in the way different organisations try to solve problems around patients and populations, that they feel is at risk, by the way—not just from the Bill putting things together, but from the stripping out of resource to do anything different.
The Chair
Thank you very much indeed, Mr Restell. Thank you for your patience, thank you for coming and thank you for the evidence you have given. It is greatly appreciated.
Examination of Witness
Sir Andrew Dilnot gave evidence.
The Chair
We shall now hear oral evidence from Sir Andrew Dilnot. Sir Andrew, for the benefit of the record, could you identify yourself, please?
Sir Andrew Dilnot: I am Andrew Dilnot; it is great to be here.
Dr Johnson
Q
Sir Andrew Dilnot: It is largely absent from the Bill—indeed, when I was asked to come and give evidence to this Committee, I was initially somewhat puzzled, since it is so largely absent. The question you ask is absolutely to the point: certainly, we can improve the efficiency of the NHS without doing anything about social care, but we cannot really address many of the fundamental problems facing the NHS if we do not sort out social care.
That is partly because not having a good social care system means that we are not achieving the levels of human flourishing that are the objective of the health service and the social care system. It is also the case that the social care system is now under such pressure that it is leading to direct challenges for the NHS. We hear a lot about delayed transfers of care, which are an important part of this, but it is not just those; it is people who end up needing healthcare because they have not had appropriate social care support.
The short answer to your question is that we can make the NHS a bit more efficient without reforming the social care system; but until we address social care we have at least two hands, and probably one foot, tied behind our back. It seems pretty astonishing to me that we have a 10-year NHS plan but no real plan for social care.
Dr Johnson
Q
Sir Andrew Dilnot: I would not claim to be expert here, but I have read the Bill and the briefings. The role of local authorities in social care is a very interesting one. If we were to stand way back and honestly answer the question, “Why is social care managed by local authorities at the moment?”, we would say, “Because it was forgotten in 1948, when the rest of the modern welfare state was created.” At that stage, social care was a pretty small activity, and it was just left with local authorities. What has happened since then is that it has grown and grown, and it is now putting enormous strain on at least many local authorities.
I think we should draw a clear distinction in something that is definitely appropriate—that is, care being provided within a local context. The kind of care that is appropriate in Camden will be different to the type of care that is appropriate in the highlands of Scotland. Local delivery seems relevant, but whether local financing makes sense in 2026 is a very big question. That is the context.
On its own, it is hard to see the potential reduction in the role of local authorities in ICBs making things better. It will not necessarily make things significantly worse, but I do not think it will help local authorities and the NHS in trying to integrate these two essentially non-integrated functions.
Karin Smyth
Q
Sir Andrew Dilnot: The question of the fine details of how legislation should be passed is certainly outside my skillset, so I have to be agnostic about whether the Bill should have addressed the wider questions of social care. On the question of whether we could address social care or not, the answer is definitely yes. After all, several Governments over the last few years have promised to do so. The former Secretary of State for Health and Social Care, when he was the shadow Secretary of State during the election two years ago, promised that he would do it. Such measures have received Royal Assent twice, but they have still not taken place, even though they were promised by the then shadow Secretary of State for Health and Social Care, before he became the Secretary of State.
Yes, we definitely could do it. The amounts of money involved, while of course significant, are small relative to the aggregate costs of the NHS or the uplift in spending on the NHS that, with my full support, we have seen in the last couple of years. I think it is a genuine puzzle and a black mark for all of us, including me, that all these years have gone by and we have done nothing. We have a social care system that is supported by millions of wonderful informal carers and about 1.5 million formal carers, benefiting hundreds of thousands of people, but it is creaking under intolerable strain. It really makes no sense to me, and I really do not know why or how we have managed to go for so long without addressing it. We should do so, not only because it is the right thing to do, but because it is now so bad that it is doing direct, instrumental damage to the NHS.
Helen Morgan
Q
Sir Andrew Dilnot: I think there are two main ways. The first, and perhaps the one that has received most attention, is that there are people who have been hospitalised, perhaps following a fall or infection, who have some mobility challenges and need some care, but who cannot leave hospital because a social care package is not available for them in the community. That is extremely damaging for the NHS, because if we have somebody in a bed that they do not need to be in because they have nowhere else to go, not only are we spending money having them there but we are then not able to use the bed for other activities.
If you have somebody with a delayed transfer of care that means they are stuck in hospital, when they do not need to be, for 20 days, which is not uncommon, very large numbers of elective procedures cannot take place because that bed is being used. That is a dead-weight loss from the system.
There is another thing that I think is at least as important, which is that, because of the lack of good social care, we have people falling, injuring themselves and needing to be hospitalised. We have people sustaining more urinary tract infections than they perhaps would if they had good social care. That is adding an additional burden, which the NHS deals with as well as it can, but all of this just seems unnecessary.
Social care appears to be so invisible to us all. It is easy to blame politicians, and of course it is politicians like you who ultimately have to vote for these things, but the electorate—the whole of our society—have to look at ourselves and ask, “Why can’t we make this challenge, which is so significant, better?” Any of you who have experienced it in your own family know how brutal and difficult it can be.
If I can be allowed one more general point, we should reflect that this is the result of the great triumph of the last 150 years. At the beginning of the last century, across the world, average life expectancy at birth was 32, and now it is 73. In this country, average life expectancy at birth in 1900 was 46, and now it is 81. We have added 35 years to the expectation of life from birth, which is an astonishing transformation. Some consequences come with that, one of which is that there is much more social care to be done, but we should be celebrating this, delighting in it and doing it well, instead of hiding it away and ignoring it for so long that it is doing real damage to the NHS, let alone to the lives of people who need social care.
Helen Morgan
Q
Sir Andrew Dilnot: Yes, it is very odd. It is worth doing the odd thought experiment: imagine that the bit of healthcare that was underfunded and available only subject to a means test, and not free, was for heart disease. We cannot imagine it. The fact that it is dementia and severe arthritis means we have drawn an arbitrary line, and while that line still exists and there is still inadequate funding, even in a means-tested system, we are hamstringing the NHS. Now, that is not the most important problem, which is that we are failing to give people flourishing lives and allow them to live to the full, but it is now so bad that it is actually making it hard for the NHS to work.
Joe Robertson
Q
Sir Andrew Dilnot: That is a very good question, to which I do not have a very immediate answer. Well, I do have an immediate answer, which is that, as far as I can see, it is nothing very substantial.
The single patient record offers some prospects here, and it is terribly important for people receiving social care, which again reflects how much longer we are living. There is much more multiple morbidity now. Many of the people who can and are benefiting from social care will have quite complicated medical experiences and histories. That is the kind of group that could particularly benefit from a single patient record, so that we are not having inappropriate prescription and so on. That is going to help, but it will be a second-order issue.
Let me be very blunt. There are two fundamental challenges facing the social care system. The first is that the means-tested bit of it, where we say, “If you don’t have any resources of your own, the state will look after you,” must be a minimum for any humane society. Essentially every year for at least the last decade, the Treasury has announced emergency funding for that in year. That money then does not get spent well. Honestly, if you are announcing an emergency package every year for 10 years, it is not an emergency package. You should wake up, pay attention, have a mature response and fund that system properly. That is the minimum.
The second is that the only big risk we all face that is not pooled is social care. Our risk of healthcare is pooled by the state, our risk of having a car accident or our house burning down is pooled by private insurance. This is the one risk that is not pooled, and the reason is that the state does not, and the private sector cannot. The reason the private sector cannot is that it is too far ahead for a private insurance market to deal with it, so only the state can pool the risk. If there is any area where the case for social insurance is absolutely clear, it is social care; the case is even more powerful in social care than it is in health.
At the moment we have a situation where often people will feel that the best thing that can happen to them, if they think they might have a social care need, is that they die before too long. It is a bit like standing in the middle of the road with a lorry driving towards you and hoping that the best thing that might happen is that you die before it hits you. That is not a good way to be running any kind of society or country. Those challenges—the lack of adequate funding of the means-tested system and the lack of any risk pooling for the population as a whole—lead directly to the kind of experience that you are describing in the Isle of Wight, where there is simply excess demand and so we are trying to ship people across to the mainland. It is a reflection of the fundamental challenges that we have ignored for 35 years.
Dr Johnson
Q
Sir Andrew Dilnot: You are absolutely right to emphasise the importance of non-elderly adult social care, which is roughly half of all of the expenditure and growing. One reason that we see particular pressures in the elderly care sphere is that the less-elderly need has grown very dramatically, again because of the scope for increased human flourishing.
On the whole, as far as I can see, there is very little understanding of the integrated nature of these costs between social care and the NHS, so I think there is very little thinking in budgetary terms about the consequences of the squeeze on social care leading to increased expenditure and needs elsewhere in the NHS. That is not easy to resolve. Moving to a system that properly integrates those trade-offs will be difficult, and it requires a different sort of funding regime, but while we do not, those costs exist. My sense is that they are second order at the national level, but where they are certainly not second order is for the individuals concerned and their families, for whom this kind of thing is an eruption of anxiety and grief, in the context that families are already under pressures that most of us would find hard to imagine.
The Chair
Thank you very much indeed, Sir Andrew, for affording us the benefit of your considerable knowledge in this area, and thank you again for your patience. We are most grateful to you.
Sir Andrew Dilnot: Thank you. I am delighted that you are thinking about social care in the context of this Bill.
Examination of Witness
Karin Smyth gave evidence.
The Chair
Minister, for the sake of the record, would you identify yourself, please?
Karin Smyth: I am Karin Smyth, the Minister of State at the Department of Health and Social Care.
Dr Johnson
Q
“The reorganisation of health services always distracts from people’s jobs, destroys morale and wastes money”.—[Official Report, 22 September 2020; Vol. 680, c. 809.]
In response to a written question this week, though, which asked what assessment you have made of the disruption of development of new services caused by the abolition of NHS England, you said:
“The abolition of NHS England is causing no disruption to the development of new services.”
I wonder which of those statements you agree with the most and whether you want to change your mind in the light of any of the evidence you have heard today.
Karin Smyth: I do not know exactly what year you are quoting from, but I am happy to take that full on. Of course, change, reorganisations and changes in legislation have consequences at different times depending on what they are. That will determine changes to some services at local level.
I think that quote probably relates to the 2012 changes, which, as I have often said, brought me into Parliament. The entire infrastructure of the health service was destroyed and changed in order to bring forward that legislation. I can never find anybody—I think I have heard Lord Lansley say this—who thinks that was a good thing. I am very happy to say that part of the rationale was the fact that, despite lots of warnings about the damage to that infrastructure, that lesson was not learned. We will not go through the history of the passage of that Act. It even had to be paused mid-way through to enact other ways of making things work.
I am sure that you will come back in your second question to decisions about some of the provisions in this Bill. It is true, and a matter of record, that as an incoming Government we did not intend to abolish NHS England as an organisation; in our determination to change the outcomes of the health service, that decision was made some eight months into our being in government. Today, we have not heard a single person suggest that that decision is wrong. Dr Johnson is from the Opposition. The Bill was not opposed in principle on Second Reading. There is overwhelming consensus on the major provision in the Bill—the abolition of NHS England—and on the single patient record.
I am mindful, on a personal level, of the consequences for individual people’s jobs and of trying to get that right. I accept much of the criticism from Mr Restell about how it would be better to do it much more quickly, and about making sure that it is done in a different way, but the consequences of abolishing NHS England are some of the things that we are seeing.
Dr Johnson
Q
Karin Smyth: In terms of service delivery—I think the written question was about delivering services— I stand by that.
Dr Johnson
Q
Karin Smyth: Do you mean the future state of ICBs?
Dr Johnson
No, I mean the system as a whole. My right hon. Friend the Member for Melton and Syston spoke earlier about how ICBs were designed to link in with upper-tier local authorities, and he gave a reason why. Under these reforms, Lincolnshire ICB, which was part of a mayoral authority, will now link in with Derbyshire and with Nottinghamshire, which are part of another mayoral authority but not a complete mayoral authority. You have things jumbled up. I wonder whether that is because, rather than having a vision, you have started to unpick somebody else’s work because you did not like it. Likewise, with the single patient record, we have heard that lots of necessary decisions were not made before the Bill was introduced, so people are being asked to deliver things that have not been properly considered. Is that fair?
Karin Smyth: I think they are two separate things. On the provision made in the Bill, abolishing NHS England brings with it a lot of technical detail to ensure that the legal responsibilities and duties are placed, rightly, on the Secretary of State and into ICBs. It clarifies the landscape on very technical matters such as licences and foundation trusts, and there is a large chunk of detail on the consequences of abolishing NHS England.
Alongside that, there is a move to give ICBs a larger footprint, in parallel with the Government’s agenda on devolution. I accept that that is a lot of change in all our constituencies and for all our areas. We are making sure that we make the most of mayoral authorities to allow mayors to be on ICBs, as they are largely determiners of a lot of economic development, transport and indeed the wider determinants of health. We are still going through some of that change; you will recently have been written to for your views on it as local Members of Parliament, along with local government. We need to make sure that that is embedded as quickly as possible so that we can stabilise that side of the system.
On the single patient record, the Bill will provide enabling powers to bring it forward in regulations. There will be further detailed consultation both with clinicians and with patients and the public, as we have heard, because building trust is critical. That will come next, which is usual in parliamentary terms: as legislators we understand that primary legislation makes provision and secondary legislation sets out regulation. I thought Dr Byrne was very helpful earlier on the point about bringing public trust with us and explaining the two stages of bringing this forward.
Dr Johnson
Q
Karin Smyth: There is a fundamental philosophical, and perhaps political, difference in the approach that this Government are taking compared with what has gone before, in terms of the notion of responsibility and accountability for both commissioning and delivering services, and the position of independence. We talked earlier today about perception and reality.
The system has not worked. To my earlier question— I think I said this on Second Reading—we have had what is called an independent voice in some of these bodies for over 50 years, and we have had numerous recommendations. I disagree with Jeremy Hunt on this. Under his stewardship of the new NHS England, we had a plethora of recommendations and new organisations, and layer upon layer of bureaucracy, totally remote from any kind of democratic accountability or oversight. That is not working, and I do not think that anybody is really defending that.
It is the job of the NHS—both providers and commissioners—to include patient voice and patient experience in their work. I think Ciarán Devane from the NHS Alliance said that getting boards right, in terms of their managerial, clinical and patient experience work, is their responsibility. Outsourcing lots of that work to other bodies has not worked, and I think it is outsourcing that responsibility. We have to make boards work at a local level; they have to step up to the plate, and I think they want to. They are certainly equipped to be able to do that—not taking into account that people will need some skilling in some of these areas. There is a debate to be had about independent organisations, and I think we will have a good debate on it in Committee.
As a final comment before you come back, this is a bit of a bugbear of mine, and perhaps as I am speaking on behalf of the Department I should not say it, but I will: none of my constituents are hard to reach—not a single one of them. We know exactly where they are; we largely know what is wrong with them; we largely know what their health outcomes are going to be; we know their ethnicity, demographics and so on. What are hard to reach are the remote organisations that have not served them well, and that is what we are determined to put right. Putting that right in this Bill is the start of doing that.
Dr Johnson
Q
Karin Smyth: I will come back to the waiting lists, but you are absolutely right about trust. In saying that I expect this to be the board’s job, I think it is its job to get this right, and we need to support it to do that. We heard a bit from Penny Dash about the national quality board and the patient experience directorate inside the Department of Health and Social Care reporting directly to the chief executive and the permanent secretary. That has to be part of the wider architecture, which is of course outside the Bill, so we need to be able to tell that story to the wider public.
We know from all the recommendations, reviews and the support that we give as Members of Parliament to our constituents that trust is really important. Getting that right and bringing people on that journey with us will be really important. Independence helps with that, and that it is why it is good to debate it as we consider the Bill—it is good to be able to air some of it—but I think people accept that things are not working and have not been working.
I think your question about waiting lists is about the data and the information that says where we are at. It is really complex. To follow NHS England’s data, of which there is a lot—I commend the amount of data that is available—you need to be quite clever at spreadsheets, and at finding and articulating data, in order to bring it back to your own constituency and local place. These things are complex. It is complex to record, track and recognise how people move through a waiting list, for example.
It is good that we are transparent about that. One thing that I am keen to push out is data on performance in trusts. Making so-called league tables is controversial, but the more information that we have out there, and the more we have honest debates about how complex and difficult it is—I am happy to take your questions around how that moves in order to for us to explain that—the more that helps to build trust.
Liz Twist
Q
Karin Smyth: I will come to the single patient record because I think it is a gamechanger. We have heard today from some fantastic experts about the work they are doing to identify how it might work and how we might bring patients and the public with us. Again— I do not think we should just bank this—we have not heard anybody object to it.
We did have some evidence highlighting how things have gone wrong in the past. I worked at a primary care trust and clinical commissioning group at the time when care.data was brought forward. We can all point to where it has gone wrong, but nobody has said that this is not the right thing to do. That is good, but there is still a lot of detail to go through.
We need to keep highlighting the benefits. We heard from Peter Prinsley about whether patients have more control—we do think this is about empowering patients. That was what we said in the 10-year plan. The 10-year plan is about empowering patients in this very large system, for which they are now paying £200 billion of their taxes.
We heard from the excellent clinical panel. I defer to clinicians about what they need, both if they are dealing with chronic long-term conditions—we heard that it can sometimes take two and a half hours for an assessment—or if they are working in a busy emergency department. The fact that this is needed will be controversial. There will be a lot of questions about it and a lot of concern about privacy, data, cyber and so on. We need to hold on to those benefits, which are huge in clinical terms and for patients.
Another point we heard, which is also true, is that people think this already happens. People do not understand why, when they turn up at an A&E in Whitby, as we heard, or somewhere else, and then go back to central London, the systems cannot talk to each other. For me, that is about people’s trust and belief in what is a public service. It is a really important part of that.
On abolishing NHS England, I do not think anyone has come to one of my constituency surgeries and said, “Please do this,” or talked about it in great detail, but people do understand. My experience in opposition and so far in government is that MPs are perplexed when they try to intervene on behalf of patients, or to get an answer locally as to why on earth chief executives of ICBs or trusts sometimes do not respond even to a Member of Parliament’s requests for meetings. I find that shocking, but it does happen. How on earth is a patient or somebody struggling through the system expected to get a response? Getting it right is not black and white, and it is not easy to get the balance right between the Secretary of State’s democratic oversight and autonomy at a local level, but the Bill starts the process of doing that, and it is fundamentally important.
Regarding the other provisions, I accept that great work has been done by many people in Healthwatch and its predecessor organisations, and by people working in the patient safety landscape, but again it is not working. I think that those bodies have been allowed to abdicate responsibility for the core role of patient experience and patient voice. That is not their homework; it is their actual job. It is not something that should be outside, and that is why I think this Bill is really important.
Helen Morgan
Q
It would, however, be helpful to reflect on where there is not agreement: on abolishing Healthwatch and HSSIB. You make the very good point that they have not been successful in their current incarnation, but it is important to consider whether that is because they do not have teeth, or because the organisations that they are trying to change are defensive.
We heard earlier about the culture of fear, and I think that we have probably all had people in our surgeries who can describe being frightened to speak up about their own personal care because they feel that they might be victimised for it. I know of clinicians who are frightened to speak up about their own experience in the organisation in which they work, because they feel that they will be punished for it.
In the light of that defensive culture that we know exists in the NHS, and has been highlighted time and again—Mid Staffs; the Shrewsbury and Telford maternity scandal—is the answer not to put the patient voice in the organisations that have a culture problem, but to give those other organisations the teeth they need, or confer a duty on the ICBs or providers to act on recommendations that are given to them, because I think that might be a more helpful way of dealing with this problem?
Karin Smyth: I think that gets to the crux of some of this. We will discuss it a lot in Committee, and I am obviously very open to keep discussing it.
Thank you for your support on the main provisions. I do not take that for granted because, again, they are still controversial. However, as I think I said earlier, you are right, although it is not true everywhere. I am not blaming individuals, because I think that people have been trying to do a difficult job, particularly in getting us through the pandemic and beyond. But they are defensive. That is why Members of Parliament and others do not get responses to their phone calls or their emails. That is a culture that we have to change, and we need to support people to change.
One of the things that we will do is to bring in regulations—that is a manifesto commitment from the Government—but another commitment that we have made outwith the Bill is to develop a leadership college to support in particular clinical and non-clinical managers, who have a very difficult job, in having the right skills for the new world, which patients and the public rightly expect to be more open and more transparent. We have to change this defensive culture.
However, even since Francis, the adding of bodies and the adding of recommendations, and with the bad experience that you have done so much around, something different has to happen. Again, what we heard from Jeremy Hunt was that we needed to put more prescription into the system and yet more requirements to do something without actually making that someone’s central function and job.
Now, it is a source of disagreement. As I have said, I think that there is a philosophical disagreement about the best way forward. It is not an antagonistic disagreement; there are fundamentally different views about what to do. We will continue to have discussions, because I think that ultimately we all want the same thing: a more open, transparent and supportive culture. By the way, nobody wants to work in a defensive culture, so I think people want that outcome.
It is up to us as politicians to support difficult conversations and trade-offs that happen locally. My view has always been that politicians will support difficult conversations and trade-offs—we heard a little bit about reconfigurations earlier—if the system provides good clinical rationale, good data and good evidence, but those bits of it do not always line up.
That is what I would like to get to. I absolutely understand and hear what you say—we will hear more about it and discuss it more, and I have read all the amendments about the best way forward. I think that we all want to get to the same place, but what is the best way to do that, given that we all know that this is really not working and cannot continue?
Helen Morgan
Q
Karin Smyth: I will need to come back to you on the detail of that. In much of the Bill, we are trying not to over-prescribe. However, we need to get foundation trust licensing right. There are some things that are needed in the Bill, which is what we have put in as far possible, and some things that are not. Can I come back to you on that specific point if that does not answer your question?
Jo White
Q
Karin Smyth: That is a good question. When I was in opposition, I spoke frequently about accountability and democracy, as the hon. Member for Sleaford and North Hykeham was trying to highlight—I am sure that we will hear some more quotes. I cannot speak for the former Secretary of State, as he is not here, but it did surprise us going into the financial year when, despite very clear direction and expectation about the financial situation that the Government inherited and what needed to happen, we were still faced with a very large projected deficit. The duplication meant that there were a lot of people in the room and clearly things were being handed off and that was not working. Ultimately, this is a question that always lurked. I know that the right hon. Member for Melton and Syston is here, and during the passage of the Bill that became the Health and Care Act 2022, we said to the Department that that might have been the opportunity to act. I think that previous Secretaries of State, as was alluded to earlier, thought that they might do that. Ultimately, the benefits of doing it now outweigh the risks and that is the only way to make the system change. We heard from the King’s Fund about opportunity costs and that the benefits do not outweigh the risks—we do not think that is true.
The Chair
That brings us to the end of the time allocated for the Committee to ask questions. On behalf of the Committee, I thank the Minister for her evidence.
Ordered, That further consideration be now adjourned.—(Emma Foody.)
Health Bill (Third sitting)
Thursday 18th June 2026
(1 month, 1 week ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 18 June 2026 - (18 Jun 2026)
The Chair
Before we begin, I remind all Members to switch their electronic devices to silent, please. I am sorry to tell you that tea and coffee are not allowed; you are limited to water. As you are able to see, I am content if Members wish to remove their jackets, so please do so if it makes you more comfortable.
Before we go any further, I believe that the Government Whip intends to move an amendment to the programme order agreed on Tuesday.
Ordered,
That the Order of the Committee of Tuesday 16 June be varied, in paragraph 1(b), by leaving out “and 2.00 pm”.—(Emma Foody.)
The Chair
We will now move to line-by-line consideration of the Bill. The selection list for today’s sitting is available in the room and on the parliamentary website. It shows how the clauses, schedules and selected amendments have been grouped together for debate. A Member who has put their name to the lead amendment in a group will be called to speak first. Other Members will then be free to indicate, by bobbing, that they wish to speak in the debate. Please do that on each occasion on which you wish to speak during proceedings.
At the end of a debate on a group of amendments and new clauses, I shall call the Member who moved the lead amendment or new clause again. Before they sit down, they will need to indicate whether they wish to withdraw the amendment or the new clause, or to seek a decision. If any Member wishes to press any other amendment—including grouped new clauses—in a group to a vote, that is at the Chair’s discretion. My fellow Chairs and I shall use our discretion to decide whether to allow a separate stand part debate on individual clauses following the debates on relevant amendments.
I hope that that explanation is helpful and that no Chair needs to give it again during the course of proceedings.
Clause 1
Abolition of NHS England
Question proposed, That the clause stand part of the Bill.
The Minister for Secondary Care (Karin Smyth)
Clause 1 formally abolishes NHS England as a statutory body, which is one of the key aims of the Bill. The current structure, with its two centres, has led to layers of unnecessary bureaucracy, duplication and unclear lines of accountability, and has come with significant cost, with the centre growing significantly in size since 2013. Through the Bill, we are simplifying the organisational landscape of the NHS and removing unnecessary complexity and overlapping roles among NHS England and the Department of Health and Social Care. The reform will enable leaders and staff to focus on delivering care, rather than on navigating bureaucratic hurdles. Importantly, it will also restore Ministers’ central role in national oversight and setting strategy, which the public rightly expect as part of a democratic system. The creation of an arm’s length body of this size was a mistake, and we seek to rectify it.
Clause 2 is integral to the orderly abolition of NHS England. It empowers the Secretary of State to establish transfer schemes, which will provide a structured and transparent means of moving property, rights and liabilities from NHS England to the Department of Health and Social Care, the integrated care boards and other relevant bodies. This robust legal mechanism is required to ensure a responsible transfer of NHS England’s assets and staff. It ensures that all necessary legal powers and permissions for the transfer are in place, preventing uncertainty or loose ends for staff, patients, service users and partner organisations as NHS England is abolished. The clause allows provisions to be made similar to those under TUPE to ensure the protection of employment rights for staff who are transferred from NHS England. In addition, the clause allows for the shared ownership or use of property, ensuring that assets can be distributed and used in a way that supports service continuity for patients and the broader health system.
Clause 3, at its core, provides a power for His Majesty’s Treasury to ensure through regulations that transfers from NHSE to the DHSC, ICBs and other bodies are delivered smoothly and on a tax-neutral basis. In particular, it allows HM Treasury to make adjustments to how existing tax legislation applies to transfers of NHS England’s property, staff and liabilities in a scheme made under clause 2. That will ensure that no tax charges arise, and that neither NHS England nor the transferee organisations end up with a different tax position due to the organisational changes. Importantly, the scope of the power is tightly constrained: it applies only to specified existing taxes and only for the purpose of ensuring tax neutrality in relation to transfers made under clause 2. Without the power, there would be a risk that transfers could trigger unintended tax liabilities that would divert public money away from frontline services and undermine the policy intent of the legislation. Clause 3 therefore protects value for money and ensures that organisational change does not come with avoidable fiscal costs.
Without the changes made by clauses 1 to 3 we will not be able to meet the ambitions set out in the 10-year health plan. The abolition of NHS England, delivered in an orderly, proportionate and considered way that safeguards the interests of staff and taxpayers, is a necessary precondition for an NHS that is more effective for patients, delivers better outcomes across the country and achieves the ambitions that the public expect of us. I therefore commend the clauses to the Committee.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Sir Jeremy. First, I declare a number of interests. I am a consultant paediatrician working in the NHS, a member of the British Medical Association and a member of the Royal College of Paediatrics and Child Health. Like the Minister for Secondary Care, I got into politics after working in the health service. I am sure she agrees that what you see when working in the health service stays with you when working in the House, and that it benefits the House to have people who have done all different jobs working here.
The NHS constitution says that health services should
“improve, prevent, diagnose and treat both physical and mental health problems with equal regard”,
yet in my work as a doctor—and I worked across several hospitals during my training—the gap between the vision of what should be delivered and the reality of what is being delivered has become apparent to me. The answer frequently given seems to be top-down reorganisation. As I will talk about in a minute, such top-down reorganisation has been done so many times but does not seem necessarily to have delivered in practice what it promised. Indeed, to an extent, we seem to be changing things from how they were to how they are to how they were, backwards and forwards. This Government have decided, in pursuit of better outcomes and cost savings, once again to reorganise the health service, and they seek to do so with this Bill and particularly clause 1.
Clause 1 formally abolishes NHS England. The clause may have very few words, but they represent one of the biggest changes to our health service in decades. Abolishing NHS England is not just a decision about organisational structure or trimming bureaucracy, but a break with the direction of travel the health service has been on since its inception.
Prior to the creation of the NHS in 1948, health services were fragmented: some people used contributory workplace schemes, people who could afford it paid out of pocket, and everyone else relied on very limited state and voluntary provision or went without. In the aftermath of the second world war, the national health service created a state monopoly provider. The Minister of Health had a duty to provide a comprehensive health service free for all at the point of use and a bureaucracy was created to manage it.
There was a tripartite split between hospital services, local authority services and independent practitioner services. The hospitals provided secondary care for those with serious disease and those requiring emergency response. The NHS also took over many cottage hospitals in rural areas that had previously been run by GPs, and larger hospitals that used to be run by local authorities and the voluntary sector. At that time, hospital staff were managed by hospital management committees appointed by regional hospital boards. Those boards implemented Government policies and oversaw the budget. Meanwhile, teaching hospitals kept more independence, directed by their own boards of governors.
Councils, operating as local health authorities, had a duty to provide several personal health services including health centres, maternity care, home nursing, immunisation and ambulance services—some of those are now provided by NHS England. They also had substantial powers to prevent illness and to care for the disabled. Independent practitioners—GPs, dentists, pharmacists and opticians— delivered services to local communities under contract from the health service. Now they deliver under contract from NHS England and the ICBs.
The health service underwent significant reorganisation in 1974, not long before I was born. The main objective at that time was to create a unified, integrated system. Community health services previously operated by councils moved into NHS control. These functions were put under the control of new area health authorities, which took control of most NHS hospitals. Some larger area health authorities had their own distinct management teams, which managed services on the ground—we can look at the current process and ask how it is similar and how it is different. The majority of teaching hospitals lost independent governance, in the way that we, too, are seeing that go back and forth. Above the new area health authorities sat regional health authorities, which were responsible for planning and allocating financial resources. Their members were appointed by the Secretary of State.
In the 1980s, Ministers recognised that the system had become very bureaucratic—perhaps similarly to today—and in 1982, area health authorities and district management committees were scrapped in favour of new district health authorities, with the aim of reducing what was in effect a three-layer structure to two layers. The thinking was that the new district health authorities would be closer to local populations, but primary care was left mostly unchanged. Once again, there are parallels with what is happening now.
From its inception to the end of the 1980s, the NHS had gone through several waves of rationalisation, but the model remained that of a centrally planned public service. However, during that time, there was an intellectual change—the concept of choice. Previously, people had been happy just to get a health service, which they had not had access to before, but that changed and people wanted choice. We now see the benefits of giving patients choice, and we will hear about how the Government’s changes through the Bill will apparently improve patient choice.
Of course, individuals have different values and preferences and live their lives in different ways, which makes it impossible for there to be a single public interest for the Government to pursue. Against that backdrop, the new public management approach to Government administration emerged, advocating for the introduction of market mechanisms and performance metrics—we have heard about the targets that NHS England follows—in public institutions. In theory, if elements of the state could operate more like the private sector, perhaps Ministers could achieve both cost savings and better outcomes.
In 1991 the Government introduced market logic into the health service. They created an internal market by splitting the purchasers—mainly, at that time, the district health authorities—from the providers, which were the hospitals. The Secretary of State gained the power to create NHS trusts—hospitals with the freedom to acquire, hold and dispose of assets; make bids for capital directly to the NHS management executive, in the way they might for NHS England; borrow money within limits; develop their own management structure; and employ their own staff with their own terms of employment. Within three years, almost all providers had become trusts. GP fundholding was established, enabling larger practices to receive budgets to buy secondary care on behalf of their patients, but that was short lived and was shelved in 1999.
When new Labour came to power in the late ’90s, one might have thought that things might swing back the other way, but in some respects the trajectory was similar. Initially, the Labour Government talked critically about the internal market. In 1998 the then Health Secretary told Members that the Government were
“sweeping away the internal market”—[Official Report, 1 July 1998; Vol. 315, c. 314.]
and the NHS plan published in 2000 claimed that
“the internal market introduced competition but failed to bring improvements.”
However, the policy choices of that Government furthered, rather than dismantled, the marketised aspects of the health service. They were saying one thing but, to some extent, doing another. There are similarities with this Bill: we have talked about decentralising power but, as we heard in evidence on Tuesday, many people feel it is more of a centralising Bill than a decentralising Bill.
It was clear that the new public management approach had been adopted across the political divide. The NHS plan promised patients more choice about how to access the NHS—a good thing. It promised a system of inspection, accountability and far greater local autonomy. It said:
“For the first time the NHS and the private sector will work more closely together not just to build new hospitals but to provide NHS patients with the operations they need.”
When GP fundholding went, the Government introduced primary care groups, which meant that GPs, nurses and other staff came together to commission for local populations. Those groups then evolved into primary care trusts, which by 2002 were responsible for spending 80% of the annual NHS budget—a budget that is now distributed by NHS England.
Karin Smyth
This is an interesting point, and it is always helpful to have one’s comments put back to one. I am happy to come back to this again. I ask my question again: do the Opposition oppose the abolition of NHS England? I do not think the Opposition oppose the abolition; they think it is the right thing to do. I appreciate that that was confirmed on Second Reading. As I have said before, the previous Government had the opportunity to do this in 2022 and chose not to. The fact that it has not been opposed suggests that it is the right thing to do.
As for what we found on coming into Government, we thought that delivering on our manifesto through the existing powers, flow of funds and priorities would be possible. We were clear that we did not seek this as an initial outcome, but having got into that position, we immediately found, even while developing the 10-year plan and bringing together one team, that it was not possible. I am afraid that the line through which ministerial intentions could be delivered was convoluted, and obstructed by various measures throughout the system. That independence—
The Chair
Yes, that was the point I was about to make. I know the Minister is trying to help and answer the point that was raised. As she knows, she has another opportunity to speak at the end of the debate. If she wants to briefly summarise the point now and then come back to it in more detail, she is more than welcome.
Dr Johnson
Thank you, Sir Jeremy. I will be grateful if the Minister clarifies at the end, because she seems to be suggesting that Lord Darzi’s report was wrong in some way. He was assessing the NHS at the same time that she was, with the experience of having been a Minister, and made the counter-suggestion.
It is not just about what one does; it is about how one goes about it. As we heard on Tuesday, there is in general a plan of what is going to happen, but so many decisions have not been made yet in relation to this. In particular, one of the witnesses from the union talked about how unsettling that was for staff and how difficult it is for staff to be asked to go from the current location to a destination unknown. It is very difficult to make transformation in a direction when it is not clear where one wants to be.
In March 2025, the Government announced that NHSE would be abolished. The largest healthcare union described the handling of the announcement as “shambolic”, coming only days after the announcement of a 50% cut to staffing levels at the centre. In the days and months since, Ministers have provided only some clarity about what they are trying to achieve. According to the Government, the restructure will cut red tape, save money, devolve power and improve accountability, all with a view to improving patient outcomes. Those are not new objectives; they are the same objectives that underpinned the creation of NHS England. How is it that the same objectives require dismantling the institution created to deliver them? Again, I just do not understand what has changed the Government’s mind.
Let us look at cutting red tape. As a Conservative, I welcome the ambition to make the health service more efficient. My constituents do not want to pay for staff in the Minister’s Department duplicating the work of those in NHS England, particularly when thousands every day are subjected to care that could certainly be improved. On Tuesday, we heard from the former Health Secretary, my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), that
“the bureaucracy has got completely out of hand.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 33, Q58.]
However, that bureaucracy is not confined to NHS England and any medical practitioner will explain that bureaucracy exists across the entire health system. Can the Minister explain how the changes will improve that?
Lord Darzi’s independent investigation said that, taken together, there are nearly 80 people employed in regulatory and headquarters functions for each NHS provider trust. Can the Minister say how many people will be in such roles once the abolition of NHS England is complete? Can she talk about how abolishing NHS England will review the volume of paperwork on patient safety, some of which is helpful for patient safety and some of which is not. That was identified by Dr Dash in her report.
I remind Members that abolishing NHS England is not a prerequisite of undertaking a robust cost-benefit analysis before introducing changes. We have had difficulty in getting answers on numbers. We have been told that this will save money—£1 billion a year, I believe—but no sums have been produced for us to scrutinise to explain where that will come from. Indeed, when asking questions about where it might come from, it has been quite difficult to establish that. We have heard that the redundancy package will be worth £1.1 billion to £1.3 billion. It does not seem clear exactly where that will come from or how it will benefit patients. It is also not clear how many of those staff will end up re-employed by the new organisation, having received redundancy from the first, and what effect that will have on the country’s finances.
More than a year on from the Government’s announcement that they will abolish NHS England, how much progress have Ministers made? In March 2025, Lord Scriven tabled a question about the legislation required to abolish NHS England. In her response, the Health Minister in the other place, Baroness Merron, wrote:
“Ministers and senior Department officials will work with the new transformation team at the top of NHS England, led by Sir Jim Mackey, to determine the structure and requirements needed to support the creation of a new centre for health and care.”
One year later, in March 2026, the Liberal Democrat health spokeswoman, the hon. Member for North Shropshire, tabled a question asking what functions had been transferred over since the announcement was made. In response, the Minister for Secondary Care wrote:
“Work is progressing at pace to develop the design and operating model for the new integrated organisation, and to plan for the smooth transfer of people, functions, and responsibilities.”
One does not need to enlist the services of Hercule Poirot to see that, one year later, that work has not been done. The Government have no comprehensive plan for how they will abolish NHS England. They can write a line in the Bill to abolish it, but how that will happen, to which clauses 2 and 3 relate, is, as yet, really uncertain.
Jo White (Bassetlaw) (Lab)
We all know how important our NHS is to the people we represent. I know how frustrated patients and staff have become after years of rising waiting lists, cancelled appointments and growing bureaucracy. Since coming into office, this Labour Government have already started to turn things around by delivering more than 3 million extra appointments ahead of schedule, cutting waiting lists and agreeing a new GP contract that begins the work of restoring the family doctor.
However, the challenge remains enormous. We inherited an NHS facing the worst crisis in its history, and public finances under severe pressure. That means that every pound must work as hard as possible for patients. That is why I welcome the decision to abolish NHS England and bring its functions back into the Department of Health and Social Care. The complex structure created by the 2012 reorganisation has left us with duplication, inefficiency and too many layers of management, separating decision makers from the frontline. Far too many NHS leaders and clinicians tell us that they spend their time filling in reports and navigating bureaucracy, when they should be focused on delivering care. We owe it to taxpayers and patients to change that.
These reforms are not about criticism of the dedicated public servants working in NHS England; they are about creating a simpler, more accountable system that supports staff rather than holding them back. By reducing duplication and cutting unnecessary bureaucracy, we can redirect hundreds of millions of pounds to frontline services. That will cut waiting times, improve access to care and give local NHS leaders more freedom to innovate. This is about one simple principle: fewer checkers and more doers; less bureaucracy and more patient care. It will create a stronger NHS that delivers for communities such as Bassetlaw and for people across the country.
The NHS is facing huge challenges. With the right reforms and leadership, we can build an NHS fit for the future and there for every patient when they need it most.
Helen Morgan (North Shropshire) (LD)
The Liberal Democrats broadly support the abolition of NHS England. As constituency MPs and users of the NHS, we see a huge amount of duplication and unnecessary bureaucracy as our local health organisations try to navigate the processes of securing capital investment, for example. Reducing duplication between the Department and NHS England is clearly welcome if done well, but we have concerns about the way in which that is being undertaken.
We think that this centralising process, under which the Secretary of State takes on more powers, risks political capture. That may not seem like a huge risk considering who the current Secretary of State and shadow Secretary of State are, but given the febrile political atmosphere that we are working in, it seems a poor time to give a Secretary of State sweeping operational powers over the detailed functioning of the NHS, with few checks and balances. I will speak about the most concerning elements and make the argument in greater detail when we debate cause 11.
As the hon. Member for Sleaford and North Hykeham said, the former Health Secretary, the right hon. Member for Ilford North, said that top-down reorganisation of the NHS was the last thing he wanted to do, and yet that is where we find ourselves today. It feels as if the plan has been pulled together very quickly, and that it has been complex to turn into a piece of workable legislation. It has taken a long time even for the Treasury to agree on the funding of the redundancy bill. We have found out that redundancy costs of £800 million will be taken out of the future operating costs of the NHS. I hope that the Minister will describe how that will be delivered to ensure that the costs do not detract from patient care on the frontline.
There is still some uncertainty about the new structures within the DHSC and NHSE reorganisation. We have heard that the previously announced plan for three top-level roles—a permanent secretary, a chief medical officer and an NHS chief executive officer—might be changed, and that there is a proposal to merge the permanent secretary and NHS CEO roles. At this stage, as we start to consider the legislation, it would be helpful to have clarity on who will be in charge of the NHS and how the layers below will be organised. We have also heard that hours of staff time, leadership focus and money have been directed away from frontline services. In the oral evidence session, Sarah Woolnough of the King’s Fund and Jon Restell of the Managers in Partnership union suggested that that has been distracting and that, in any body, a significant reorganisation has an opportunity cost.
In my previous life, I was an accountant at Centrica plc—one of those back-office checkers everybody wants to get rid of, but who turns out to be quite important in providing the information that enables the business to run smoothly. We found reorganisation hugely distracting; it took away from our ability to do our day jobs well. Then, within a couple of years, a lot of the equivalent roles were re-hired and we were back to square one. It is critical that the Government avoid that scenario in this big reorganisation of the NHS. I hope that the Minister can provide reassurance that it has been well thought through and that we will not find ourselves, two or three years down the line, with similar numbers of people replicating the roles that exist currently, following a huge distraction that resulted in no improvement in patient outcome or experience.
My questions are fairly limited. Does the Minister know, at this point, what the impact the reorganisation has had on the system and how much it has cost in secondary impacts? We have had eight Health Secretaries in the past 10 years. After all that swapping and changing, how can the Minister ensure a degree of continuity when the new Secretary of State takes over? One benefit of quangos is continuity over a long time, divorced from the political turmoil of Westminster. We must be clear about how distractions will be avoided in the new structure.
Finally, we heard in evidence on Tuesday that the new structure feels like a centralisation of power in Whitehall, when what is needed is more power devolved down to local level so that local services can be shaped to reflect the demographics that they serve and to address the important point of health inequality. Will the Minister explain why she is confident that measures to ensure local accountability and local shaping of services will be able to go ahead? Tackling health inequalities is the priority of everybody in this Room, and we need to ensure that we have an efficient structure in place to ensure that it happens.
Dave Robertson (Lichfield) (Lab)
It is a pleasure to see you in the Chair, Sir Jeremy. One of the most powerful things we can do as Members of this place is bring our constituents’ stories here so that they can form part of our discussions. That is what I will do as we discuss the future of NHS England.
I openly admit that I have never knocked on a door and found that someone’s burning question was about the abolition of NHS England. I have never had that particular discussion, but I do have regular discussions about the NHS. We know how important it is to people. They value the greatest gift that the Labour party has ever given the United Kingdom. As we have those discussions, one thing that comes up time and again is that people will always want more; they will always want better healthcare, and they should be able to expect it.
Across my constituency, the biggest health need is access to primary care. Two towns each make up one third of my constituency, so a third of my constituents live in Burntwood, 4 miles up the road from Lichfield— I believe my constituency is misnamed, but that is a matter for the boundary commissioner, not for me. When I talk to people about healthcare and access to primary care in Burntwood, one thing comes up time and again: the new health centre for Burntwood that was promised but never delivered.
That centre was promised in 2009 when the old one was demolished, but its funding was cut in 2011 following the change of Government, and we are still waiting. A modular building had to be put up in the car park of the leisure centre—“modular building”, by the way, is a grand term for what are portacabins stacked on top of each other. A huge number of people have worked at that site for a long time, delivering the best care they can, but they are being failed by the facilities that they are forced to work in. When I have conversations about primary care with people in Burntwood, they are never unhappy about the care they receive, about their doctors or about others who work in the NHS; they are unhappy about the facility that they are forced to use. I am standing here in 2026 and we still do not even have planning permission for the replacement centre. It has been promised so many times that people are beginning to doubt that it will ever happen. That is so hard to hear.
Edward Argar (Melton and Syston) (Con)
I approach this with a sense of déjà vu—standing in a Committee Room in the Palace to debate a Health Bill opposite the Minister for Secondary Care, the only difference being that our sides and places have swapped over in the interim. It is a pleasure to be on this Committee opposite the now Minister.
I will focus my remarks largely on clause 1. My hon. Friend the Member for Sleaford and North Hykeham raised a number of questions about clauses 2 and 3 and their breadth, but I consider them to be necessary and consequential on clause 1, so I will focus on the points made in that clause, which sits behind them. One thing I want to address is the Minister’s question about why, in the Health and Care Act 2022, the Conservatives did not abolish NHS England. I have to say that arguments were made on both the pros and the cons, but the simplest answer is the context of that legislation. At the time, we were just emerging from a pandemic, and I wanted that legislation to retain a clear focus on my vision for the NHS: a linking of ICBs at the local level with the upper-tier local authorities, so that we could deliver social care through a permissive model, rather than a prescriptive one, allowing that local co-operation. I was also conscious that, emerging from the pandemic, there was only so much that the system could realistically bear while it was still grappling with its immediate aftermath, hence the approach we took.
In reality, it cannot be disputed that, inevitably, this is a top-down, centralising reorganisation, and it was not in the manifesto. As Sarah Woolnough said in her evidence on Tuesday:
“These arguments were very well rehearsed by the previous Secretary of State. He undertook personally that he would not follow this course of action, exactly because these things take longer and cost more, and because the benefit realisation case is not always clear.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 10, Q23.]
On that point about centralisation, Jon Restell in his evidence said:
“Obviously, some functions of NHS England moving into the Department, with powers going to the Secretary of State, feels like a centralising measure… On the whole, it is probably more of a centralising measure.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 79, Q122.]
We have to recognise that this is a centralising measure, rather than any sort of devolution that provides local areas with greater autonomy.
For me, there is a worrying lack of clarity at this stage in the process—around 15 months later—on the actual plan and approach. The hon. Member for Lichfield gave a very good speech that not only highlighted the local issues but drew a national read-through from those local examples, and he rightly highlighted that he did not want a protracted reorganisation. However, 15 months on—with the hare having been set running by the Prime Minister’s announcement back in March 2025— we still have protracted uncertainty on what will happen. That is having a very real impact on not only staff but the opportunity cost, through its impact on how services are actually being delivered and what the NHS is focused on.
On that lack of clarity, when asked how this measure will work and whether it can save money, Sarah Woolnough of the King’s Fund said:
“I think, on the basis of the question, we do not know. Our worry has been about the opportunity cost. The Government, when in opposition, said that they would not launch wholescale reorganisation, because they understood the potential opportunity cost on time and other resources. As this has played out, taking longer than anticipated, we have had multiple examples of teams left in limbo about where they will end up in the target operating model.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 10, Q12.]
Jon Restell also highlighted the impact on staff when he said,
“this is becoming psychologically very difficult. You have a change programme that started in March last year with the announcement by the Prime Minister of the abolition of NHS England and the halving of the staff of NHS England and ICBs. For 18 months, that process has dragged on, with lots of design decisions still to be taken about how the organisation will look, what functions it will have, what will be going to the Department and what might be going elsewhere”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 80, Q125.]
Dr Danny Chambers (Winchester) (LD)
I too think the hon. Member for Lichfield gave an excellent speech on the need for clarity, but there is another factor to consider. Not only is NHS England being abolished, and ICBs are having their budgets halved, but in Hampshire and other areas we also have local government reorganisation. We are going from having district councils and county councils to unitary authorities, and a mayor will be coming in next year. This is another level of reorganisation in the delivery of healthcare and social care, so there is a huge amount of change. However, there seems to be no clarity, at any level, on how this will affect services on the ground, because there are so many moving parts coming in at once.
Edward Argar
The hon. Gentleman makes his point very clearly and he is absolutely right. Not only is there a lack of clarity in the legislation and in the plans for how the NHS will look, but, as was alluded to during evidence, the missing bit from the Bill, which is highly relevant, is social care. It will be deeply concerning if, when the implications of local government reorganisation emerge from the Ministry of Housing, Communities and Local Government in a few weeks’ time, the two are not properly meshed together, because we will risk, yet again, a widening disconnect between the two vital parts of our health and social care system, both of which have to work well in tandem for the whole system to function. The hon. Gentleman makes a pertinent point. He also highlights ICB budgets. I suspect hon. and right hon. Members around the country are already seeing the genuine impact of those changes to the budgets, which are actually pulling through into the frontline services that our constituents receive.
I know that the Minister cares deeply about our health and social care services, and has a wealth of experience from in this place and outside it. Given the comments from our witnesses and the impact assessment, which has page after page listing the risks associated with this approach, I ask her how she will mitigate that loss of focus and that distraction, which is an inevitable human reaction when there is uncertainty. When she comes forward with the plan to merge NHS England into the Department, how will she ensure that she retains the best, most experienced staff? In any organisation where there is a change, it is often the most able and experienced who find it easiest to go to another role, by virtue of their skillset. How will she ensure that there is not a loss or drain of that expertise and knowledge?
I turn to a deeply concerning element that links to the lack of clarity. The impact assessment on the abolition of NHS England is pretty much silent on the monetised costs and benefits and specific figures. The first two pages with the boxes and the summary just say “N/A” in pretty much every box on assessing the costs. If I flick through to the section headed “Monetised and non-monetised costs and benefits of each option”, I see page after page. There are lots of words but virtually no figures, and where there are figures, there is no breakdown of how they were reached, and no explanation of the degree or range of confidence in the few figures that are there.
I ask the Minister whether a detailed spreadsheet of all the statistics, costs and benefits, risks, confidence levels associated with the numbers, and the phasing over years of savings and costs will be published during the Commons passage of the Bill so that Members of the House can consider it. If not in Committee, could it be published at least before Report so that we can have an informed debate? More broadly, once the Bill in whatever form is passed—I expect, given the Government’s majority, that it will be—what mechanisms will the Government put in place to ensure that when a target operating model and all the other details are available, Parliament will have an opportunity to not only debate them, but have a meaningful say, potentially with a vote, be it through delegated legislation or in the House?
Joe Robertson (Isle of Wight East) (Con)
It is a pleasure to serve on the Committee with you in the Chair, Sir Jeremy.
I echo and endorse all the comments made by the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham, who was comprehensive in setting out our position. I therefore speak from a broad consensus surrounding the Committee that the final days of NHS England as a body are here, and so be it, because there are advantages to be gained from its abolition. The Minister set out some of the leading reasons why she and the Government are abolishing NHS England. She referred to the growing bureaucracy, the unnecessary complexity, and the overlap of roles and responsibilities between the organisation and DHSC. She also spoke about being able to better focus on delivering care rather than navigating bureaucratic hurdles.
Dr Johnson
My hon. Friend talked about how the ICBs have merged. There are lots of different types of reorganisation going on at once: the abolition of NHS England, the changes to local authorities, the introduction of mayors in some areas, and the changes and cuts to ICBs. What effect is that having in his part of the country?
Joe Robertson
The shadow Minister points to a much wider issue entirely relevant to the Government’s plans here: the more reorganisation we do, the more we shrink the bandwidth to deal with smaller and more operational problems because so much of the resource has been pulled in. In my area, although it is probably true everywhere, reorganisation of Department or Government responsibilities causes endless frustration that while Governments and politicians—I take some responsibility for my own side’s actions at times in the past in very limited ways—talk about reorganisation when so much can be done on what might be termed low-hanging fruit.
I worry that the Government are missing out on opportunities here to make a much more meaningful difference day to day and much more quickly than this huge reorganisation will achieve. Everything is about priorities. Plainly, no Government can do everything they want to do all at one time. It slightly surprises me that reorganisation of the NHS and doing away with NHS England has become such a major priority, considering it did not feature in the Labour party manifesto just two years ago. I do not seek to put words in the Minister’s mouth, but the gist of her evidence to this Committee was that within eight months of this Labour Government coming into power, they realised that NHS England had to go. Eight months is eight months, but it seems a short timeframe in which to decide to do away with a fundamental way that health is organised and delivered in this country.
Going back to priorities, I recall that before the election, the former Secretary of State for Health and Social Care—then the shadow Secretary of State—the right hon. Member for Ilford North, talked about introducing a national care service. That was the Labour party’s big priority. Although Conservative Members and, frankly, the majority of the public were slightly sceptical of his intentions, we all agree that social care needs reform and that ultimately, the success of the NHS will be delivered only if we deal with the long-standing crisis in social care, which extends back three decades or more, as it is entirely dependent on that.
Before the election, the priority was the national care service, but since the not-so-random date of 5 July 2024, when the right hon. Gentleman became the Secretary of State, he ceased to refer to reform of social care, and it seems once again to have been put on the back burner. I wonder whether the Government’s plan to abolish NHS England has gotten in the way of equally large, and perhaps even more substantial, reforms, which might ultimately have made a much more meaningful difference to the delivery of not only healthcare but health and social care, as well as to the overall wellbeing, including financial wellbeing, of so many people in this country. Social care refers to people living with frailty or dementia, and the family carers, and families more widely, on whom that has an impact. Every decision made is a decision not made, given the resource and bandwidth of those whom any Government ask to implement change, such as the civil service, advisers and the hundreds or thousands of people who are relied on to deliver in their day-to-day job.
I and, it seems, all the other Committee members do not disagree with the fundamentals of what Government are trying to do; their reasons for doing this are broadly sensible, so who could disagree? However, because of the manner in which it is being done, I urge caution and a check on being too optimistic—just doing it and expecting all the good things to flow. It will take an awful lot more than simply passing the Bill to make the NHS the success that, to take the Minister at her word, she intends, wants and will do her best to achieve.
Ordered, That the debate be now adjourned.—(Emma Foody.)
Health Bill (Fourth sitting)
Tuesday 23rd June 2026
(1 month ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 23 June 2026 - (23 Jun 2026)
The Committee divided: - Ayes: 3 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 5 / Noes: 9 - Question accordingly negatived.
The Chair
I remind the Committee that with this we are considering clauses 2 and 3 stand part.
The Minister for Secondary Care (Karin Smyth)
Casting my mind back to before the weekend, we had a wide-ranging debate on clauses 1 to 3 but, I think, substantial agreement about the central proposition to abolish NHS England. I pay tribute to my hon. Friend the Member for Lichfield, who succinctly put his finger on the key issue: it is fundamentally right that people and their elected representatives should be able to hold Ministers to account for the performance of the health service. It is also right that Ministers should have the tools to make the changes that are needed. The abolition is a necessary result of restoring that principle.
The debate raised a number of questions, a substantial number of which we will address during the course of the Committee as we reach the relevant clauses. However, I will pick up a couple now. I reassure the right hon. Member for Melton and Syston that the Government do take the impact of this process on staff seriously. We will treat people with the care, respect and fairness that they are owed through this process, now and in the months ahead. I am also committed to consulting recognised trade unions and I have a joint partnership forum to support ongoing engagement. More broadly, we recognise that change of this type is never easy, but we will need to go through the process quickly, which means, of necessity, proceeding in parallel with the legislation on the detailed internal design work for the new Department. That is in the interests of staff, patients and the public.
The hon. Member for Sleaford and North Hykeham raised the issue of whether the Bill was the cause of delays to the workforce plan. To be clear, it has not been, and we will publish that imminently. She also asked about the opportunity costs for other programmes, and I assure her that the Department, NHS England and Ministers are clear that we are here to deliver the 10-year health plan and other changes that make a difference to patients. We can, should and will do several things at once, and the Bill will help us with that by providing clarity of roles, greater freedom to local organisations and other positive changes.
To take just one example of the real impact, we are already saving on agency costs, and this is the first time in many years that the Department has not had to go back to the Treasury for a further injection of cash mid-year. That is getting a grip on the system. I add that the opportunity costs of not acting are very clear to the public, to staff and to patients in every single staff or patient survey that is issued. Those are the opportunity costs of not doing something; that is why we are acting. Clauses 1 to 3 are a necessary requirement for an NHS that is more effective for patients, delivers better outcomes across the country and achieves the initiatives that are expected of us.
Edward Argar (Melton and Syston) (Con)
This brings back memories of being in probably this same Committee Room a few years ago. I made this point during the previous sitting, but is the Minister able to commit that before the Bill leaves the Commons, a full and detailed statistical breakdown of the costs and benefits will be published, given their absence from the impact assessment?
Karin Smyth
I can tell the right hon. Member that we expect that NHS England coming into the Department will deliver up to about £1 billion in annual savings by the end of the Parliament, driven primarily by reductions in headcount, calculated using the average staff costs—about £77,000 per staff member in the Department and £94,000 per staff member in NHS England—including all pension and employer costs, which I think should help contribute to those numbers. As I think he knows, we will publish all accounts in the usual way.
I commend the three clauses to the Committee.
Question put and agreed to.
Clause 1 accordingly ordered to stand part of the Bill.
Clauses 2 and 3 ordered to stand part of the Bill.
Clause 4
Reducing inequalities
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I beg to move amendment 13, in clause 4, page 3, line 22, leave out lines 22 to 29 and insert—
“1C Health improvement and health inequalities duty
(1) In exercising any functions relating to the health service, Secretary of State must have regard to the need to—
(a) improve the health of persons in England,
(b) reduce inequalities between the people of England with respect to their ability to access health services, and
(c) reduce inequalities between the people of England with respect to the outcomes achieved for them by the provision of health services.
(2) Health inequalities ‘between the people of England’ means health inequalities between persons, or persons of different descriptions, living in, or in different parts of England.
(3) ‘Health inequalities’ means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.
(4) Under subsection (3) ‘general health determinants’ are—
(a) standards of housing, transport services or public safety;
(b) environmental factors, including air quality and access to green space and bodies of water;
(c) employment prospects, earning capacity, and any other matters that affect economic security;
(d) access to public services;
(e) the use, or level of use, of tobacco, alcohol or other substances, and any other matters of personal behaviour or lifestyle, that are or may be harmful to health;
(f) any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors.”
This amendment would amend clause 1C of the National Health Service Act 2006 to introduce a duty on the Secretary of State to have regard to health improvement and health inequalities.
The Chair
With this it will be convenient to discuss the following:
Amendment 29, in clause 4, page 3, line 22, leave out lines 22 to 29 and insert—
“1C Health improvement and health inequalities duty
(1) When considering whether or how to exercise any functions, the Secretary of State must have regard to the need to—
(a) improve the health of persons in England,
(b) reduce health inequalities between persons in England, and
(c) reduce inequalities between persons in England with respect to their ability to access health services and to the outcomes achieved for them by the provision of health services.
(2) Health inequalities ‘between persons’ living in England means health inequalities between persons, or persons of different descriptions, living in, or in different parts of England.
(3) ‘Health inequalities’ means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.
(4) ‘General health determinants’ are—
(a) standards of housing, transport services or public safety,
(b) environmental factors, including air quality and access to green space and bodies of water,
(c) employment prospects, earning capacity and any other matters that affect levels of prosperity,
(d) the degree of ease or difficulty with which persons have access to public services,
(e) the use, or level of use, of tobacco, alcohol or other substances, and any other matters of personal behaviour or lifestyle, that are or may be harmful to health, and
(f) any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors.
(5) In subsection (1)(a), the reference to improving the health of persons includes a reference to mitigating any detriment to health which would otherwise be occasioned by the exercise of the Secretary of State’s functions.
(6) In subsection (1)(b), the reference to reducing health inequalities includes a reference to mitigating any increase in health inequalities which would otherwise be occasioned by the exercise of the Secretary of State’s functions.”
This amendment would amend clause 1C of the National Health Service Act 2006 to introduce a duty on the Secretary of State to have regard to health improvement and health inequalities, reflecting the duties placed on combined authorities and CCAs in the English Devolution and Community Empowerment Act 2026.
Amendment 34, in clause 4, page 3, line 29, at end insert—
“(c) reducing inequalities between the people of England with respect to hospital transportation access.”
This amendment would create a duty for the Secretary of State to have regard for reducing inequalities in England with respect to hospital transportation access when exercising functions in relation to the health service.
Amendment 30, in clause 4, page 3, line 29, at end insert—
“(2) In discharging this duty the Secretary of State must have regard to the need to involve all departments of government in reducing health inequalities, and must take reasonable steps to ensure that other all departments consider the impact of their policy proposals on health inequalities.”
This amendment would require a whole government approach to addressing health inequalities by requiring the Secretary of State to involve all departments in the discharge of their duty in relation to health inequalities and took reasonable steps to ensure other departments consider the impact their policies might have on health inequalities.
Clause stand part.
New clause 19—Health improvement and health inequalities strategy—
“(1) Within six months of the passage of this Act the Secretary of State must publish a health improvement and health inequalities strategy.
(2) In preparing the strategy under subsection (1) the Secretary of State must consult all bodies which they consider appropriate.
(3) The strategy under subsection (1) must include—
(a) long-term targets related to health improvement and the reduction of health inequalities in England,
(b) provision for the establishment of a public authority with functions for additional monitoring and reporting on progress towards the targets set by subsection (3)(a), and
(c) any other provisions the Secretary of State considers appropriate.
(4) All Ministers of the Crown must have regard to the strategy under subsection (1) in carrying out their functions.
(5) Within 12 months of the publication of the strategy under subsection (1), and every 12 months thereafter, the Secretary of State must prepare and publish a report on the implementation of the strategy.
(6) ‘Health inequalities’ means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.”
This new clause would require the Secretary of State to publish a strategy for health improvement and the reduction of health inequalities.
Peter Prinsley
I apologise for being a little delayed, Sir Jeremy. I am moving the amendment on behalf of my hon. Friend the Member for Stoke-on-Trent South (Dr Gardner). It would place a clear duty on the Secretary of State to have regard to health improvement and health inequalities when exercising functions.
Between 2011 and 2021, the UK was one of only five high-income countries where healthy life expectancy fell. Over the same decade, we faced a cost of living crisis, the covid-19 pandemic and economic decline across the post-industrial regions. We cannot shy away from the fact that ill health is rising. Economic inactivity due to sickness is at its highest level since 2012, and we witness a widening disparity in health outcomes. People living in the most deprived areas of the UK, on average, live just 52 years of healthy life. There is now a 16-year gap in life expectancy between the richest and poorest parts of the UK. Even within individual constituencies, the life expectancy gap can be as wide as seven years between local postcodes.
The purpose of the amendment is to ensure that decisions taken at the highest level of the health system consistently reflect the reality that health outcomes differ sharply depending on where someone lives, the conditions that they live in and their opportunities to achieve good health. The amendment would require the Secretary of State to have regard to the need to improve the health of persons in England. The intention is that this duty would include the need to reduce inequalities in health. That is in addition to the duties that are already in the clause, relating to inequalities in access to and outcomes of healthcare.
At present, the Bill brings together old duties on the Secretary of State and NHS England to reduce inequality in access to and outcomes from NHS services. Those are too narrow and do not reflect the wider determinants of health that the Government have pledged to tackle through their 10-year plan. The amendment would strengthen the duty to reflect the wider cross-Government goals for health improvement and health inequalities. That would make an important statement of the Government’s commitment to improving health and tackling health inequalities, and would set in train an important step towards achieving them.
The amendment also provides a clear definition of “health inequalities” and “general health determinants”. Health inequalities means inequalities in respect of life expectancy or general state of health, which are wholly or partly a result of differences in respect of general health determinants, including housing standards, environmental factors, public transport, economic factors and other wider determinants of life expectancy. The amendment has been drafted to mirror the wording of the newly enacted section 45 duty on combined authorities in relation to health improvement and health inequalities under the English Devolution and Community Empowerment Act 2026.
Accepting the amendment would ensure consistent focus on the mission of creating a fairer country where everyone lives for longer, from the top of Government to regions and neighbourhoods. By setting this out explicitly, the amendment would ensure that future Secretaries of State cannot overlook the wider conditions that shape health outcomes. In sum, the amendment would require that when decisions are made, the Secretary of State must consider their impact on health improvement and on distribution of health across the population.
The amendment is supported by the Health Equals coalition, including 27 organisations that wrote an open letter to the Minister on 15 June. Those organisations range from the Health Foundation to the King’s Fund, Ramblers UK and the Wildlife Trusts, showing the breadth of support from across the sector. The cross-party Health and Social Care Committee also recommended that the clause be amended in this way.
Embedding this duty in legislation would strengthen accountability and ensure that the reduction of health inequalities is treated not as a secondary consideration, but as an integral part of how the health system is led and managed. If accepted, the new duty would ensure clear alignment at national and local levels about the importance of prevention.
Joe Robertson (Isle of Wight East) (Con)
It is a pleasure to serve under your chairmanship once again, Sir Jeremy. I will speak generally about the amendments on health inequalities, and specifically about some points that the group of amendments homes in on.
On the general principle of dealing with health inequalities, the sentiment behind amendment 13 is important, and I support hon. Members’ motivation for tabling it, but I question exactly what “persons of different descriptions” means. Does it relate to protected characteristics, which employment law deals with, or to geography? I suspect that it is both, and I wonder whether there are more considerations than those two. It would assist us if the amendment were clearer on that, notwithstanding the fact that clarification may be made during the debate or to the amendment itself if it is accepted later. I have concerns about what “persons of different descriptions” means. Certainly, in everyday English, every individual could be described as a person of a different description, so the phrase does not have any particular legal meaning.
If the phrase means something equivalent to protected characteristics, I wish to say something about health inequalities affecting those of different ages. I am the Member for Isle of Wight East, which, of course, has an older population. I want people of all ages to have equal access to health and social care, and inequalities in access to be levelled out and removed, but it is not only older people who find accessing health services difficult, not least for reasons of physical access; the entire population within an area with an older age demographic is affected. The Isle of Wight has a small local authority. We are fairly unique, in that we are surrounded by water and have a higher age profile, which, taken together with other challenges, makes health equality a challenge for the entire population, not just older people. The issue is aggravated by other considerations, primarily relating to geography.
Amendment 34, tabled by the hon. Member for Winchester, refers to hospital transportation access. That can mean a lot of different things in different places. I support at least the aim of putting more pressure on the Secretary of State and the Department and encouraging them to recognise and eradicate inequalities in hospital transportation access. For my constituents, accessing specialist services means crossing a body of water, which is not only a physical barrier—a ferry has to be taken—but a cost barrier, because ferries cost money. I understand where the hon. Gentleman is coming from, given the challenge in my constituency, but of course other places have different but challenging hospital transportation issues.
Amendment 30, tabled by the hon. Member for Oxford West and Abingdon (Layla Moran), the Chair of the Health and Social Care Committee, refers to cross-departmental working to ensure that health inequalities are taken into consideration. I think this is key. Of course the primary responsibility for health inequalities rests with the Department of Health and Social Care, but it is by no means the only Department with that responsibility. The more we think about the various inequalities that exist in this country, the more we realise that other Departments have considerable responsibility. We hear from politicians—of all parties, but particularly the Labour party in government—about better joined-up working between Departments, but without something more concrete in Bills such as this one, that will remain one of those aspirations that many talk about but few actually achieve.
The most obvious Department to help achieve the reduction in health inequalities is the Ministry of Housing, Communities and Local Government, given its responsibility for local government funding. Of course, local government has primary responsibility for delivering social care and public health within its area. It is a well-known feature of the system we have in this country that healthcare is free at the point of use and delivered effectively by central Government, while social care is a combination of different provision but private funding and local government have the largest role to play, and too many people fall through the gaps in those fundamentally different ways of funding two parts of the system. Unless MHCLG is bound into the way we reduce health inequalities, even with the best intentions of the Secretary of State for Health and Social Care, it clearly will not be delivered in a comprehensive and holistic way.
I refer again, as an example, to my area, which has a higher age demographic but a small unitary authority with a lower funding base. It is a matter of public record that the funding decisions made by the current Government at the beginning of this year have meant an effective reduction in funding for my local authority, notwithstanding its responsibility for an older population and the existing challenges in delivering social care. That is an argument that I and my constituency neighbour, the hon. Member for Isle of Wight West (Richard Quigley), are making to the Government in an ongoing conversation about how we can resolve that issue. We are having that conversation with MHCLG, notwithstanding the fact that it has a very direct impact—the biggest impact, in my view—on health inequalities in my constituency and the effectiveness of the Government’s 10-year health plan and their intention to improve the general health of the population. That is the probably the key departmental relationship that will be relied on to deliver the reduction in health inequalities.
The Department for Transport also has responsibility for this. If we refer to its responsibilities for reducing health inequalities outside the context of this argument, people might scratch their heads and wonder what we are talking about. but as soon as it is brought into a real-life example within this debate, it makes sense that the Department for Transport has some responsibility for reducing health inequalities. However, we will not achieve all we want to unless that responsibility is made more obvious and specific, named somewhere in some Bill. We have an option to achieve our intention to have joined-up decision making, and to ensure that every decision in any Department that has the potential to impact health inequalities is considered, whether in a formal impact assessment or just in the ordinary day-to-day decision making and mindset of the relevant Ministers, Secretary of State or departmental officials.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to speak to clause 4 and this group of amendments. Health inequalities are commonly defined as the systemic differences in health status and distribution of health resources between different population groups. There are limits to how far the state can equalise health in a free society, but I am sure all Members would agree that the service should not preside over differences in access to health resources. Unequal access runs contrary to the vision of the NHS as a comprehensive service, available to all and based on clinical need, not ability to pay. Those principles are violated when people without fixed addresses struggle to access general practice, or patients in rural areas, such as my constituency, miss out on treatments—for example, specialist cancer treatments—that are available in more urban areas.
The Health and Social Care Act 2012 inserted section 1C in the National Health Service Act 2006, placing a duty on the Secretary of State to consider the need to reduce inequalities in the benefits that people obtain from the health service. As the explanatory notes to the 2012 Act made clear, the intention of that was to
“include consideration of the need to reduce inequalities in access...and the outcomes”.
Clause 4 of this Bill takes that which was understood and makes it more explicit.
The Minister will be pleased to hear that I support updating that duty—she is smiling. The word “benefits” in the original section is a nebulous and subjective term. The wording introduced by the clause is less imprecise and requires the Secretary of State to consider the whole health pipeline. None the less, I have some questions about the lens that clause 4 and its predecessor, section 1C of the 2006 Act, invite the Secretary of State to look through, particularly in relation to other statements made by the Government.
In the Government’s policy paper “ICBs as strategic commissioners”, they say that increasing the commissioning responsibilities of integrated care boards will result in them being
“better placed to support innovation”
and
“design new models of care”.
Innovation can produce disparities; that is true in healthcare as well. If one ICB decides to innovate and produces a better service, that area will have a better service than another, and the Secretary of State will have the job of undoing that. That could be done by spreading the innovation across the whole of the country, but if the innovation is expensive or difficult to roll out, it could in effect be quashed. Does the Minister recognise that empowering health leaders to innovate and do things differently could widen inequalities, at least in the short term? Is she willing to accept that?
A problem with using inequalities as a stand-alone metric is that it does not really tell you whether things are getting better or worse; it must be taken into consideration alongside a wide range of other metrics. An often forgotten fact is that disparities can be reduced by levelling down as well as by levelling up. Fixating on determining the size and cause of disparities can, in some cases, come at the expense of eliminating them. I recently tabled a written question to ask the Government if and when they plan to
“set an explicit target to close the Black and Asian maternal mortality gap.”
I note that the Minister stood on a manifesto pledge to close that gap. The Government response to my question indicated that they are waiting for Baroness Amos to finish looking at the drivers of inequalities before they do anything. It is possible to produce tomes on the nature of disparities; I suggest that energy would be better spent on addressing them.
Amendment 13 would require the Secretary of State to consider health inequalities arising from differences in general health determinants. I understand the sentiment behind the amendment, as statistically, those with lower earning capacity, limited access to green space or unhealthy lifestyles have comparatively worse health outcomes, but would placing a duty to take stock of that on the Secretary of State make the health service any better for such groups, or for the population as a whole?
What would be the practical purpose of the amendment? As somebody said to me yesterday evening, do we have a section in education legislation stating that the Education Secretary has to consider that their job is to ensure that people are educated? Do we have clauses in defence Bills saying that the Defence Secretary must consider the defence of the realm? I cannot be sure, but the amendment seems to be a statement of the blindingly obvious, so what effect would it have? Does the Member who tabled the amendment think that the Secretary of State will not consider those factors—essentially, that he will not do his job properly? Do they not have confidence in him or in future Secretaries of State?
Under the amendment, the Secretary of State would need to consider inequalities arising from people’s employment, environmental conditions and lifestyle choices, which his Department has little to no control over. If poverty is the problem, the solution is employment and welfare policy, which is not in his gift. If poor environment is the problem, the solution is environmental policy. If a well-informed adult chooses, despite knowing the detriment it may cause them, to consume unhealthy food or an excessive volume of alcohol, or not to exercise, what can and should the Minister do about it in a free society?
Amendment 13 would risk distracting from the focus of clause 4, which is, as I see it, to ensure equal access to health resources regardless of a person’s standing in society. What is the practical effect of making it a duty on the Minister to do these things? Will it cause a whole load of bureaucracy? Will the Minister have to produce impact statements for every new hospital? If, for example, one opened on the Isle of Wight—my hon. Friend the Member for Isle of Wight East was talking about that—would we need to consider what effect it would have on smokers, people who do not exercise or people who have a lower earning capacity, and produce an endless list of assessments? It would take a lot of money and effort and not really add anything. The amendment would also risk the Government getting bogged down in litigation, as people who disagreed with the Government’s or the ICB’s decision would spend their time litigating the question whether something that may or may not even be relevant was considered properly.
Members will not be surprised to hear that my thoughts on amendment 29 are similar to those on amendment 13. I do not doubt for a minute that its supporters have the best intentions, but this type of public sector equality duty language does not do anything to improve public services. Too many arms of the state have been so concerned with disparities that they have become incompetent at getting on with the job that they are actually meant to be doing; they are distracted by trying to measure all these different equalities.
Amendment 30 would require the Secretary of State to involve all Departments in reducing health inequalities and take all reasonable steps to ensure that all other Departments
“consider the impact of their policy proposals on health inequalities.”
Is this spreading the bureaucracy and the impact assessments more widely? If the Government decide to buy a new submarine, do they have to consider what effect it would have on people who smoke on the Isle of Wight? It does not make sense to me. It is a statement of the obvious that members of the Cabinet and Government have to work together to deliver better health for the country. Of course that is true, but what would be the practical effect? The Minister may be able to tell us.
New clause 19 would require the Secretary of State to publish a health improvement and health inequalities strategy within six months, and an annual report thereafter. Again, that would invite more glossy brochures from the Government, using the precious time of civil servants. The new clause seeks a cross-Government approach by mandating that all Ministers of the Crown must have regard to the strategy when carrying out their functions. Again, it is basically stating what their job is.
Joe Robertson
My hon. Friend hits the nail on the head. Although all these amendments come from a very good place, they are so obvious that they should already be happening, and are too obvious to be enshrined in some overriding duty in a Bill.
Dr Johnson
I agree. The amendments include, in many cases, a statement of what someone’s job is. Does the Member who tabled them think that the Secretary of State is not doing his job and therefore needs to be told what his job is? That could create a whole load of bureaucracy detracting from the actual job in hand.
Amendment 34 concerns transport access. I understand that that is a problem for many people in rural areas, such as my constituency. They often have a harder time, as the distance they need to travel is longer and public transport services are infrequent. Healthwatch, which will be cancelled by this Bill if the Government get their way, has heard from patients who struggle to book transport online, and whose transport turned up several hours early or was cancelled with little or notice at all. Those problems are well documented.
I visited Lincoln county hospital, which has a unit for renal dialysis, where I heard that although transport is provided for individuals having dialysis, which is good, it often does not turn up when it should or does not pick people up at the time that it is supposed to. More concerning is the fact that if they need a transplant and transplant assessments, most have to go to Leicester to have that done, which is several hours’ drive from some parts of Lincolnshire. Most disturbingly, I heard concerns that some people would choose not to go through the transplant programme, and a factor in that decision would be the ability to get to the transplant centre to have the significant amount of testing and follow-up that needs to be done. Clearly, that is not equal access, so I urge the Minister to look at that.
Imposing a duty on the Secretary of State to consider reducing inequalities is a good thing, but it does not magic up the resources necessary to fix them. In exercising his functions, it is a problem the Secretary of State is already capable of addressing. I am sure the Secretary of State, like the Minister, is a good person and wants people to be able to access the services. If Members believe the Government are failing in that regard, I would advise that adding another legislative duty is not likely to bring about the change desired. If we are being honest with the public, we must challenge the premise that every disparity is evidence of a policy failure. The duty placed on the Secretary of State should be to ensure that care is of an equally high standard across the board.
Dr Danny Chambers (Winchester) (LD)
It is an honour to serve under your chairship, Sir Jeremy.
The hon. Member for Isle of Wight East highlighted extremely well the difficulties of accessing hospital services on an island, but it can be a problem anywhere, including in rural constituencies. Winchester is about 60% rural. Since I was elected, an issue that I have had a great deal of correspondence about—even protests and petitions—has been the cancellation by Hampshire county council of bus services, particularly from rural villages such as Colden Common. People need buses for a variety of reasons—obviously to get to work and school—but the No. 1 issue concerning people is that of mainly elderly people using the bus to access hospital and GP services. They are really worried. It is causing a huge amount of stress that they will not be able to access hospital and GP services and not be able to remain living independently in the village that they have lived in for years.
One of the new hospitals in Hampshire is due to be built in south Basingstoke. Extraordinarily, the consultation on the location of the new hospital did not include consultation with the South Central ambulance service. When moving an A&E department and maternity service to another location, it seems blindingly obvious that the ambulance service should be heavily involved in deciding where a new hospital may be located, given that it is primarily responsible for ensuring that people can get there in a timely manner. Although there is obviously a need for local councils to ensure their constituents can get to a local hospital, it is important that we have some kind of obligation. I assume it would have been an obligation that when setting up the location of new hospital services, the ambulance services must be consulted and engaged with to get their input.
Sureena Brackenridge (Wolverhampton North East) (Lab)
On amendment 13, the shadow Minister asked why my hon. Friend the Member for Stoke-on-Trent South felt the need to table amendment 13. One can only assume it is because health inequalities have continued to widen for far too long. In a 20 or 30-minute drive across my Wolverhampton North East constituency, life expectancy drops by seven years. I accept that tackling health inequalities is not just about health; it is about a wider web of societal issues, including educational, employment and housing inequalities. That very long list is beyond the responsibility of the Secretary of State for Health and Social Care.
Amendment 13 will put the tackling of preventable ill health and health inequalities at the centre of national decision making by ensuring that the Secretary of State must consider not just NHS treatment but wider social and economic factors. Will the Minister assure the Committee that future Secretaries of State will not overlook the wider social and economic factors that drive ill health and unequal life expectancy, and that there will be a responsibility to work across Departments to tackle that wider and growing inequality?
Karin Smyth
I am grateful to all hon. Members who tabled amendments in this group, some of which have not been spoken to. I will address the central points that Members have rightly highlighted. I am grateful to the Chair and members of the Health and Social Care Committee for their report and recommendations for the Bill.
Before I turn to the detail of the amendments, I will set out what clause 4 does. As my hon. Friend the Member for Wolverhampton North East highlighted, the wider determinants of health inequalities are important. On the point that the hon. Member for Isle of Wight East made about the Labour party, they absolutely run through our DNA. Clause 4 restates and reaffirms our commitment to tackling health inequalities. It reformulates section 1C of the National Health Service Act 2006, aligning it with the duty imposed on NHS England by section 13G of that Act. It makes plain the need to achieve greater equality between the benefits that people receive and the provision of health services—for their ability to access those services and for the outcomes achieved. Importantly, “outcomes” includes the safety and effectiveness of health services and the quality of the experience undergone by patients. The clause will ensure that the Secretary of State must have regard to reducing inequalities in respect of all those benefits.
The wording of the revised duty more directly encapsulates the benefits that must be taken into consideration and obtained from the health service to support action that reduces or prevents inequalities. Fundamentally, the clause underpins our commitment to improving the health of the population and tackling the stark inequalities that blight the health of communities up and down the land, which have got worse over the past 14 years. That is central to this Government’s ambition, which is why we highlighted it in the 10-year health plan.
We also recognise that this is not a matter for the Department of Health and Social Care alone, which is why we are already working across Government to address the root causes of health inequalities and the barriers to accessing health and care services. We are ensuring that our action on health is embedded in policies that shape people’s daily lives, from the homes they live in to the air they breathe.
Helen Morgan (North Shropshire) (LD)
Before the general election, I was the Liberal Democrat housing spokesperson, and one thing that came up regularly was how important housing is, and not just for obvious physical conditions—mouldy houses can cause breathing issues. Temporary accommodation is devastating for the long-term health outcomes of the people who are placed in it. Does the Minister agree that working with MHCLG to improve housing—particularly social housing—is critical to achieving the Government’s objective?
Karin Smyth
The hon. Lady pre-empts my next comments. I absolutely agree with her, and so do the Government. That is why we are improving living conditions through the new decent homes standards, which set standards across all rented sectors. Awaab’s law requires social landlords to act promptly to fix housing hazards. Since coming into government, we have launched the warm homes plan, the Keep Britain Working review and the homelessness strategy. In April, we published a renewed women’s health strategy, marking a decisive shift to ensure that women and girls receive the care, respect and outcomes that they deserve. Last November, we published England’s first ever men’s health strategy, to improve the health and wellbeing of all men and boys. Within the Department, we are reviewing the Carr-Hill formula and the Advisory Committee on Resource Allocation to ensure the funding matches need.
However, there is much more to do. The Minister for Public Health and Prevention, my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson), will continue to engage with key stakeholders, including representatives of Health Equals. I have a meeting with representatives of that body this week.
I sympathise entirely with the motivation underpinning amendment 13, which was moved by my hon. Friend the Member for Bury St Edmunds and Stowmarket, and I commend hon. Members for working on this important agenda, but I am not convinced that the amendment is necessary. I note that it draws on the duty that was recently placed on combined authorities by the English Devolution and Community Empowerment Act 2026, with a view to creating a similar duty for central Government.
Fortunately, I can reassure hon. Members that the Secretary of State already has a duty to secure improvement in the health of people in England, and the power to take such steps to improve public health as they consider appropriate. We would not want to narrow the definition of the existing duty, because health inequalities come from many causes, as has been discussed. As I have said, we are already working across central Government and local government to address those wider inequalities, including in housing and air quality, and by getting more people into work.
The hon. Member for Sleaford and North Hykeham said that innovation might expand inequalities across our country, but we have seen a shocking expansion in the inequality gap across our country. That is what we are seeking to reverse, as we have made clear in our 10-year health plan, and the Bill will ensure that that happens. That is why we say that we will take the best to the rest; we are not about taking people down.
Finally, I turn to amendment 34 in the name of the hon. Member for Winchester. He has spoken before about his constituents’ experience, and I have spoken with him about the new hospital programme, his constituents’ reliance on transport to access hospital appointments, and the difficulties experienced in more rural areas, which the hon. Member for Isle of Wight East also mentioned. That is why, in our 10-year health plan, we are very clear about our strong commitment to rural and coastal communities—we are the first Government to do that.
We agree that reducing inequalities in hospital transport is important. The Bill already places a duty on the Secretary of State to
“have regard to the need to…reduce inequalities between the people of England with respect to their ability to access health services”.
Inequalities in access to transport to receive care fall under the scope of that duty. As such, the amendment is superfluous.
I also offer the reassurance that NHS England has been implementing a range of actions to reduce inequalities in patient transport, including the speeding up of reimbursement for patients eligible for the healthcare travel costs scheme. I also inform the Committee that the cancer plan included a commitment to provide up to £10 million a year to pay for the travel costs for cancer care for children and young people, and their families, as people have long campaigned for.
Some important issues have been raised in this debate, and I am sure that we will return to them. In the meantime, I ask my hon. Friend the Member for Bury St Edmunds and Stowmarket to withdraw the amendment. I commend clause 4 to the Committee.
Peter Prinsley
I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 4 ordered to stand part of the Bill.
Clause 5
Patient involvement and choice
Dr Johnson
I beg to move amendment 59, in clause 5, page 4, leave out lines 2 to 4 and insert—
“(1) In exercising functions in relation to the health service, the Secretary of State must act with a view to enabling patients to make choices with respect to aspects of health services provided to them, including to make choices as to the provider of those services.
(2) For the purposes of subsection (1), the Secretary of State must ensure that patients who are referred for a service to be provided outside a hospital setting (‘out-of-hospital services’) are offered a choice of provider of that service from among the providers available in their integrated care board area and, where relevant, in neighbouring areas, in accordance with regulations made under section 14Z45B.
(3) Regulations under section 14Z45B must provide that, where an out-of-hospital service is to be provided to a patient, the integrated care board must—
(a) offer the patient a meaningful choice of at least two providers capable of providing the service, which may include NHS bodies and independent sector providers approved to provide that service under arrangements with the integrated care board;
(b) provide the patient with information to support an informed choice, including for each available provider—
(i) indicative waiting times;
(ii) the location at which the service would be provided;
(iii) the quality ratings or outcomes data applicable to that provider for that service where such data is available; and
(iv) whether any costs would be incurred by the patient in travelling to or receiving the service at that provider;
(c) not exclude from the list of available providers any provider approved solely on grounds of commercial interest or organisational type; and
(d) take all reasonable steps to give effect to the patient's choice within a clinically appropriate timeframe.
(4) For the purposes of this section, ‘out-of-hospital services’ means services—
(a) provided in community, primary care or ambulatory settings rather than in a hospital inpatient or outpatient department; and
(b) which the Secretary of State specifies by regulations as being within the scope of the choice obligation under subsection (2),
and may include diagnostic services, audiology and hearing aid care, podiatry, dietetics and nutrition, physiotherapy, ambulatory cardiac monitoring and such other services as the Secretary of State may specify.
(5) In specifying services under subsection (4)(b), the Secretary of State must have regard to—
(a) the potential for the expansion of choice to reduce waiting times for the relevant service;
(b) the availability of sufficient independent and NHS providers to make genuine choice meaningful; and
(c) the desirability of ensuring access to choice for patients in all parts of England, including in rural and deprived areas.
(6) The Secretary of State must publish, and lay before Parliament, within 12 months of the date on which this Act is passed, a statement setting out—
(a) the out-of-hospital services for which choice obligations under subsection (2) will initially apply;
(b) the timetable for extending the choice obligation to further services; and
(c) the support that will be made available to patients, in particular those with limited digital access or literacy, to exercise the choices to which they are entitled under this section.
(7) The Secretary of State must review and update the statement required by subsection (6) at intervals of not more than two years.”
This amendment strengthens the new patient choice duty inserted by Clause 5 from a general aspiration into a specific, enforceable right to choose between providers for out-of-hospital services.
Dr Johnson
This group is about how patients can exercise choice. When the national health service was founded in 1948, patients could select their own GP, but it was difficult to change things and exercise choice elsewhere in the system. The health service has come a long way since then. Successive Governments believed that they could make state institutions more responsive by treating the public, to some extent, like customers. Today, patients can choose their GP, hospital, consultant and different types of end-of-life care and mental health service, but choice is about more than just selecting among providers.
Gregory Stafford (Farnham and Bordon) (Con)
I rise to support my hon. Friend the Member for Sleaford and North Hykeham on amendment 59.
The amendment fosters competition. That is not ideological; the Government themselves have accepted, in clause 5, that competition and choice are important. As my hon. Friend said, this is about ensuring that patients have real choice, and not just something that the Secretary of State has thought about. If one provider has a waiting list of 30 weeks, for example, while another can see patients in just four weeks, patients should clearly be given the opportunity to choose the faster option. By expanding patient choice and making better use of the available capacity, my hon. Friend’s amendment has the potential to reduce bottlenecks without necessarily increasing overall NHS spending—that is a good thing.
Importantly, the amendment allows patients to choose between all approved providers, including NHS bodies and independent sector providers. It prevents integrated care boards from excluding suitable providers simply because of their organisational type. I think all Committee members believe in provision that is free at the point of use, but that can come from a number of different providers, including the independent sector.
Peter Prinsley
Does the hon. Member recognise that there are circumstances in which independent provision within a district has the effect of disabling the NHS service? A pertinent example is the ophthalmology world. Services have become difficult to deliver in NHS hospitals because large numbers of NHS staff have chosen to work in the independent sector. That makes the comprehensive provision of a service in an eye department difficult, as the staff are all off operating on cataracts.
Gregory Stafford
I do not recognise the characterisation that the hon. Gentleman puts forward. He is essentially saying that, by allowing the private sector to carry out operations and procedures, we are somehow making the NHS unsustainable. The follow-on from that logic is that we remove all private sector providers and practice so that every single doctor, nurse and therapist is working in the NHS. I do not think that he is arguing for that situation, but it is the logical progression of his argument.
Dr Johnson
When I met surgeons, they said that one reason they like working in elective independent sector hospitals is that they can do more operations on a given day. The shadow Secretary of State visited a provider of cataract treatment yesterday. It is able to perform more treatments on a given day, partly for organisational reasons. The NHS, which is quite frustrating for surgeons, could learn from that. Does my hon. Friend agree?
Gregory Stafford
My hon. Friend is absolutely correct. I do not want to go down the cataracts route, but she and the hon. Member for Bury St Edmunds and Stowmarket have both mentioned them. Clearly, cataracts are a relatively low-complexity, high-volume type of operation. My hon. Friend is absolutely right to say that some providers can do five or six operations per list, while other places are doing two or three. That is often about the private sector being able to move more quickly, which is obviously better for patients, as well as for clinicians, who want to do the surgery that they have trained for.
Unlike the hon. Member for Bury St Edmunds and Stowmarket, I think that competition can play an important role in driving improvement. When providers must attract and retain patients, they have a stronger incentive to deliver timely, high-quality services, and to innovate in how they provide care. In that sense, competition is not an end in itself but a means of improving outcomes and responsiveness for patients. If both sides of the Committee support clause 5, because we are interested in choice and competition, amendment 59 is the logical extension of that.
The amendment is also clear about where the new obligation choices would apply. It covers a range of out-of-hospital services, including diagnostics, audiology, hearing-aid care, dietetics, physiotherapy, ambulatory cardiac monitoring and so on. By clearly defining the services in scope, it provides a realistic and workable road map for implementation.
As I said, the amendment is not about ideology—I think we all agree about choice and competition—but about ensuring that patients receive timely care and have a meaningful choice about where that care is delivered. By fostering healthy competition, making full use of the capacity in the system and putting patients at the centre of the decision-making process, it offers a practical route to improving access and raising standards of care. For those reasons, I support it and commend it to the Committee.
Karin Smyth
I am grateful to the hon. Member for Sleaford and North Hykeham for bringing this discussion before the Committee. We almost went down a cataract rabbit hole, but I think the points were well made. I will outline the Government’s general approach to choice and then move on to the amendment.
I recognise that hon. Members from both sides of the Committee are committed to protecting and upholding patient choice in our system, as are the Government. That is why clause 5 introduces new duties that require the Secretary of State to promote
“the involvement of patients, and their carers and representatives”
in decisions relating to the prevention or diagnosis of their illness, and their care or treatment. That applies when the Secretary of State is exercising health functions.
The clause also requires the Secretary of State to
“act with a view to enabling patients to make choices”
about the health services provided to them. The Government are committed to involving patients and carers in decisions about their care. We know that supports a better experience of care and, in many cases, better outcomes. Furthermore, if they want to be, patients should be active participants in decisions about their own care, rather than passive recipients of services.
I appreciate the sentiment of the amendment in the name of the hon. Member for Sleaford and North Hykeham, but I do not think it is necessary. It turns a general duty into one with more prescriptive detail, which risks adding complexity. Details on service types and operational details currently sit in secondary legislation, which allows them to be updated and amended as services evolve. I reassure the hon. Member that we will protect and maintain all the existing rights and duties set out in the choice regulations.
In any future consideration of expanding patient choice, which this amendment requests, I hope the hon. Member would agree that we would need to build up and test the evidence base to ensure that any changes were effective and meaningful for patients, before legislative changes were made. I am not sure what problem the hon. Member is trying to solve.
The Government are committed to protecting patients’ rights to choose. It is absolutely right that the duty to involve them in decisions will remain a central principle of the new health system and that patients are empowered to make informed, meaningful choices. I believe that the clause, unamended, does just that. For that reason, I ask the hon. Member to withdraw the amendment, and I commend the clause to the Committee.
Question put, That the amendment be made.
Dr Johnson
I beg to move amendment 58, clause 6, page 4, line 10, leave out from “promote” to end of line 11 and insert—
“(a) innovation in the provision of health services and in the arrangements made for their provision;
(b) take steps to ensure the timely adoption and spread of clinically effective innovations across the health service in England;
(c) identify and seek to remove barriers to the uptake of innovation by NHS bodies, including procurement barriers, regulatory barriers and cultural barriers to change;
(d) promote access to innovation so that patients in all parts of England, and patients from all socioeconomic backgrounds, have equivalent access to effective new technologies, medicines and care models; and
(e) have regard to the economic and industrial benefits to the United Kingdom of developing and deploying healthcare innovation in the NHS.”
This amendment would further define the meaning of promoting innovation in health services in England.
Dr Johnson
In healthcare, as in many parts of life, innovation is the way in which new ideas, products and services are developed to solve problems and improve patient outcomes. Here, the entire country has a record to be proud of that goes back a long time. Dr John Preece, a GP and research fellow at the University of Exeter, was the first general practitioner to use a computer in a patient consultation. He co-designed a model with IBM in 1969, and his work led to the creation of the electronic patient record, the forerunner of the electronic patient record that we will discuss later. Innovators working with NHS England have also been seeking to reduce single-use plastic in gastrointestinal procedures, improving outcomes for haemodialysis patients, as well as improving the environment.
Peter Prinsley
Does the shadow Minister accept that, in order to encourage innovation within the health service, we need to do whatever we can to support clinical academics? It is within the academic departments of universities, where people are working in hospitals and teaching in medical schools, that we see the most fruitful innovations.
Dr Johnson
The hon. Gentleman is right, but there are pressures and challenges for clinical academics, which he will be aware of. I am sure the Minister, in summing up, will tell us what she is doing about those.
We need to support innovation in all parts of the health service, not just in university hospitals. One of my concerns is that there has been a drive towards a hub and spoke model. There are good reasons for that, and there have been some good outcomes for patient care, but in some cases it restricts innovation in the peripheral parts of the model; it can disincentivise innovation and make it more difficult. We need to consider how we support innovation in all areas of the NHS.
Helen Morgan
One of the challenges of recruiting staff in Shropshire relates to exactly that point: some areas of the health service are perhaps less exciting to work in than others. Ensuring that innovation is driven across every NHS site and every region will help us understand the recruitment and retention problems that have plagued some of the country’s more rural areas.
Dr Johnson
The hon. Lady is absolutely right. When I was a very junior doctor, whether one wanted to work in a small hospital in the countryside or a large teaching hospital in a big city mostly related to whether one wanted to study a specialist, narrow field of medicine or a wider, broader field of medicine with a variety of different conditions. During my career, I have seen consultants make choices that meant they had to move from their district general hospital to a teaching hospital in order to make progress—in one case, a consultant was told he would not get a professorship unless he moved. The hon. Lady is right: we need to carefully consider how we support innovation.
I have concerns with the clause as it is drafted. Section 13K of the NHS Act 2006 gave NHS England the power to award prizes in support of innovation. Clause 6 ensures the Secretary of State has that power, but there is a big difference between an arm’s length body of technocrats awarding prizes and a political office holder awarding prizes, because then the prizes come out of taxpayers’ money and Governments are particularly short of that—not because they are not taking higher rates of tax, but because they are squeezing the economy.
There is a risk that those awards, and funding for innovation more broadly, become exposed to political cycles. When Governments face a fiscal straitjacket, Ministers are often quick to slash discretionary spending, even though it provides a long-term return on investment. There is also a risk that prizes will be awarded on the basis of who shouts loudest. Certain charities will want the Government to focus on awarding innovations in cancer care, for example; some unions will want the Government to focus on awarding innovators who achieve greater equity in service delivery. There is little doubt that Ministers will have a tough time batting away lobbyists calling for more funding to incentivise this or that type of innovation.
Clause 6 also gives the Secretary of State the power to set up a committee to provide advice on awarding prizes. It is right that the Health Secretary should solicit expert advice when determining which trusts, teams or individuals deserve incentive payments, but does that require the power to set up what is effectively a whole new quango? The Government created more than 25 arm’s length bodies and advisory councils in their first six months. Does the Secretary of State require the power to pay members of the advisory committee when there are many experts in their field who can give their time charitably? I notice there is no requirement for any prize committee to include the chief scientific officer or representatives from ICBs. It is ultimately an unchecked spending power.
Gregory Stafford
What my hon. Friend describes is the real nub of the Bill. If we are to abolish NHS England and move most of its functions to the ICB level or to the Department of Health under a Secretary of State, it would be utter madness for us to, at best, move one set of bureaucrats from NHS England to the Department of Health and therefore gain no extra efficiency, or at worst, as seems to be the case in this clause, not only transfer the NHS England bureaucrats, but create a whole new set of bureaucrats and committees to continue the functions already performed under NHS England.
We need to understand whether the Bill is really about making our NHS more efficient by removing levels of bureaucracy, as was the stated intent of the Minister and the previous Secretary of State, or whether it is simply a political power grab where we keep all the bureaucrats and the inefficiency of the current system.
Dr Johnson
My hon. Friend, as ever, puts things very succinctly. Much of what is said about the Bill is different from what it seems to mean in practice. We have heard the Government talk about the decentralisation of power so decisions are made locally, but in the oral evidence session, even the union rep said that the Bill is more of a centralisation of power. I agree that creating new bureaucracy to replace old bureaucracy—particularly if that involves redundancies—does not help to save money or to make the system more efficient.
I tabled amendment 58 to make the duty on innovation more robust. It would make clause 6 specifically require the Secretary of State to promote innovation in the provision of services, ensure that innovations are spread and adopted across the NHS, tackle barriers to innovation and consider the wider economic benefits of innovation. That is important, because when we talk to people in the life sciences industry, they tell us that one of the biggest challenges is the roll-out of innovation. They can develop innovations in the UK, but it can take a long time to get them on to the shop floor, which is a disincentive to innovating in the United Kingdom. That process needs to move more quickly.
As currently drafted, the clause does not make it clear what innovation is for or whom it is meant to benefit. Amendment 58 would make it clear that innovation should be to benefit patients, no matter their location or socioeconomic status. I welcome the principle of keeping innovation on the statute book, but innovation is an organic process, and it does not begin in the Department of Health and Social Care or in NHS England—that is a fundamental principle that I think the Government fail to understand across many areas. Innovation begins with the frontline workers: the scientists, the technologists and the people who have ideas about better ways to care for patients. I am encouraged that the Minister understands that.
The Government’s vision for ICBs is that they will have more responsibility and more freedom to innovate—although we will discuss whether the legislation actually delivers that later in the Committee’s consideration—and I hope that vision extends to other areas of health policy. The clause is not disagreeable, but it must be made more robust. If Committee members agree, I hope they will support amendment 58.
The Chair
I gently suggest to all Committee members that it would help me tremendously if they could stand at the beginning of the debate on a group if they wish to be called.
Liz Twist (Blaydon and Consett) (Lab)
I will speak in support of clause 6 and against amendment 58. I work with a great many rare disease groups as part of my work as a Member of Parliament. Those people have specific health needs, and innovation is key to developing ways of dealing with their needs and to making their lives better, so innovation is at the heart of what we do.
We have many great institutions. In my region of the north-east, I will mention Newcastle University, which is doing a huge amount of research into a range of rare diseases and is working collaboratively with other institutions, particularly in partnership, to address those health needs. The clause allows the Secretary of State the breadth to encourage that innovation and to help to make it into a viable spin-off. We too often lose the benefits of the innovation that we create, and it is adopted in other countries.
Amendment 58 would put this important clause in danger of being too prescriptive, and sometimes, if we prescribe particular things, we lose the ability to do other things. I support the clause, and I do not support amendment 58.
Joe Robertson
The clause, and amendment 58, deal with innovation. Although the NHS is responsible for some great healthcare innovations, not only in this country but around the world, unfortunately, it is often an example of a complete failure to innovate, or even to use fairly basic technology that has been around for a long time—I am thinking of using computers for patient records, as paper records have lasted for far too long. Promoting innovation is clearly a good thing—it is essential—so I support the amendment. I will speak about the details in a moment.
Dave Robertson (Lichfield) (Lab)
I think this is the first time we have had a Robertson on Robertson intervention. It is a pleasure to break that duck.
The hon. Gentleman is making a powerful point about the need to change culture to embed innovation across the NHS. There is an example that we always come back to: fax machines. Fax machines were used in the NHS for far too long. It was mandated in 2018 that the use of all fax machines had to be stopped by the end of March 2020, yet in 2023, the NHS still owned 600. That mandation came up against a cultural barrier and it did not work, because 600 of them survived for three years after that.
In amendment 58, I see more mandation and nothing on culture. The problem with the amendment is that, by trying to mandate innovation too closely, we would miss the cultural point. We could undermine the Secretary of State’s power to say that all parts of the system are fair game for them. Would the hon. Gentleman like to respond to that point?
Joe Robertson
I thank my namesake for his intervention. I do not completely understand what he says, because the amendment refers to cultural barriers. He is absolutely right that we have to be careful when we mandate things, but the strength of the amendment is that it has a broad application and does not seek to mandate specific detail. I accept that it has more detail than the Bill, but its strength is that it gives some direction without being overly detailed. I again draw his attention to the fact that it asks the Secretary of State and the Department to identify and remove cultural barriers.
Gregory Stafford
I will not keep the Committee too long. We need to look closely at what the clause is trying to achieve, both on innovation, which I support, and on the prizes. My hon. Friend the Member for Isle of Wight East asked a number of pertinent questions about the prizes, and I want to expand on that before I talk about the amendment in the name of my hon. Friend the Member for Sleaford and North Hykeham.
We have no idea what scale of prize we are talking about. Is it thousands of pounds, tens of thousands of pounds or millions of pounds? Will the prizes be given to individuals or to organisations? Will they be given to NHS bodies? I think not, or at least not exclusively, because the clause suggests that they could be for research. Will they be given to the private sector—I know that Labour Members have antibodies against the private sector—or to university research functions? It is very unclear who the prizes will go to.
Even more interestingly, proposed new section 1CC(3)(b) says that prizes may relate to
“work done at any time (including work before the commencement of this section).”
So they could be given for something that happened prior to the Bill coming into force, but we have no idea how far back that could go. Are we talking months, years or decades? There is no clear outline about who will get the prizes, how much they will be, what innovations or technologies they will be for, or the point in time that is being referred to.
Then the clause says that the Secretary of State may set up a committee. I have been in enough Bill Committees to know that civil servants do not write something into Bills unless they have an idea of what they want to do with it. I would be very interested to hear from the Minister what sort of committee it will be, how many people will be on it, how much remuneration they will receive and how they will establish themselves and fulfil the function that the Secretary of State gives them. If we do not know that, the proposal is so open-ended that I would have real concerns about letting it go forward in the manner in which it is currently written.
My hon. Friend the Member for Isle of Wight East suggested—I do not think he was joking—that the word “prize” made this sound like a game show. That is part of what we need to understand. Will the Secretary of State set up a competition in various areas of healthcare, technology, disease or treatment? Will they say, for example, “We want to find the best technology for dealing with cataracts”? Will a call go out for people to submit bids and say, “We have produced this amazing new laser treatment,” in order to win the prize? Or will it be entirely open-ended? Will people come into the Department of Health and Social Care to this new committee and say, “We have created this amazing piece of innovation—give us some money for having done so”? It is so unclear in the Bill. As I say, I am absolutely certain that the Minister knows the answer to those questions because this clause and subsection would not be in the Bill if she had no idea what she was hoping to achieve by them.
Dr Johnson
My hon. Friend is describing something a little like “Dragons’ Den”, which is a very good TV programme—perhaps it will be televised or livestreamed. How will the Government ensure that there is no conflict of interest?
Gregory Stafford
My hon. Friend’s point is correct. There is so little detail in the clause about how these prizes will be awarded and how the committee that will award them will be set up that we have no idea how conflicts of interest will be dealt with. That is another reason that the Minister needs to explain to the Committee how this is going to work. My hon. Friend mentions “Dragons’ Den”. I see her as the Deborah Meaden of our Committee, so I look forward to seeing that play out—I will not say what that makes me.
What I see from amendment 58, tabled by my hon. Friend the Member for Sleaford and North Hykeham— I hope I am not misrepresenting her—is once again an attempt to codify, clarify and strengthen what is fairly woolly wording within the Bill. In particular, her amendment rightly emphasises the importance of
“timely adoption and spread of clinically effective innovations”.
Timeliness is so important to patients. We need innovation quickly. Again, it worries me that the prizes could be given for innovations that could have happened weeks, months, years or decades ago, according to the wording. We also need to ensure that innovation is not in isolated pockets, either in terms of geography or type of service. We need something that is consistently delivered across the healthcare system.
By highlighting the need to address things such as procurement, the regulatory sector and cultural barriers, my hon. Friend’s amendment would support a more proactive and enabling environment for innovation to flourish, not one that shuts it down, as some Labour Members have suggested. Crucially, paragraph (d) of the amendment represents a significant and commendable commitment to fairness and inclusion by prioritising equal access to new technologies, medicines and models of care regardless of geography or socioeconomic background. It would help to tackle long-standing inequalities and move decisively towards ending the postcode lottery that we often see in care quality.
The focus of the amendment would ensure that innovation benefits all patients, not just those in the most advantaged areas. It would ensure that rural and coastal communities are aligned with the urban. As someone who represents a semi-rural seat, I see those inequalities in service delivery, quality of care and innovation. The large towns in my constituency receive far more money and get far better services than the surrounding villages.
I have many concerns about the clause as it currently stands, and I hope that the Minister will be able to clarify some of the Opposition’s questions. I entirely endorse amendment 58.
Karin Smyth
I am grateful to hon. Members for bringing this discussion to the Committee. We heard about the excitement in our constituencies around innovation—my hon. Friend the Member for Blaydon and Consett mentioned Newcastle University at the start and the hon. Member for Sleaford and North Hykeham mentioned her visit to Imperial College. Those visits are inspiring. Other universities and centres of excellence are available, but they made the case for why this is so important to the Government’s approach to innovation. I will talk about that and then turn to the amendment.
The Government are fully committed to innovation. It is absolutely central to our ambitious priorities to digitise health and care, support prevention and early diagnosis, and enable a shift to neighbourhood care, to growth in our economy, and to regaining our place in the world as a centre for innovation, which was lost under the Conservatives over those 14 years. That is why clause 6 places a clear duty on the Secretary of State to promote innovation in the provision of health services, including in how services are arranged and delivered.
The clause also incorporates the Secretary of State’s existing power to incentivise innovation and research through the payment of prizes, as we have discussed. That is a flexible tool that will allow him to stimulate breakthrough ideas and reward innovation across the life cycle, including an early-stage report.
On some issues that have been raised, the Conservative party knows that Ministers have to act reasonably as this transfers from NHS England, and we would obviously want to tailor a committee to the matter in question, including membership. The clause will allow that flexibility. The equivalent duty was on NHS England; I understand that it has not actually been used over the past five years, but it was previously suggested as a way of promoting innovation.
In practical terms, the Secretary of State already supports innovation in a number of ways, for example through the work of the Health Innovation Network, supporting workforce developments in schemes such as the clinical entrepreneur programme and providing funding support for developing and evaluating promising innovations.
Dr Johnson
The Minister talked about the flexibility of the committee, and my hon. Friend the Member for Farnham and Bordon explained why it is helpful to have some direction. Could the Minister explain why there is no stipulation for the chief medical officer or the chief scientific officer to be part of the committee?
Karin Smyth
I am happy to come back to the hon. Lady if I am not correct in this, or if there is another reason, but in the existing duty and under NHS England, the committee’s membership needs to reflect the matter in the question. If there is anything to add to that, I will certainly come back to her. We are also committed to spending more on innovation, raising the NICE threshold to ensure that patients have access to more innovative medicines on the NHS. That is action, not just words.
The Government commend the intent behind the amendment tabled by the hon. Lady, and she spoke well about that. As a clinician, I recognise her support for innovation, but we recognise that barriers remain to the systematic spread of innovation. That is a long-term problem that existed under previous Governments as well, and we seek to rectify it. The ministerial foreword to the “Life Science Sector Plan” published last year says:
“We are clear-eyed about the challenges. For too long, the journey from discovery to delivery has been too slow, too fragmented, and too often held back by outdated systems.”
That is why we need to remove barriers at every stage of the journey; however, the amendment is the wrong way to do that.
The experience of supporting innovation in the NHS suggests that we need flexibility in our approach to tackle emerging barriers as they arise. Specifying several areas of focus in the Bill would limit that flexibility; those are better set out in published strategies and guidance, which is what we are doing. The amendment could also cause unintended consequences. It would create a one-size-fits-all approach, requiring all of England to have equivalent access to innovations. While tackling unwarranted variation is of course vital, we should continue our focus on providing access to innovation that best meets local needs.
Instead of over-defining what we mean by innovation in legislation, we are taking practical measures to drive it on the ground. We are already building the 10-year health plan and the life sciences sector plan to deliver an ambitious set of actions, which address the areas raised by the amendment including procurement, aligned regulation and the alignment of our NHS innovation policy with sector growth policy. That echoes our approach elsewhere in the Bill of devolving power to local levels and giving more opportunity to systems and organisations to innovate, and more agency to use their resources to do so.
The NHS has a strong record of developing and adopting new treatments, technologies and models of care. The clause will build on that record, signalling the Secretary of State’s clear commitment to promoting innovation, and it will do so in a flexible way that will allow us to respond to challenges as they emerge. For that reason, I ask the hon. Member for Sleaford and North Hykeham to withdraw her amendment, and I commend the clause the Committee.
Question put, That the amendment be made.
Peter Prinsley
I beg to move amendment 33, in clause 7, page 4, line 31, at end insert—
“(2) Training under subsection (1)(a) includes training in general health determinants as defined by section 107ZB of the Local Democracy, Economic Development and Construction Act 2009.”
This amendment would place a duty on the Secretary of State to ensure that the health and care workforce is adequately trained in the wider determinants of health such as housing standards, exposure to air pollution, occupational risk, and use of harmful substances like tobacco.
The Chair
With this it will be convenient to discuss the following:
Amendment 50, in clause 7, page 4, line 32, at end insert—
“(4) After subsection (2) insert—
‘(2A) The Secretary of State must publish independently audited forecasts of the NHS’s workforce needs every five years.’”
This amendment would require the Secretary of State to publish independently audited forecasts of the NHS’s staffing needs every five years.
Amendment 54, in clause 7, page 4, line 32, at end insert—
“(4) The Secretary of State must exercise functions under this section with a view to ensuring that managers in the NHS, who have appropriate clinical training, must also undertake clinical care.
(5) The Secretary of State must record the proportion of direct clinical care provided by those with professional qualifications both in terms of the proportion of their areas and full time equivalent by pay grade, and the Secretary of State must increase the proportion.”
This amendment would require the Secretary of State to ensure that NHS managers who are clinically trained must continue to undertake clinical care.
Clause stand part.
New clause 44—Medical training places—
“The Secretary of State must double the number of medical school training places to 15,000 by 2031-32.”
This new clause would put a duty on the Secretary of State to double the number of medical school training places.
New clause 45—Data collection: clinically trained staff—
“(1) The Secretary of State must collect and publish data on the numbers and proportion of NHS staff are qualified to deliver nursing and clinical care who delivering nursing care, or clinical care of any kind, and those who are not.
(2) Information under subsection (1) must be collected according to HCAS pay scales.
(3) Information under subsection (1) must include numbers of nursing and midwifery staff.
(4) Information under subsection (1) must be published quarterly.
(5) The NHS and ICBs are under a duty to comply with any requests from the Secretary of State for data for this purpose.
(6) Information under subsection (1) must include the proportion of time spent delivering clinical care as a proportion of the individual’s total working hours.”
This new clause would require the Secretary of State to collect and publish data on the numbers and proportion of clinically qualified staff who are delivering clinical care, broken down by HCAS pay band.
Peter Prinsley
As the Committee knows, my hon. Friend the Member for Worthing West (Dr Cooper) is one of the five medical doctors in the parliamentary Labour party. It is a great pleasure to move the amendment, which she tabled.
The amendment is about education and training. My hon. Friend would like us to consider whether there should be an additional subsection after proposed new subsection (1)(a), which is about ensuring that
“there are sufficient people with appropriate education and training to meet the workforce needs of the health service”.
My hon. Friend would like to include within that specific training about wider health determinants, which, as we discussed earlier this morning, consist of things like housing, air quality, occupation, and substance abuse—tobacco, alcohol and so on. Her opinion is that that needs to be specifically incorporated into the legislation.
Gregory Stafford
I shall speak briefly to the amendment that was just moved by the hon. Member for Bury St Edmunds and Stowmarket. I do not mean this rudely, but it is a relatively motherhood-and-apple-pie amendment. The onus would be on the Secretary of State to recognise that smoking, exposure to air pollution, occupational risk and harmful substances are bad, but I think we all agree on that. If the Secretary of State, or any future Secretary of State, does not already recognise that, I would be pretty surprised.
I have a number of issues with the amendment, the first of which is that it expands some central duties without clear limits. Potentially, it could be a gateway to what I would describe as interventionism. Perhaps, too, it lacks some of the prioritisation or proportionality that I would like to see in the Bill—as I have said, however, I think that otherwise the training element is pretty good.
Moving to amendment 50, in the name of my hon. Friend the Member for Sleaford and North Hykeham, I entirely support it. This amendment would be extraordinarily useful, because the NHS publishes independently audited forecasts of the workforce every five years, but the amendment would lead to better long-term planning. Regular, independently audited forecasts would help the NHS to anticipate staffing needs, plan training and recruitment, and use resources more effectively and with more efficiency.
Amendment 50 would also increase transparency and trust. One of the key things that we will need to do as a Parliament when the Bill becomes an Act is to convince the public that, when this new world of how the NHS is going to be managed and operated comes in, they can have confidence that the treatment they get is the best that it can be and that those who are being trained and working in the NHS get the training that they require and are being established as some of the best in the world.
Independent audits would make such forecasting more credible and give reassurance to the public and the stakeholders that the workforce planning is evidence-based and not potentially politically influenced, which is one of the big problems about having the Secretary of State in charge of everything throughout the Bill. The key thing must be improved patient care. Accurate workforce predictions will ensure that we have the right number of healthcare professionals available. We will see a reduction in shortages and more consistent, high-quality care.
I support amendment 54, in the name of my hon. Friend the Member for Sleaford and North Hykeham, because it ensures that clinically trained managers maintain patient-facing roles, making better use of scarce clinical expertise and improving workforce efficiency. It strengthens accountability, like amendment 50, by tracking and increasing the proportion of care delivered by qualified professionals, helping to optimise staff deployment and reduce pressure on frontline services. I have some concerns about amendment 33, but amendments 50 and 54 have my support, and clause 7, hopefully amended, will also have my support.
Sojan Joseph (Ashford) (Lab)
I rise to support clause 7 and amendment 33, tabled by my hon. Friend the Member for Worthing West. Having worked in the NHS for many years, I have seen that education and training, especially mandatory training, is absolutely necessary. Some may argue that health staff have too much training, particularly mandatory training, but this amendment specifically concerns training
“in the wider determinants of health such as housing standards, exposure to air pollution, occupational risk, and use of harmful substances like tobacco.”
We may have staff, especially those working in mental health, who have training in some of those areas, but staff in A&E, where patients first present, may not have that training, and may be missing that curiosity. We have heard many incidents involving families living in mouldy houses or people exposed to air pollution. It is important that staff have the curiosity to consider where a patient has come from when they turn up at A&E, or, when planning a discharge, where they are being discharged to.
In the last few years, we have seen many internationally trained healthcare workers join our health sector who may not be familiar with the social and housing situation in this country. Whether this is to be a part of their initial training as nurses or doctors, or through mandatory training at work, the amendment is important because it could help to prevent illnesses and identify them earlier through professional curiosity. I support amendment 33.
Dr Johnson
I declare an interest as a member of the NHS workforce and an NHS consultant paediatrician. In England, around one in every 17 working people is employed by the national health service. That is quite a shocking statistic. It is the largest employer in the country and, indeed, in Europe. It has grown significantly over time, in part because the needs of the population have changed. Life expectancy is longer, which is something to be cherished—that is a good thing—but it brings challenges to the health service, as people are more likely to be living with multiple chronic conditions rather than easily treatable ailments. They require more tests, medicines and clinical care. Demographic change requires a larger NHS workforce, particularly in secondary care.
The previous Conservative Government not only recognised the scale of that challenge but took swift action to increase staffing levels across the board, adding more than 42,000 doctors and 55,000 nurses, health visitors and midwives. Conservative Ministers also supported the pipeline responsible for producing the next generation of medical practitioners. They funded 1,500 additional medical school places and opened five new medical schools, including in Sunderland, Lancashire, Chelmsford and Canterbury, and one just outside my constituency in Lincoln. Emergency care became the fastest-growing specialty, with the number of emergency care doctors doubling. That is what support for the NHS workforce looks like.
Conservative investments in the workforce helped to improve survival rates for cancer, increase the number of GP appointments and deliver the fastest vaccine roll-out in Europe. Under existing legislation, the Secretary of State has a responsibility to ensure that there is an effective system for planning and delivering education and training to current and potential staff. Health Education England has been rolled into NHS England, so it is ultimately NHS England that has the duty to ensure sufficient and appropriately trained staff to meet NHS workforce needs. Now that NHS England is to be abolished, it is right that this duty is to be given to the Secretary of State through clause 7, although to some extent it is a statement of the obvious that that is part of his job.
The job of members of this Committee is to improve the Bill, not just wave it through, and that means recognising that the existing legislation had some inadequacies. Clause 7 states:
“The Secretary of State must exercise functions…with a view to ensuring”
several things about the workforce. It is not a cast-iron requirement; the Secretary of State must just think about it, but actually he should not just think about his job; he should get on with it. I have a bit of a bee in my bonnet about legislation that creates obligations that are easy to proclaim and that are virtuous but are difficult to measure. Such legislation makes legislators feel good about themselves because they are writing nice things into legislation, but they are not really robust. What does
“sufficient people with appropriate education”
mean? What is “sufficient”?
One reason concerns are particularly acute is the Government’s shambolic record on workforce planning. They came to power saying that they had a plan, but their workforce plan has still not been published, almost two years since they came into office. I heard the Minister say “imminently”, but I had a written answer last week, I think, saying “imminently”. I appreciate that “imminently” is probably better than “soon”, but what does it really mean, and how soon can we expect the plan to be published? Does she mean that it is coming this week or next? Can she guarantee that it will be published before the summer recess? Has the Prime Minister’s resignation yesterday put all this up in the air once again?
The Royal College of Radiologists has said that the shortfall in clinical radiologists has grown from 29% to 32% since 2024, and the Royal College of Nursing has released data showing that the growth in the nursing workforce slowed last year to its lowest level in eight years. Newly qualified midwives are finding themselves with no jobs to go to in the health service, despite the fact that there is a maternity staffing crisis in some areas. Will the Minister explain the reason for the delay? She said earlier in this sitting that it was not NHS England, but what is causing the delay?
We were told that stakeholders wanted more time to have conversations, test ideas and work together. One would think that after the many months of deliberation, Ministers would have put together an exceptional workforce plan, but the Royal College of Nursing, the British Medical Association, of which I am a member, Unite the union and several other organisations wrote to the Health Secretary earlier this month to urge for the plan, which they have but which has not been published, to be “paused”, because they are
“concerned that the current direction falls significantly short of the scale of workforce growth required to meet patient need and relies too heavily on assumptions about the current state of NHS services, productivity and technology that are not borne out of frontline experience.”
I recently tabled a question asking who had been given advanced sight of the workforce plan, and I received confirmation that the royal colleges and unions have been involved. As I mentioned, I am a member of the Royal College of Paediatrics and Child Health. We now have a situation where a workforce plan is being delayed, and it has been brought before other organisations for discussion rather than elected Members of this House. It is taking far too long. In the meantime, things are going backwards. It is simply not good enough. Ministers are now about to roll out a plan that has mortified seemingly everyone who has seen it, while expecting members of the Committee to rubber-stamp a rather flimsy legal duty.
In May, the Financial Times reported that plans drawn up under this Government would see recruitment cut back. The article reads:
“A workforce plan being finalised by health officials says the NHS in England will have to use technology to get by with hundreds of thousands fewer staff than envisaged under the previous Conservative government.”
Is that clinical staff? Are we going to have fewer doctors? It is not clear because we have not seen the plan and it has not been published. A draft of the plan seen by the newspaper said that the NHS
“does not need anything like the…numbers…set out in its 2023 workforce plan.’
Will the Minister confirm whether those press reports are accurate? She previously said that her plan
“will ensure that the NHS has the right people in the right places with the right skills for patients when they need them”.—[Official Report, 13 January 2026; Vol. 778, c. 737-738.]
Does that mean fewer people and more AI?
Health Bill (Fifth sitting)
Tuesday 23rd June 2026
(1 month ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 23 June 2026 - (23 Jun 2026)
The Committee divided: - Ayes: 4 / Noes: 11 - Question accordingly negatived.
The Committee divided: - Ayes: 3 / Noes: 10 - Question accordingly negatived.
The Committee divided: - Ayes: 3 / Noes: 11 - Question accordingly negatived.
The Chair
Good afternoon, ladies and gentlemen. Members may remove their jackets and, because of the health warning—exceptionally—if Members or civil servants wish to remove their ties, they may do that as well. Please understand that that is not a precedent.
Clause 7
Education and training
Amendment proposed (this day): 33, in clause 7, page 4, line 31, at end insert—
“(2) Training under subsection (1)(a) includes training in general health determinants as defined by section 107ZB of the Local Democracy, Economic Development and Construction Act 2009.”—(Peter Prinsley.)
This amendment would place a duty on the Secretary of State to ensure that the health and care workforce is adequately trained in the wider determinants of health such as housing standards, exposure to air pollution, occupational risk, and use of harmful substances like tobacco.
Question again proposed, That the amendment be made.
The Chair
I remind the Committee that with this we are discussing the following:
Amendment 50, in clause 7, page 4, line 32, at end insert—
“(4) After subsection (2) insert—
‘(2A) The Secretary of State must publish independently audited forecasts of the NHS’s workforce needs every five years.’”
This amendment would require the Secretary of State to publish independently audited forecasts of the NHS’s staffing needs every five years.
Amendment 54, in clause 7, page 4, line 32, at end insert—
“(4) The Secretary of State must exercise functions under this section with a view to ensuring that managers in the NHS, who have appropriate clinical training, must also undertake clinical care.
(5) The Secretary of State must record the proportion of direct clinical care provided by those with professional qualifications both in terms of the proportion of their areas and full time equivalent by pay grade, and the Secretary of State must increase the proportion.”
This amendment would require the Secretary of State to ensure that NHS managers who are clinically trained must continue to undertake clinical care.
Clause stand part.
New clause 44—Medical training places—
“The Secretary of State must double the number of medical school training places to 15,000 by 2031-32.”
This new clause would put a duty on the Secretary of State to double the number of medical school training places.
New clause 45—Data collection: clinically trained staff—
“(1) The Secretary of State must collect and publish data on the numbers and proportion of NHS staff are qualified to deliver nursing and clinical care who delivering nursing care, or clinical care of any kind, and those who are not.
(2) Information under subsection (1) must be collected according to HCAS pay scales.
(3) Information under subsection (1) must include numbers of nursing and midwifery staff.
(4) Information under subsection (1) must be published quarterly.
(5) The NHS and ICBs are under a duty to comply with any requests from the Secretary of State for data for this purpose.
(6) Information under subsection (1) must include the proportion of time spent delivering clinical care as a proportion of the individual’s total working hours.”
This new clause would require the Secretary of State to collect and publish data on the numbers and proportion of clinically qualified staff who are delivering clinical care, broken down by HCAS pay band.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Before the lunch break I was saying that, in essence, clause 7 states what the Secretary of State’s job is. It moves the function of planning the workforce from NHS England to the Secretary of State, which is a reasonable thing to do. I talked about the previous Government’s record on opening new medical schools and how that has helped with the number of clinical staff.
We also talked about workforce planning. The Government are due to produce a workforce plan, but it is not clear when it is due to come out. It was due to come out at the end of last year, but it did not; it was then due to come out in the spring, but now it is the summer. Given the Prime Minister’s resignation, it is not at all clear when it will come out. Will the Minister let us know whether it will come out before the summer recess, this week or whenever?
I quoted some of the concerns of the Royal College of Nursing, the British Medical Association, of which I am a member, and others. Those concerns include the workforce plan. Those organisations have seen what we have not seen, so they have been asked to comment on something that we have yet to see. That brings me to new clause 44, which is in my name.
Before the general election, Labour promised that it would double the number of medical school places. The now Chancellor of the Exchequer promised to double the number of medical school training places, as did the now Secretary of State for Science, Innovation and Technology. Once the general election had passed and Labour was in government, the promise was reiterated. At oral questions in October 2024, the now former Health Secretary said:
“This Government are committed, as we were in opposition, to doubling the number of medical school places”.—[Official Report, 15 October 2024; Vol. 754, c. 683.]—
but there has not really been any progress.
During a debate this year on the junior doctors’ foundation programme, I asked the Minister for Care whether the Government’s intention was still to honour that pledge. He said:
“Yes, that is the Government’s intention.”—[Official Report, 22 April 2026; Vol. 784, c. 133WH.]—
only to later submit a written correction stating that the Government had never committed to doing so. Are they going to, or not? It is not clear.
Labour promised to double the number of medical school places, but now that pledge appears to have been airbrushed out of history. Can the Minister please explain why she and her colleagues deemed the workforce pledge essential before the election but not after it? Can she tell us whether it is Government policy? In essence, my new clause 44 asks Members on the Government Benches to vote for what they promised before the election and have promised since.
New clause 44 is very simple: it stipulates that the Secretary of State must double the number of medical school training places by 2031-32. That is what Labour promised, so it should be fairly easy for Labour Members to vote for it. I hope that the Committee will support the new clause, which only requires Ministers to do what their party promised before it came into government.
If the Government are not keen on committing to clear targets, they can at least commit to full scrutiny of their workforce plans. Of course, there is a risk that the House has been misled. Either the promise was made or it was not. The Minister for Care said that it was promised and then submitted a written correction to say that that was inaccurate and that it was never Government policy, but if it has been stated by the Secretary of State at the Dispatch Box, representing the Government, then it is Government policy. Can the Minister help to clarify that point? If the House has been misled by either her former boss or the Minister for Care, perhaps she can clear that up for us. Perhaps the vote will help.
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
Does the shadow Minister agree that if we doubled the number of medical students, we would simply not be able to accommodate those people as young doctors unless we also doubled the number of training places? After five or six years, those medical students become young doctors. If we are to correct any problem with the medical workforce, it is insufficient to simply state that we will double the number of medical students.
Dr Johnson
The hon. Gentleman is right. When all the new doctors that the Government have promised have been trained, they will need jobs and postgraduate medical training, and there are issues with that. Nevertheless, the Government asked the public to vote for them on the basis that they would double the number of medical school places. Many of the hon. Gentleman’s colleagues produced little videos to that effect, which can be viewed on Twitter. They toured the newsrooms saying, “Please vote for us, we’re going to double the number of medical school places.” They suggested that there would be a revolution in Government to make sure that there were enough doctors. This is important—more doctors would help.
All new clause 44 does is ask the Government to commit to doing what they have said that they will do—or to say that they will not. Either way, we have had the Secretary of State saying one thing and a Minister saying the opposite and then correcting it, so we need clarity. The public deserve that. The Minister herself said that they would double the number of medical school places so that we have the doctors that our NHS needs. If they do not double the number of medical school places, it follows that they will not have the number of doctors that the NHS needs. Presumably that is in their workforce plan, but it needs to be cleared up.
Amendment 50 would put a duty on the Secretary of State to publish independently audited forecasts of the NHS workforce every five years. The logic is straightforward: if the Government believe that their plans are sufficient, they can be compared to an impartial assessment of the workforce. The previous Government published a workforce plan in 2023, setting out how to tackle existing and future workforce challenges over several years. That included doubling the number of medical school places. Yet three years later, this Government are on course for a new plan that is reportedly far less ambitious—we will find out in a minute.
The workforce affects whether patients can be seen on time, maternity wards are safely staffed and elderly patients get the dignity they deserve. It is the difference between the NHS meeting the challenge of an ageing population or slipping into decline. If Labour Members are confident that the Minister’s workforce planning is robust, I expect that they will support my amendment, which requires an independently audited forecast. If they are not willing to support it, that suggests that they know this Government cannot be trusted to deliver the workforce that patients need.
Amendment 54 and new clause 45 were also tabled in my name. Amendment 54 would require the Secretary of State to look at the amount of clinical work that NHS managers undertake. As a clinician, I have increasingly noticed that highly qualified clinical practitioners come in, become the person on the ward who can be relied on, and then go off because they get promoted to a nine-to-five job that is easier and pays more, but does not deliver clinical care.
The chief medical officer, for example, still delivers clinical care, and the amendment probes the Government to consider how many nurses and clinicians in hospitals are delivering clinical care. I asked that in written questions, and the Government did not know the answer. It is materially important information, particularly when looking at the Dash report, which talks about an explosion in the number of people who are clinically trained but not providing clinical work—instead, they are creating guidelines and monitoring whether other clinicians are doing the work. If more of those people were engaged in clinical activity, that might improve the quality of both the guidelines and care, because more junior staff would have senior staff around to help them.
Sojan Joseph (Ashford) (Lab)
I strongly support the argument that clinical staff, even if they progress into a senior role, should carry out some sort of clinical practice. Does the hon. Lady agree that that is what went wrong over the past few years, especially when NHS England was created? Many senior clinicians who were moved into management posts had no contact with clinical areas. That is what this Government are trying to fix by abolishing NHS England.
Dr Johnson
I am talking predominantly about clinicians working in trusts who are trained and very experienced, but then move to work in the same trust but in a more managerial role that does not involve clinical care. I am not saying that every single person needs to be delivering clinical care—there may be exceptions, of course; people do have career changes—but I encourage the Government to reflect on the number of posts being created that take people away from the clinical arena, and on the effect that that has. When the Minister is presented with the number of nursing or midwifery-qualified staff working in a particular department, that may not reflect the number who are delivering clinical care and, by their own admission, the Government do not know which is which.
Amendment 33 would place a duty on the Secretary of State to ensure that the workforce is trained on the wider determinants of health, such as housing standards, air pollution and the use of harmful substances. In my many years as a paediatrician, I have yet to meet a nurse, doctor, surgeon, porter or care co-ordinator who does not know that damp and mould are bad for people’s health, and I have yet to meet a fellow employee who does not know that air pollution causes asthma, or that tobacco use increases the risk of chronic obstructive pulmonary disease, cancer and a whole host of other ailments.
Considering the many pressures on NHS workers, I do not believe that mandating a new programme on health determinants is a good use of time. I fear that it is rooted in the agenda of creating more and more mandatory training, and I would actually encourage the Minister to look at rationalising mandatory training to that which is absolutely necessary. Control of the curriculum for such staff is dealt with separately, so I object to amendment 33.
Joe Robertson (Isle of Wight East) (Con)
It is a pleasure to serve under your chairmanship, Sir Roger. Clause 7 says—I abbreviate:
“The Secretary of State must exercise functions…with a view to ensuring that…there are sufficient people with appropriate education and training to meet the workforce needs of the health service, and…there is an effective system in place for the planning and delivery of education and training of people to meet those needs.”
That is all very nice—who couldn’t agree with that?—but amendment 50, tabled by the shadow Minister, would add a means by which the public, in the interests of transparency, could make an assessment of that by requiring the Secretary of State to publish independently audited forecasts of the NHS’s workforce needs every five years. That seems entirely sensible, it is something that I am sure any Government would want to do anyway, and it would add meaning, assessment and transparency to what is already in the Bill.
New clauses 44 and 45 would do something similar in relation to the number of medical school places. As the shadow Minister said in response to an intervention, new clause 44 seeks to do only what the Government have already said they want to do. Hopefully, the Minister can give us some clarity on whether that is still the Government’s intention and, if it is, what aversion she has to including it in the Bill.
Separately, new clause 45 seeks to establish a benchmark of data collection. Of course, duties and requirements placed on a Secretary of State, such as those in clause 7, can be delivered only if we start with the proper collection of data and, in the interests of transparency, publish it. For that reason, I also support new clause 45.
The Minister for Secondary Care (Karin Smyth)
I thank hon. Members for bringing this discussion before the Committee. The Government are committed to ensuring that the NHS has the right people in the right place and with the right skills to care for patients when they need it. We will be publishing our 10-year workforce plan imminently. I cannot give the shadow Minister any more details on that at the moment, but it will set out the action to create a workforce that is ready to deliver the transformed service set out in the 10-year health plan. High-quality education and training for the NHS workforce will be fundamental to that, and clause 7 is in keeping with that commitment.
Before turning to the clause, I will address some of the issues raised during the debate and in the amendments. I understand the intention behind amendment 50, but I cannot accept it. The 10-year workforce plan will set out the staffing needs of the NHS for the next 10 years. That goes further than the amendment calls for and will be updated every two years in line with our manifesto commitment to publish regular, independent workforce planning. It is only because the Government have set such a clear direction for the service through the 10-year health plan that we can credibly set out a sustainable approach to staffing the NHS over the long term.
As hon. Members will understand, workforce planning is a complex topic. It is closely related to the wider service planning, which is why we have engaged so widely with independent experts to develop our forthcoming workforce plan. To divorce the process of workforce planning from service planning in the way that is suggested by amendment 50 would not produce a more reliable or useful set of forecasts. However, it would reduce the potential for innovation and reform of the kind that is needed and which the Government have set out so clearly in the 10-year plan for the NHS. I can only conclude from listening to Opposition Members that they really did learn absolutely nothing from their time in office or, indeed, from the problems with their workforce plan, which focused on headcount but notably did not reform care, did not look at new patterns of care, did not look at retention or training, and created some of the bottlenecks and problems that we have had to deal with.
Our commitment will be guided by the workforce plan, which is why we cannot accept new clause 44. Decisions on training numbers must be guided by workforce need, and that will have to be considered as part of the forthcoming plan. Adding to the point made by my hon. Friend the Member for Bury St Edmunds and Stowmarket, whatever the Government’s position on the number of medical school places that will be required in the future, fixing a number in primary legislation would be unhelpful as it would limit our ability to adjust target training numbers subsequently to reflect any changes in workforce need.
I was asked about correcting the record. The last Government did double places in their 2024 workforce plan, and I commend the movement of medical schools across the country. If the former Secretary of State is reported in Hansard as having said something contrary to the correction of the record by my hon. Friend the Minister for Care, we will of course pick that up.
Amendment 54 and new clause 45 look to reduce flexibility and increase bureaucracy for a workforce that is simply trying to deliver what is best for patients. On amendment 54, I think we can all agree that we need strong leadership and management to deliver national priorities, including the 10-year plan’s three shifts. Having a clinical voice in management positions is vital and many of our board-level and senior leaders are also clinicians. While some choose to carry on with clinical practice, others might prioritise their managerial role, and it is right that they should have that flexibility. Prescribing that all NHS managers with clinical experience must also undertake clinical care risks reducing board capacity and expertise, including clinical leadership, and disincentivising opportunities for management experience at a time when the NHS has seen a reduction in the number of managers per NHS staff from 2010 to 2025. We do not think that simply prescribing that requirement would benefit clinicians, managers or, crucially, the wider health service, so we oppose the amendment.
New clause 45 would require the collection of further data on the proportion of time spent on clinical care. Detailed statistics on the number of staff working for NHS provider trusts broken down by profession and pay band are already published by NHS England on a monthly basis. Adding requirements to that is not simple. There is not a centrally held collection of data about NHS staff time, and setting one up would have costs both centrally and for NHS trusts to collect specific data. It is also not easy to separate out clinical care meaningfully. Clinicians spend time in supervision, education, safeguarding, quality improvement and clinical leadership, and the amount of time they spend on different activities can vary from month to month. The new clause risks putting more burdens on NHS staff if they are being asked to record what they are spending time on beyond existing procedures. We therefore cannot accept it.
I turn to amendment 33, which was moved by my hon. Friend the Member for Bury St Edmunds and Stowmarket, on workforce training. It would require the Secretary of State to intervene in the content and design of healthcare programmes. Standards of proficiency, conduct and performance of registered professionals are the statutory responsibility of independent healthcare regulators, although universities and practice partners develop the specific content and design of programmes to meet those standards. It is vital that the independence of regulators and universities is maintained to respect their expertise in designing standards and curricula that ensure public safety.
We have published our 10-year health plan setting out major NHS reforms, including moving from sickness to prevention. Supporting healthcare workers to address the wider determinants of health will be essential to delivering that shift. That is why we are providing the “All Our Health” e-learning on critical public healthcare topics for people working in the health and care sector, and revitalising the “making every contact count” approach to ensure that every contact that a person has with the healthcare system supports a shift to prevention.
I assure colleagues that our upcoming 10-year workforce plan will set out plans for ensuring that we train the staff we need so that we have the brightest people and the right skills to support patients. For those reasons, I ask my hon. Friend to withdraw the amendment.
Finally, I turn to clause 7. The Secretary of State already has an overarching duty in relation to the education and training of the NHS workforce. Currently, that duty is partially delegated to NHS England. NHS England also has a duty to ensure that there are sufficient numbers of appropriately trained healthcare workers across England. Clause 7 will simply merge those existing duties into a single, robust education and training duty on the Secretary of State.
The Secretary of State will be entirely responsible and accountable for exercising relevant functions with a view to ensuring that there is an effective system for the planning and delivery of healthcare education and training, and that we have enough healthcare workers with the right training to meet England’s health service needs. Bringing those duties directly under the responsibility of the Secretary of State will reduce bureaucracy, streamline oversight and enable the Government to provide national strategic leadership across the NHS workforce.
I reassure colleagues that accountability will not be diluted. Bringing these responsibilities into the Department will create clearer, stronger lines of accountability with the education and training of the NHS workforce. Ultimately, the Secretary of State will continue to be accountable to Parliament for the health service in England, including for the planning of education and training and ensuring sufficient numbers of trained healthcare workers. I commend the clause to the Committee.
Peter Prinsley
I am happy with those assurances, so I beg to ask leave to withdraw amendment 33.
Amendment, by leave, withdrawn.
Amendment proposed: 50, in clause 7, page 4, line 32, at end insert—
“(4) After subsection (2) insert—
‘(2A) The Secretary of State must publish independently audited forecasts of the NHS’s workforce needs every five years.’”—(Dr Caroline Johnson.)
This amendment would require the Secretary of State to publish independently audited forecasts of the NHS’s staffing needs every five years.
Question put, That the amendment be made.
Karin Smyth
Clause 8 will give the Secretary of State the power to direct integrated care boards to exercise his or her functions. This power, similar to that currently employed by NHS England, will promote subsidiarity by enabling such functions to be delivered at the lowest appropriate level. The clause builds on the existing section 7B of the National Health Service Act 2006, which allows the Secretary of State to direct ICBs but only in respect of public health functions.
With our plans to abolish NHS England, the Secretary of State will again have broad powers and responsibility relating to the health service, and so this power encompasses a wider range of functions. Unlike the delegated frameworks set out under sections 65Z5 and 75 of the 2006 Act, which are entered into voluntarily, any integrated care board directed under this power would be obliged to carry out the stated functions.
I reassure the Committee that, while the ICB will be legally responsible for how it discharges a function, overall accountability will remain with the Secretary of State. Furthermore, the Secretary of State might also use directions to place restrictions on the onward delegation of any functions, preventing delegation where it may be inappropriate. Finally, any directions must be published, ensuring transparency and allowing proper accountability.
This measure will empower the Secretary of State to assign functions to ICBs where most appropriate. It aligns with and facilitates our broader direction of travel towards flexibly planned and delivered local services. I therefore commend the clause to the Committee.
Dr Johnson
Clause 8 is essentially about the control that the Secretary of State has over ICBs. When we discussed the clause abolishing NHS England, we talked a lot about the balance between democratic accountability on the one hand and independence from political interference on the other.
The Government suggest that the Bill is a decentralising Bill. What this clause does is essentially to recentralise by default. As the Minister has just said, the Secretary of State can change what the ICB is doing if they think that it is inappropriate. What does “inappropriate” mean exactly, and how will that power be used? It may be used very infrequently—perhaps the current and previous Secretaries of State think that the power would be used infrequently—but equally it could be used in response to considerable pressure from MPs, lobbyists and campaign groups. Instead of issuing directions sparingly, we may end up in a position where the Secretary of State is issuing day-to-day instructions.
The Government want ICBs to take greater responsibility for commissioning decisions, but then they want to be able to undermine them by direction from the Health Secretary. The Health Secretary will never have as good a grasp of the situation in the local geographic area as local leaders, but he has the power to tell them what to do and issue blanket instructions with different characteristics. That will be inherently inefficient. ICB leaders will be under pressure, knowing that if they make a particular decision they can be removed or be told to do something different. They have the job and they have the power, but they haven’t really—all at the same time.
There is also the plan, as the Minister outlined, to make directions something that the Government publish. The clause says that directions must be published by the Secretary of State, but only
“as soon as reasonably practicable”.
The intention behind requiring the prompt publication of directions is to reduce the surface area for back-room pressures, but the lack of a clear timeframe makes it rather a weak measure.
We currently have a Government who seem open to greater use of the private sector, whether in financing projects or in delivering out-patient care. Well, our Prime Minister resigned yesterday, and there is no guarantee that the Government of the right hon. Member for Makerfield (Andy Burnham) will take the same approach. Will the Minister confirm whether the powers in clause 8 could be used by a Health Secretary to instruct ICBs to stop using a specific type of provider?
I would not dispute the idea that the Secretary of State needs to be able to exercise some control over the health service now that NHS England is being abolished, but the clause seems contrary to the Government’s stated vision for health management. I am not sure whether it is in the best interests of patients.
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship, Sir Roger. I agree heartily with the shadow Minister, and a couple of other things concern me about clause 8.
On the one hand, the clause appears to bring more centralisation, but on the other hand it pushes things down to an ICB level at the same time. I am worried that if we have individualisation of ICBs, we will only exacerbate the disparity of services across regions. I would be interested to understand from the Minister how the Secretary of State’s functions will allow the independence of ICBs and, where an ICB understands its local population well, ensure that patients do not end up in a postcode lottery based on which ICB area they happen to live in.
The danger here is that if the Bill does not deal with those problems and close regional gaps, it is not immediately clear from the clause how the Secretary of State could intervene to ensure that ICBs have the autonomy to make decisions based on their local populations and ensure at the same time that patients do not receive a worse service just because they happen to live in one ICB area rather than another.
Karin Smyth
I recognise that this is a subject of some debate; we may discuss it further when we come to the part of the Bill on ICBs. The abolition of NHS England and transferring all its functions to one body has a consequence, which is that the Secretary of State retains that accountability and power. We are keen to have that power clear but flexible in order to empower local systems. That remains the intent.
The power is necessary for the Secretary of State to update national commissioning standards, for example. The ICBs will have wider roles as strategic commissioners. We expect them to take on formal responsibility for a number of services delegated by NHS England. That allows us to issue a common set of commissioning standards, on the point made by the hon. Member for Farnham and Bordon about variability in different places. There need to be common standards across the piece: eligibility criteria, the treatments the provider should use, and national reporting requirements. ICBs having those standards means that there will be a reduction in unwarranted variation in some of these events.
The shadow Minister raised the timetable. The Opposition will recognise that there needs to be flexibility for the Secretary of State and Ministers to respond to unforeseen or changing events. That is why it is purposely broad, because the range of events that can impact the NHS is clearly very broad. We cannot predict the future.
The hon. Member for Farnham and Bordon said that the Bill needs to deal with all these problems. The Bill needs to give enough flexibility to the system and devolve as much power to the system. The Bill needs to make sure that the powers are in the right place, but it is for the local systems to respond to their local needs within that framework. They will be held accountable, for example through the NHS oversight framework and through ICBs’ normal accountability frameworks.
Dr Johnson
The Minister is talking about flexibility. I understand that if a Minister is responding to an unforeseen circumstance, he or she may be very busy, but where a direction has been made, it should not take very long for a member of staff to publish it, because it will already have been written and sent. I understand that a Minister might take a day or so to sign it off because they are so busy, but it should not take months. The addition of a deadline is therefore not an unreasonable request.
Karin Smyth
With due respect to the hon. Lady, it is not a matter of the Minister being busy, whether that is me or anybody else. It is about the operational running of a £200 billion organisation with 1.5 million staff treating millions of people every day. I am sure we all remember from our own experience incidents and unforeseen events that have happened in the local system, and sometimes very tragic events that have required the Secretary of State to take action. We are trying not to increase the number of reports and documentation and to rid the system of bureaucracy by putting something out in that timeline.
Karin Smyth
No, I have finished.
Question put and agreed to.
Clause 8 accordingly ordered to stand part of the Bill.
Clause 9
Secretary of State’s power to provide assistance
Question proposed, That the clause stand part of the Bill.
Karin Smyth
Clause 9, which will insert new section 12DA into the National Health Service Act 2006, will give the Secretary of State a clear statutory duty to provide financial, staffing or other practical assistance in connection with the health service. The power may be used to support persons providing, or proposing to provide, services as part of the health service or which are beneficial to the interests of the health service. It may also be used to support public authorities where the assistance relates to education or training for people employed, or considering becoming employed, in activities connected with the provision of health services. The assistance may include financial assistance, the services of civil servants or other resources of the Secretary of State, and it may be provided on agreed terms, including terms about payments by or to the Secretary of State.
The clause will support the wider purpose of the Bill by enabling a small centre to act in a supportive and enabling way towards the wider system. Where appropriate, the Secretary of State will be able to provide assistance directly to those delivering or supporting health service activity. The clause is needed because the existing statutory framework does not include a clear power that enables the Secretary of State to provide practical support across the full range of health service activity. Relevant support may be financial, practical, staffing-related or connected with education and training.
Without this clear power, there is a genuine risk of confusion about the basis on which such support may be offered, particularly where the Secretary of State is acting to facilitate the delivery of services by others. The power is permissive and facilitative: it does not require the Secretary of State to provide assistance, and it does not require any person or body to accept it. The power is also limited by its connection to the health service and matters relevant to education, training or activities considered beneficial to the health service. Its exercise remains subject to ordinary public law principles and public financial controls. For those reasons, I commend the clause to the Committee.
Dr Johnson
In a system as large as the NHS, covering an area as diverse as England, it is necessary that the Government be able to deal with unexpected situations. The pandemic may be half a decade behind us already, but the Committee will remember that the previous Government had to act quickly and part with a lot of money in a short time. In such instances, it is essential that Ministers have the power to provide financial assistance. It is not only about crises, however; ordinarily, there are occasions when a Government will want to roll out a new prevention programme or address deficiencies in care in particular areas. I know that health policy is always evolving, and the case for flexibility is clear. The Health Secretary may need to be able to provide financial assistance in pursuit of supporting the health service.
I am sure that hon. Members are familiar with the existing legislation. Section 12D of the National Health Service Act 2006 gives the Secretary of State, NHS England, an ICB or the local authority the ability to make direct financial payments as an assistance to persons or bodies. Clause 9 would new section 12DA of the Act, under which the Secretary of State would be empowered to provide assistance to any person or body carrying out, or proposing to carry out, activities that they deem beneficial to the service.
This is where semantics are important. The existing legislation allows the Secretary of State to make payments, but clause 9 is different: it would allow the Secretary of State to provide financial assistance and to make available persons employed by the civil service or any other resources that the Secretary of State has. This is a remarkably open-ended power that would allow the Secretary of State to spend taxpayers’ money while bypassing standard scrutiny. When NHS England spends money, there is transparency: the public can see how much has been spent on different types of care, ranging from hospitals to public health programmes. The public can see how much money has gone into trusts, into the independent sector and into procurement.
Transparency builds trust in the system and disincentivises wasteful spending. Where will parliamentarians or the public be able to see the financial expense of civil servants, or literally any other resource that the Secretary of State may offer in support? For the first time, the Health Secretary will have the power to insert politically directed civil servants into elements of the health service that are not under public ownership.
As clause 9 is drafted, the Secretary of State could provide civil service labour to private or mutual health providers that work within the NHS. Will the Minister elaborate on how that would be used, and how it would be beneficial to the taxpayer and the health service? The number of civil servants taking home more than six figures has increased under this Government. Their time should be focused on delivering public services, not propping up providers, especially ones that are private businesses.
It is also unclear where the legal liability lies under such arrangements. If something goes wrong and the human resources provided by the Secretary of State are responsible, is the Secretary of State responsible or the entity into which those staff have been inserted? Can the Minister clarify that?
It may be politically beneficial in the short term to provide state support, but it can be costly to the public purse and damaging to markets in the long term. By allowing the Health Secretary to issue assistance in the form of free civil servant labour, clause 9 effectively creates a new type of off-the-books subsidy. How can Members of the House or NHS providers tell whether assistance is operational support or a de facto subsidy? It could undermine the idea of a level playing field for firms contracted to deliver NHS services.
There is also the question of when assistance crosses from operational support into running a provider or firm. We do not necessarily want to be in a position where the Bill is used to bail out failing private firms with NHS contracts. I return to the phrase
“any other resources of the Secretary of State”.
It is difficult to understand why the legislation was written in this way, allowing financial assistance, the provision of labour, and then the use of absolutely any other resource at the Health Secretary’s disposal. As with several other provisions in the Bill, it seems another sign that the legislation was rushed. Instead of circumscribing power tightly where it is needed, the Bill gives huge sweeping powers while claiming that it decentralises.
The Minister has described clause 9 as a discretionary power intended to support the effective functioning of the health service and its workforce. Although that may be what she sought to achieve, that is not the reality. The clause paves the way for arbitrary and unaccountable deployments of state resources, and that should concern all hon. Members.
Gregory Stafford
I endorse the comments made by my hon. Friend the Member for Sleaford and North Hykeham.
I am particularly concerned about subsection (2)(a) of proposed new section 12DA. On examination, this provision raises significant concerns about the control of public expenditure and the efficient use of resources within the health service, and I find it rather vague. There is no definition of the terms used, no indication of scope and no express limitation on how the power is to be exercised.
When read together with subsection (1) of proposed new section 12DA, the effect, as I read it, is to allow the Secretary of State to provide funding to an extremely wide category of recipients. That includes not only public bodies and established NHS providers but, as my hon. Friend the Member for Sleaford and North Hykeham has said, private entities, charities, individuals and any person engaged in activities that the Secretary of State considers to be beneficial to the health service.
That breadth is not accompanied by a corresponding statutory safeguard. The clause does not set out criteria for eligibility, priorities for funding or principles to guide decision making. It does not impose limits on the sums that may be disbursed, nor does it require any structured process for allocating funds. There is no express provision for transparency, such as publication of decisions or reporting obligations to another body such as Parliament. That absence is significant.
Control over public expenditure ultimately lies with Parliament, yet the clause delegates a wide and flexible spending power to the Executive with little direction as to how that power is to be exercised. While it may be said that Treasury rules, audit requirements and general public law principles continue to apply, those are external controls and they do not substitute for clear statutory discipline within the provision itself.
The practical consequences of such a broad power need to be considered. The NHS is already under considerable financial strain; as we all know, demand is rising and resources are constrained, and there is a continuing need to ensure that funding is allocated in a way that delivers measurable improvements in outcomes. In that context, certainty, prioritisation and efficiency are essential. By framing this power in such open terms, the clause risks undermining those objectives. It will create the possibility of fragmented funding decisions, with resources distributed across a wide range of initiatives without clear and consistent frameworks, and it may lead to duplication of effort or to supporting projects with benefits that are uncertain or difficult to evaluate. Without clear criteria or structured oversight, it will become more difficult to ensure that funding is directed to the areas of greatest need.
Karin Smyth
In concluding the debate on this part of the Bill, the Opposition have helpfully made most of my arguments for me. The hon. Member for Sleaford and North Hykeham opened with reference to the pandemic and the unusual circumstances in which we have found ourselves. It is obviously important that this Government learn the lessons from that pandemic in the round, that we are prepared and that, as NHS England is abolished, those powers come back to the Secretary of State so that we can respond to any eventuality that comes before us.
As the hon. Member for Farnham and Bordon said, there are existing standards and rules of procurement. Any spending that happens through the Department and the NHS will be publicly recorded and published in the Department of Health’s consolidated accounts. Those come before Parliament, so there is direct transparency through the parliamentary process in the usual way and, as we all know and as the hon. Member for Farnham and Bordon said, Treasury rules apply.
The point about the use of civil servants has been made. Again, it is really important that we recognise that we are bringing together NHS England, NHS staff and civil servants in the Department. It is right that the Secretary of State, in whatever eventuality comes before him or her, is able to deploy the right person for the right job, be they a civil servant or someone currently under NHS staff terms and conditions, to support that work going forward. The clause is necessarily flexible and broad to provide for those eventualities, and to enable the necessary assistance to be deployed. I commend clause 9 to the Committee.
Question put and agreed to.
Clause 9 ordered to stand part of the Bill.
Clause 10
Secretary of State’s duty as respects variation in provision of health services
Dr Johnson
I beg to move amendment 53, in clause 10, page 6, line 21, leave out from “interests” to end of line and insert “of patients”.
This amendment would only allow the Secretary of State to vary the balance between the public and private sectors in the NHS where it is in the interests of patients to do so.
Dr Johnson
This is perhaps the oddest provision in the Bill. Since time immemorial, the Labour party has accused its political rivals of wanting to privatise the health service. In the early 2010s, the then shadow Ministers indulged the idea that the Health and Social Care Act 2012 was a Trojan horse for privatisation. Several years later, after the Minister had herself joined the House, claims continued. The then leader of the Labour party urged the previous Government to
“undo the very damaging privatisation of so much of our NHS”. —[Official Report, 23 October 2019; Vol. 666, c. 960.]
In the 2019 election, the public were even presented with a dodgy dossier—not Labour’s first—that purported to show that the NHS was on the table in negotiations for a trade deal. We now have a trade deal and the NHS is still intact.
Even though Members know full well that no sensible opposition party is advocating for abandoning our NHS system, they keep saying that Governments have been selling off the health service through the back door. Today, private providers deliver only about 10% of NHS care and the system continues to be free at the point of use.
That brings us to the deep irony of today’s debate. After years of peddling the NHS privatisation myth, the Labour party has introduced legislation to make privatisation possible. The Health and Social Care Act 2012 inserted a safeguard against privatisation, section 12E, into the NHS Act 2006. That section prohibits the Secretary of State from exercising his functions for the purpose of “causing a variation” in the proportion of services provided by the public or the private sector.
Clause 10 substitutes the text in that section and makes two small but significant changes. The first change is to expand the type of providers beyond public and private to
“different kinds of legal entity”.
That is probably a good change, because it encompasses the mutual and voluntary sectors, which do have an important role to play in health provision going forward.
The second change is what has caused alarm. The Secretary of State cannot alter the provider mix unless they deem it to be
“in the interests of the health service.”
Could the Minister set out some scenarios when it would be deliberately beneficial to privatise provision or, indeed, when it would be beneficial to deliberately nationalise provision? I cannot recall an instance where Ministers needed to privatise an entire service to ensure patients did not lose access to care.
In February, the Minister of State for Secondary Care told the House that lessons had been learned from private finance initiatives. Yet the Government announced that 80% of neighbourhood health centres will be privatised through public private partnerships. The Government are able to use these partnerships to loan money outside their limits, but it tends to be more costly than public sector borrowing. Essentially, it is borrowing, but not borrowing on the balance sheet.
What is the effect of these private initiatives? I remember receiving my own office on being promoted as a doctor to consultant. It is quite an exciting moment; before that, resident doctors share an office. I had my own space, my own desk, my own computer and a big whiteboard for notes. When I asked whether I could place the whiteboard on the wall, I was told I could not—it was £800 to stick it on the wall under the private finance initiative contract.
So my great big whiteboard sat there, propped against the wall. Periodically, I would move a piece of paper, knock the bottom of the whiteboard and it would tip and fall on me when I was sat at my desk. I did suggest putting it up myself, but that would also incur a charge through the PFI contract—for modifying things without getting them to do the modifications—so I just had to sit there with it propped up against the wall, ad infinitum.
The Government are on the hook for more than £100 billion of payouts, simply for the use and maintenance of PFI facilities. The Labour scheme was a shambolic waste of taxpayers’ money that could have been spent on improving care. When my hon. Friend the Member for Hinckley and Bosworth (Dr Evans) asked the Minister about public private partnerships, she told him she was
“very proud of the capital investment under the last Labour Government”.—[Official Report, 4 March 2026; Vol. 781, c. 386WH.]
But is clause 10 simply a mechanism for Ministers to develop further private finance initiatives? If Government spending is under pressure, may Ministers seek to shift provision even if it proves more costly in the long run?
There is another side to the conundrum of clause 10. Instead of a Health Secretary intent on privatisation, what if we get one intent on squeezing out private sector provision? Who our new Prime Minister will be, we do not know, but one of the candidates has called for the country to abandon 40 years of neoliberalism. Perhaps the Minister could elaborate on what that means, since the tax take as a percentage of GDP is the highest it has been in 40 years. To me, it signals a potential hostility towards choice and competition. We do not want to be in a situation in which the decision is made to alter the provider mix in service of ideology, rather than in the best interests of patients.
I am aware of several private firms that provide services to the NHS and are concerned that clause 10 could be wielded against them. If a future Health Secretary decided to reduce private provision on the basis of ideology, what would happen to the 10% of planned activity that is currently delivered by for-profit entities? NHS providers could not feasibly handle such a surge in demand, waiting lists would increase further, and patient choice would suffer. It would also be expensive. If private providers fear that the NHS is no longer a reliable customer, and that they may suddenly lose their contract if this clause is invoked, they will charge a risk premium on their services—that is what firms do when they face shifting regulatory goalposts. That would only damage the public purse.
Under clause 10, it would be legally possible for the Health Secretary to alter the provider mix. As a result, it would be worth it for several types of providers and ideologically motivated groups to spend vast sums of money hiring lobbyists to convince Ministers that their sector deserves favourable treatment and that they serve the interests of the NHS. Organisations would invest less in resources and more in influencing the rules, which is not a good outcome either.
All those issues are compounded by the fact that clause 10 is imprecise. What does the Minister define as
“the interests of the health service”?
I am not trying to catch the Minister out; I just want to illustrate the problem with legislation drafted in such terms. It is difficult to prove that the Health Secretary has not acted in what they thought were the best interests of the health service. What could that refer to? It could refer to the interests of patients, to the interests of NHS staff or to the financial stability of the health service—it is entirely subjective. What is the health service there for? It is there for patients, which is why I tabled amendment 53.
Amendment 53 would revise clause 10 to specify that the Secretary of State must not alter the provider mix unless doing so is in the interests of patients. I would like to place patients at the centre of the Bill’s changes, in recognition that we do not have the numbers on the Committee to change the clause altogether. My revision would make it harder for the Health Secretary to justify altering the provider mix if it harms patient access or reduces their choice. It would make NHS providers less fearful to know that the Health Secretary would be subjected to a better defined legal threshold.
Gregory Stafford
The shadow Minister has outlined a couple of hypotheticals for the future, when we have a different Prime Minister and a different Secretary of State. One might go down a route of more privatisation, another down a route of removing the private sector from health service provision. My concern is more practical and for the here and now: if the clause stands part of the Bill, it must be because the Government have some desire to do one of those two things now. Would it not be a good idea to hear from the Minister which of those two options it is?
Dr Johnson
It does raise questions about the point of new section 12E. That provision was not there before; there must be a reason for adding it. Either the Government want ideologically to reduce the amount of private provision in the NHS, or they want to increase it. The clause gives them the power to do both.
Labour politicians very often tell the public that the NHS is being privatised. Data has shown that that is not happening, but that did not matter; they found the myth politically advantageous and repeated it ad nauseam. Now, the Minister and her colleagues are in office—they have the levers of power—and are proposing to change the law to make it easier to change the provider mix. That is not only ironic but deeply misguided.
I tabled amendment 53 to require any changes to the provider mix to be in the interests of patients. If the Minister is unwilling to support that, will she offer a compelling explanation why? Clause 10 has alarmed stakeholders across the health sector and the political spectrum. That really ought to tell us something. I look forward to her response.
Helen Morgan (North Shropshire) (LD)
It is a pleasure to serve with you in the Chair, Sir Roger. I have concerns similar to those of the shadow Minister about clause 10. Proposed new section 12E allows Ministers to vary the proportion of activity by provider, and I am interested in the rationale behind that. The powers to retain the provider mix were put in place because of concerns that the NHS would be privatised by the back door, so the requirement to maintain the mix is there for a reason.
As we heard earlier when discussing ophthalmology, there are risks to using private provision for certain NHS activities, as there can be unintended consequences—a bit like the deregulation of buses. In ophthalmology, private providers do thousands of cataract operations very efficiently, but the less exciting and more critical work of preventing people from going blind, which is done in NHS hospitals, is under threat because so many people want to work in easy and profitable areas. I am concerned that that will occur in more areas of the NHS if the Bill allows more privatisation. Although I do not have an ideological problem with the NHS contracting out to private providers—that has worked well to bring down elective waiting lists, for example—the provisions to protect the mix are important.
I am not sure that amendment 53 really moves us forward; it just requires the Secretary of State to consider who benefits from the change in mix.
Peter Prinsley
It is true that the situation in ophthalmology is now quite serious, but is the hon. Lady aware of the problems in radiology and pathology? Some hospitals are unable to recruit histopathologists or significant numbers of radiologists, who provide key services, because the personnel necessary to run those services have been attracted into a private system, although they are contracted to the NHS. That jeopardises the ongoing services for urgent and emergency care.
Helen Morgan
The hon. Gentleman outlines an unintended consequence of the NHS contracting out to private providers. There are ways to get the pricing of those services right, but the clause could introduce that unintended consequence.
Why is this proposal included in the Bill, and what does the Minister see it being used for? Is there a risk that a future Government might use it to bring much more privatisation into the NHS? The general public consensus is that that would be a bad thing. What safeguards can she put in place to ensure that does not happen?
Karin Smyth
I will respond to that question before picking up the other comments. If I do not address all the Committee’s comments, I will come back to Members.
Everyone would expect this, but let me be clear: this Government are absolutely committed to a free-at-the-point-of-use, taxpayer-funded service. We also think that unless it is reformed and changed, it is an existential problem for the British public, who will not continue to support the service. As Members know, one Parliament can never bind another one, so I cannot predict what a future Government will do. There is talk from some of our Reform colleagues about an insurance-based system. There are people who were in the Conservative party but have moved over who think that, so obviously I cannot—
Karin Smyth
I will make some points, and then I will be happy take the hon. Lady’s intervention if I do not address what she was going to say.
The hon. Member for North Shropshire outlined some of the history. This clause seeks to strike a balance. The governing principle behind it is that the decisions of the Secretary of State must not vary the proportion of providers by the type of legal entity that they are. Decisions must be taken according to what serves the health service and the people who depend on it. The clause permits, by way of exception, the balance between sectors to be varied purposefully, but only where doing so would be in the interests of the health service. That would, for example, prevent the Secretary of State from deliberately choosing to grow the proportion of NHS services delivered by private providers for solely ideological reasons.
I understand the concern that drives the amendment. It is that the exception might be relied on to support the convenience of those already providing the service, without taking into account what is best for patients, as the hon. Member for Sleaford and North Hykeham said. That is not the Government’s position, and the clause does not lead to that outcome. The test that it creates is whether the interests of the health services are served.
As the hon. Member for Sleaford and North Hykeham also said, the definition of the health service—as defined under section 1 of the National Health Service Act 2006—is not separate from the people it exists to serve. It is defined as “a comprehensive health service” for “the people of England”, directed at improving their health and at the “prevention, diagnosis and treatment” of illness. A decision to rely on the exception must be justified by reference to that duty; one taken merely because it was easier or more convenient for existing providers or any other group, with no such justification, would be unlawful. The protection that she seeks is, in substance, already secured by the clause.
The amendment would also create another difficulty. Section 1 of the 2006 Act reaches the entire population and includes the prevention of illness before anyone becomes a patient at all. The “interests of patients” reaches only those already receiving care, which is a narrower test than I think the hon. Lady intended, and would allow a Secretary of State who was so minded to provide a landscape that ignores vital preventive health and wellbeing concerns. I hope that she will take from my remarks an assurance that the clause already meets her concerns.
The hon. Lady also highlighted the example of PFI—a subject of much discussion over many years—and of being unable to change her whiteboard. That is absolutely one of the lessons that needs to be learned from the way in which some past PFIs were procured and dealt with. For example, as a new Government, we outlined proposals for a new model of public-private partnerships for neighbourhood health centres, among other things. The previous Government could also have learned the lessons and done something about that, but they chose instead to completely halt the building of any kind of facilities. That is one reason why we are in such a shocking state at the moment. The new proposal outlines, as I think the Opposition know, an 80:20 funding route, exactly to make the point about which is the most efficient way forward. That will absolutely drive measures for growth and create more jobs in the sector.
Gregory Stafford
I want to take the Minister back to her rejection of the amendment of my hon. Friend the Member for Sleaford and North Hykeham on the basis that—I paraphrase—she felt the definition of “patients” was too limiting because it would not count people who had not entered the health system at that point. The clause itself, however, refers to the benefit for the health service. Is the Minister suggesting that the health service, as defined in the Bill, includes what happens before people enter what I would describe as the health service? Is it something before that point? She seems to be saying that our definition is too narrow, but her definition in the Bill must apply to those who have entered some kind of formal setting. Or is the health service wider than that?
Karin Smyth
I refer the hon. Gentleman back to my comments. The health service is defined under section 1 of the NHS Act 2006 as not being separate from the people it exists to serve. It is defined as “a comprehensive health service” for “the people of England”, directed at improving their health and at the “prevention, diagnosis and treatment” of illness—so, yes.
At this juncture, I will explain a number of other features of the clause. In particular, I draw the Committee’s attention to the fact that it builds on section 12E of the 2006 Act to cover the Secretary of State’s health functions, powers and duties. It recognises that, with the abolition of NHS England, the Secretary of State has a far more substantial role to play—as a commissioner of services, for example—than previously. I also put on the record that whenever the Secretary of State takes a decision in this space, the general NHS procurement requirements and other statutory duties will continue to apply.
Finally, the NHS relies on privately owned providers, as well as charities and community organisations, to provide a range of important NHS-funded services across the country. As such, it is important to ensure that, where there is a mixed-market provision between public and private for providers of a particular service, the Government’s powers are not used to distort the provision and potentially discourage important investment from outside the NHS. Conversely, they should not be used purposefully to favour independent providers over NHS providers for reasons unrelated to the quality or efficiency of NHS-funded healthcare.
Dr Johnson
If I heard the Minister right, she said that the clause did not provide for changes on the basis of ideology. However, it says that changes are not to be made
“unless the Secretary of State considers that to do so is in the interests of the health service.”
A Secretary of State whose ideology is that the private sector is bad, good or whatever else could well believe that it is in the interests of the health service to be private or not private. How does the clause prevent an ideologically driven Secretary of State from changing the health service on the basis simply of his ideology, rather than of patient or clinical need?
Karin Smyth
The hon. Lady tempts me to delve into the politics of future Secretaries of State. They will respond according to the manifesto on which they are elected by the British public. That is the point of a democratically accountable public service. I think that the clause strikes that balance, as I have said. For those reasons, I hope that the hon. Lady will withdraw her amendment. I commend the clause to the Committee.
Question put, That the amendment be made.
Dr Johnson
I beg to move amendment 47, in clause 11, page 8, leave out lines 15 to 30.
This amendment prevents the Secretary of State from removing the Chief Executive of an integrated care board.
Dr Johnson
Clause 11 is particularly interesting. In August 2025, Alan Milburn was asked about the abolition of NHS England on the Health Foundation podcast. He said that the Government wanted to see a model that was “more delegated…more devolved” and “more diverse”, which necessitated the centre being smaller. Considering that he is a former Labour Health Secretary and a non-executive director at the Department of Health and Social Care, I do not doubt his understanding of what the Government wanted to achieve.
When the former Health Secretary, the right hon. Member for Ilford North (Wes Streeting), announced the 10-year plan to the House, he also talked about dissolving power. He spoke of a
“brave new world of devolution of power, resources and control”.—[Official Report, 3 July 2025; Vol. 770, c. 469.]
That was repeated in the Government publications that accompanied the Bill:
“Empowering ICBs as strategic commissioners will support putting patients at the centre of care by devolving decisions to a local level where different services can better integrate… Reforms to the NHS FT model will give providers more flexibility to design and deliver healthcare around local needs.”
Between the announcement of the abolition of NHS England and the publication of the Bill, Ministers articulated a vision for a more decentralised system. There is expert consensus that decentralisation boosts performance, reduces health disparities and fosters innovation. After listening to remarks this morning, I have no doubt that Members are clued up on the importance of innovation to the health service, but a problem—a philosophical contradiction—at the heart of the Government’s reform programme and the Bill is that Ministers talk about decentralisation while these provisions constitute a recentralisation of power.
Helen Morgan
I mentioned in Committee last Thursday that the Liberal Democrats are worried about the risk in the Bill of political capture and the Secretary of State’s ability to meddle in day-to-day operations. As I am sure the Minister is aware, speaking at the NHS ConfedExpo this month, Sir Jim Mackey, the chief executive officer of NHS England, warned that the Bill may give Ministers too much control and that there has to be operational freedom; otherwise we will grind to a halt.
I want to probe the process by which we got to this point. Originally, there was discussion about whether the seven NHS regional teams should become independent arm’s length bodies to mitigate such a risk. NHS leaders argued that this would mitigate the risk of direct political control of the service and pointed out that the 10 regional strategic health authorities had played a useful role in running the service efficiently before the creation of NHSE. That proposal was rejected by Ministers, and it is not entirely clear why. I am interested to hear the Minister’s view on that.
It is now being reported that a fresh attempt is being made to argue that regional teams should be hosted by an NHS organisation—probably an ICB—to protect their employment terms and, as staff would remain public rather than civil servants, provide some brake on political control. Can the Minister shed any light on all this? Does she recognise the importance of maintaining operational freedom in NHS decision making?
We have discussed the reality that current Parliaments cannot bind future ones, and I take that point on board. However, current Parliaments do set precedents and establish the legal frameworks within which future Governments initially operate until they change the law. With the potential for more extreme Governments, there is a risk of discrimination and political considerations entering what should be clinical decision making—for example, decisions on whether to place a trust into special measures or what services are offered, such as sexual health, IVF, outreach to migrant communities and so on.
We are concerned not about the current Secretary of State, or indeed the shadow Secretary of State, but about the risk of those sweeping powers being placed in the hands of an extreme Government. If we imagine for a moment that an incoming Government decided that they did not approve of diversity on an NHS board, for example, and replaced an executive with their own candidate, that would be a horrifying situation. I think we would all agree on that. It would be useful to include safeguards now and set a precedent that such action would not be acceptable under this Bill. Notwithstanding the fact that a future Government could come along and change that, they would have to be transparent about their reasons for doing so.
The former Health Secretary, the right hon. Member for Ilford North, claimed that he was taking powers back into DHSC in order to give them away to the system, but this Bill has a lot on taking those powers and very little on giving them to the system. How can we be sure that that will actually happen on the ground, and that ICBs, hospital trusts and other health trusts will have the opportunity to flex their local muscle and ensure that services are best shaped for the local population? The NHS Alliance has called for an operationally independent regulatory function in DHSC to oversee NHS organisations, or for an independent panel to make appointments. Will the Minister consider such practical changes to ensure that political capture is not an unintended consequence of the Bill?
Gregory Stafford
I rise to support amendment 47, tabled by my hon. Friend the Member for Sleaford and North Hykeham, and to ask a few questions about clause 11. I completely understand the thinking behind the clause. The Secretary of State for Health and Social Care is probably the most politically impotent of all Secretaries of State: as my hon. Friend said, they pull levers and not much seems to happen, because they do not have the control over the health service that the public think they do—or indeed, that Members of Parliament think they do, judging by the number of us who stand up and demand that the Secretary of State do things in our local areas.
I understand the Government and the Secretary of State’s desire to change some of that, but there is concern about the potential politicisation of NHS leadership. Integrated care boards were established in various forms under the Health and Social Care Act 2012 precisely to remove politicisation to ensure that decisions in our healthcare service were made for the benefit of patients on the basis of clinical evidence and the needs of the local population, not on the whim of any Secretary of State or Minister. More importantly, ICBs were brought in to make sure that local health systems, local authorities, clinicians and communities made decisions based on local need.
Those politically independent ICB chief executives were expected to exercise professional judgment, make difficult decisions about priorities and resources and sometimes deliver messages that Ministers, and indeed local Members of Parliament, found uncomfortable. If those leaders know that their continued employment ultimately depends on the confidence of the Secretary of State, there is a real risk that the independence of their judgment will be weakened and that patient safety will diminish.
The amendment tabled by my hon. Friend the Member for Sleaford and North Hykeham tackles a core question: should an ICB chief executive focus solely on what is best for patients and the local health economy, or should they have to consider whether their decisions may attract ministerial displeasure? Even if the power is rarely used, and even if, as my hon. Friend said, there are currently some guardrails in the clause, its existence will change behaviour—it must do. Leaders will become more cautious, perhaps more risk-averse and potentially less willing to challenge national policy when local evidence points in a different direction.
ICBs have benefited from the ability to speak truth to power. A system in which senior NHS leaders fear dismissal by Ministers risks discouraging precisely that kind of honesty. Do not get me wrong: there are good ICB chief executives and bad ICB chief executives, ones who understand their role well and ones who feel that they do not need to engage at all with their local communities. I have a very good ICB in what is currently Surrey Heartlands, soon to be a larger organisation, and an ICB that does not do the job as well—I will not name it, but any student of geography will be able to work out which one it is.
Secondly, excessive ministerial power blurs the lines of accountability. The Minister, in her defence, has argued that Ministers need powers because Ministers are accountable. I get that argument, but one of the most important principles of effective public administration is clarity of responsibility. If the Secretary of State gains extensive powers to appoint and dismiss local NHS leaders, it will become increasingly difficult to know who is actually responsible for outcomes. When performance improves, Ministers will claim credit; when performance deteriorates, local leaders may be blamed. If Ministers possess the power to select and remove those leaders, they will inevitably become more directly responsible for those management decisions, so far from increasing accountability, this might dilute it by creating uncertainty about where true authority lies.
Thirdly, there is a constitutional concern. Whether one likes it or not, the previous Act created a balance between democratic accountability and operational independence. Parliament rightly determines the funding, priorities and legislative frameworks, and Ministers rightly set national policy, but operational decisions have been made by healthcare professionals and the statutory bodies established for that purpose. That distinction exists for a good reason. No Secretary of State, regardless of ability or commitment, or indeed their own background in the health service, can personally manage every NHS organisation in England, and I do not think they should. The more powers we concentrate at the centre, the greater the temptation for Ministers to become involved in operational matters that are better addressed through professional expertise and local knowledge. My hon. Friend’s amendment seeks to preserve that distinction in a singular and precise way. It recognises that Ministers should govern the NHS and be held accountable at the top by us as Members of Parliament and our constituents, but should not seek to manage every aspect of it.
Fourthly, there is a practical problem. Supporters of ministerial intervention often point to examples of failure and ask what should happen when an ICB is underperforming. That is a fair question, but the answer is not that the Secretary of State must personally possess dismissal powers. A range of mechanisms already exist: ICB boards have governance responsibilities; NHS England has oversight powers; professional regulators oversee the conduct of clinicians; there are provisions in employment law for procedures when it comes to misconduct and capability issues; and auditors and inspectors can identify failings. It would be far better if the Bill strengthened those provisions to ensure that accountability was brought forward, rather than giving the Secretary of State the ability to fire and hire as he or she sees fit.
Of course, none of those mechanisms of accountability will disappear if amendment 47 is adopted. The amendment would not create any kind of immunity from accountability; it would simply ensure that accountability is exercised through the established governance structures, rather than through direct ministerial intervention on a chief executive. Indeed, one might ask whether a Secretary of State is really the best person to assess the performance of an individual ICB chief executive. Such judgments often require detailed understanding of local service pressures, workforce challenges, demographic factors, financial constraints and so on. Those are matters better evaluated by individual organisations with operational expertise than by politicians operating at national level.
Fifthly, I think the clause as drafted would present a risk to recruitment and retention. The NHS already faces significant leadership challenges. Senior leaders are expected to manage enormous budgets, oversee complex organisations and make difficult decisions under intense public scrutiny. If we create a system in which their tenure can ultimately depend upon ministerial whim, we may deter talented individuals from seeking those positions. As my hon. Friend said, the NHS needs leaders who are willing to innovate, take calculated risks and make difficult long-term decisions. It does not need a culture in which leaders are constantly looking over their shoulder, wondering whether a politically controversial but clinically necessary decision could threaten their position. Strong organisations attract strong leaders when governance arrangements are stable, predictable and professionally driven. They do not attract them through uncertainty and political intervention.
Sixthly, we need to consider the precedent being established. Powers granted to one Secretary of State are inherited by the next, as the hon. Member for North Shropshire said. Members may trust the intentions of the current Minister—I certainly do. They may also believe that these powers would be exercised responsibly—and at the moment I think they would be. However, legislation must be judged not on how it is going to be used by one individual, but on how it could be used by any future holder of the office. Therefore, the question is not whether the current Secretary of State or Minister would misuse the power, but whether Parliament wishes to establish a framework in which future Secretaries of State possess the ability to remove local NHS leaders whose decisions, views or priorities may conflict with their political objectives. That is a much more serious question.
Finally, we must remember what ICBs were trying to achieve, even if we do not think that they have achieved it or performed in the way that we wanted them to. If we go back to the principle of why they were set up, they were designed to encourage collaboration rather than some sort of command-and-control structure. They were intended to bring decision making closer to patients and communities. They were established to support long-term planning across local health systems. Those objectives, I am afraid, are very difficult to reconcile with a model in which local leaders remain subject to direct ministerial dismissal. Partnership working flourishes when organisations have confidence in their independence and responsibilities. It is weakened when authority is increasingly concentrated at the centre.
For all those reasons, I believe that amendment 47 in the name my hon. Friend the Member for Sleaford and North Hykeham raises an important principle. It is not about protecting poor performance or shielding individuals from accountability; it is about ensuring that accountability is exercised through proper governance structures rather than political control. Expanding ministerial powers to hire and fire local NHS leaders risks undermining all of those principles.
Karin Smyth
We have a clear political and—as I think the hon. Member for Sleaford and North Hykeham said—philosophical division here. This Government believe in democratic accountability, in politics and in good government. I understand that both Opposition parties were architects of the 2012 Act, which created this huge, independent body to run what has become a £200 billion service that clearly has not worked, and that they want to hold on to some of that, despite not opposing the Bill on Second Reading and, actually, not really opposing the abolition of NHS England—I think we will keep returning to that—but we believe that, ultimately, the Secretary of State needs to be accountable for the service, which is not working as the British public deserve or expect.
The hon. Lady asked me to go into good variation and bad variation. Our drive has been to understand the variation. I know from Members of Parliament who have come to me in the past two years, and we understand from looking in detail at the variation across the service, that there is often no rationale for the variation. Local people do not understand why services work better in one part of their county, even, than in another. The hon. Member for Farnham and Bordon alluded to that when he mentioned some places in his area that are working better than others. That is why—and I personally wanted to drive this very strongly—we are getting more information out, releasing the outcomes framework and releasing information to all Members of Parliament about where and how the current data shows their local systems are performing. That is what local people need, and in my view good local parliamentarians, of whom there are very many, should be able to go back to talk to their local systems and chief executives about why that is—not to berate them, but to understand it. There might be a very good cause for the variation; there might be structural reasons or geographical reasons, and they might be long-standing reasons. That is what we seek to do in order to regain the trust and confidence of the British public, and that is why we are publishing those documents.
I stand by my comments that my approach is more local than centralised. This is about changing the culture, which we seek to do by making that happen more locally. I absolutely get the points about operational freedom and the balance that we will seek when we release the operating model, which is being worked on in the Department, as we bring the new system into being, alongside the Bill.
However, we want to be very clear that when an ICB has failed or is at risk of failure, and that failure is significant, it is right that the Secretary of State has the tools to minimise the impact on patients and the public and to act swiftly to put things right. The public rightly expect that, in such circumstances, Ministers will take the necessary steps to protect patients, taxpayers and the public. In some cases of significant failure, that may include directing an ICB and removing the chief executive.
I am sure that all Members here today will agree that effective performance management of ICBs will continue to be essential once NHS England is abolished, not only to support the provision of a quality service, but to reassure the people served by ICBs that when things go wrong, they will be put right.
Helen Morgan
I could not agree more with the Minister that when there is an obvious failure, either in a local system or in a trust, we would hope that the Secretary of State will intervene. She will know from our experience in Shropshire that, when a system is failing or underperforming, that intervention is welcome. But the Bill gives the Secretary of State power to intervene even when things are going well, which is quite an extension of power. Will the Minister comment on that?
Karin Smyth
I thank the hon. Lady for that intervention, and I will come on to the power.
As hon. Members are aware, NHS England currently holds similar powers, so it makes sense for these powers to be held by the Secretary of State once NHS England is abolished. I want to be clear—I hope that this will address the hon. Lady’s point—that our intention is to use these significant failure powers rarely and not as a first port of call. It is far better to work closely with ICBs and their leaders to spot issues and work collaboratively to resolve them before they have the opportunity to become significant, but it would be irresponsible not to have the power to intervene as a last resort.
I want to address the other elements of clause 11. The first part of the clause establishes a general power for the Secretary of State to direct integrated care boards about the exercise of their functions. Using that power, the Secretary of State could direct a singular ICB, a group of ICBs or all ICBs, depending on the scope of the direction. This power is a necessary step in restoring democratic control over the NHS. The public rightly expect Ministers to be able to set priorities, drive improvements and set out how they expect the NHS to operate. For example, we expect to use the power to set up and update national commissioning standards.
The power is particularly relevant given the wider commissioning responsibilities ICBs will have in their role as strategic commissioners following the abolition of NHS England. By setting standards for all ICBs, the power will help reduce the unwarranted variation in the way that ICBs discharge their functions. It is also an important tool for enabling Ministers to respond to changing events. The lack of such a power has slowed the ability of NHS England to respond to unforeseen challenges within the health system.
I can also give the Committee an assurance that the clause includes a considered set of limits on the scope of the power. The Secretary of State will not be able to direct ICBs to appoint a particular individual, issue a direction about the services to be provided to an individual, or direct the use of a drug treatment or diagnostic technique where that is inconsistent with NICE guidance or recommendations. Equally, to maintain transparency in the health system, directions made under the general power to direct ICBs as to the exercise of their functions will be required to be made in writing and to be published as soon as reasonably practical. The power will enable the Secretary of State to uphold the standards that patients expect and deserve, while also protecting the principles of fairness and impartiality at the heart of the NHS.
We have already addressed much of the second part of the clause, but I should note that we have purposely placed the powers to intervene in cases of significant failure outside the general power of direction over ICBs. That is because it is important to be clear that those powers are expected to be used only rarely and in situations where an ICB is failing or at risk of failing.
I hope the hon. Member for Sleaford and North Hykeham feels able to withdraw her amendment. I commend the clause to the Committee.
Question put, That the amendment be made.
Health Bill (Sixth sitting)
Thursday 25th June 2026
(1 month ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 25 June 2026 - (25 Jun 2026)
The Committee divided: - Ayes: 3 / Noes: 10 - Question accordingly negatived.
The Chair
Before we begin, I remind Members to switch all electronic devices to silent. Tea and coffee are not allowed during sittings. As Members will have noticed, I have taken my jacket off, so please feel free to take yours off—it is hot in here.
Clause 12
Commissioning functions: responsibility
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I beg to move amendment 57, in clause 12, page 10, line 10, at end insert—
“(4A) Before making regulations under subsection (1)(b) that would alter the range of services or facilities which the Secretary of State is required to commission nationally, the Secretary of State must—
(a) prepare and publish a commissioning transition plan in accordance with subsection (4B),
(b) consult in accordance with subsection (4C), and
(c) lay the commissioning transition plan before Parliament.
(4B) The commissioning transition plan must set out—
(a) a description of each service or facility that the Secretary of State proposes to add to, or remove from, national commissioning responsibility under section 3B(1)(b), and the reasons for each proposed change;
(b) a description of the body or bodies to which commissioning responsibility for each such service or facility would transfer and the basis on which that body is considered capable of commissioning that service or facility effectively;
(c) an assessment of the impact of each proposed change on patients who rely on the affected services or facilities, including—
(i) patients with rare diseases or conditions,
(ii) patients whose needs cannot be met by a single integrated care board area, and
(iii) patients who may face differential impacts on account of a protected characteristic within the meaning of the Equality Act 2010;
(d) the transitional arrangements to be put in place to ensure continuity of service for patients during any transfer of commissioning responsibility;
(e) the workforce and capacity implications for the bodies to which commissioning responsibility would transfer;
(f) the financial arrangements for the transfer of commissioning responsibility, including the funding to be allocated to receiving bodies; and
(g) the proposed timetable for implementation of each change.
(4C) Consultation under this subsection must include—
(a) integrated care boards that would assume commissioning responsibility under the proposed changes;
(b) NHS trusts and NHS foundation trusts providing the services or facilities affected by the proposed changes;
(c) patient groups and representative organisations for patients likely to be affected by the proposed changes;
(d) clinicians with expertise in the services or facilities affected; and
(e) such other persons as the Secretary of State considers appropriate.
(4D) Consultation under subsection (4C) must—
(a) run for a period of not less than twelve weeks, and
(b) begin no earlier than the date on which the specialised commissioning transition plan is published under subsection (4A)(a).
(4E) Following the consultation period, the Secretary of State must publish a response to the consultation that—
(a) summarises the representations received,
(b) sets out the Secretary of State's response to the key issues raised, and
(c) describes any amendments made to the specialised commissioning transition plan in light of consultation responses.
(4F) No regulations under section 3B(1)(b) that alter the range of nationally commissioned services or facilities may be made until at least 60 days have elapsed after the consultation response required by subsection (4E) has been published.”
This amendment requires the Secretary of State to publish and consult on a commissioning transition plan before making any regulations under the new section 3B of the National Health Service Act 2006 (inserted by Clause 12) that would alter which services are commissioned nationally.
The Chair
With this it will be convenient to discuss the following:
Clause stand part.
Clause 13 stand part.
Dr Johnson
In essence, the clause confers the commissioning duties of NHS England on to the Secretary of State, because NHS England is being abolished. In that respect, it is quite straightforward. In the existing National Health Service Act 2006, which is to be amended, section 3 sets out the duties of integrated care boards as to commissioning health services, and section 3A similarly. Section 4 is about NHS England’s responsibility for the provision of high-security psychiatric services. In essence, clause 12 replaces the references to “NHS England” in sections 3 and 3A with “the Secretary of State”. The ICBs now must act consistently with the discharge by the Secretary of State of the section 1 duty to promote a comprehensive health service. That is consistent with the aims of the Bill. I have concerns, which I have expressed previously, about how the Government ensure that the Secretary of State can make those decisions fairly, on the basis of clinical need, rather than because of pressure from a lobby group, a celebrity campaign or such like, but again, that seems consistent.
The clause also replaces entirely section 3B of the 2006 Act. Under the previous section 3B, the Secretary of State could direct NHS England to commission the service nationally; the proposed new section 3B confers a regulation-making power to require the Secretary of State to arrange nationally services for members of the armed forces and their families specifically, as well as such services or facilities as may be prescribed. Perhaps the Minister will comment on what sort of services or facilities might be prescribed under that proposed new section.
In doing that, the Secretary of State must have regard to the number of people needing the service, the cost and the number of possible providers. That reflects a balance. Some services, such as hip replacements, are very common. They occur in all areas of the country, perhaps at different rates, but they are broadly a common service. Accident and emergency is another common service. Some people, however, have the misfortune to have a condition that is rare and requires specialist care, in small numbers. That needs to be commissioned on a more national basis, because of the need for specific expertise among commissioners and health professionals.
In subsection (4), proposed new section 3B(5) modifies section 4 of the 2006 Act so that the duty to arrange high-security psychiatric services transfers from NHS England to the Secretary of State, and the Secretary of State gains a new power to direct the providers of those bodies—but only non-public bodies—if he is satisfied that the provider is already licensed under the Health and Social Care Act 2012 and would be required by its licence to obey the direction.
In one respect, as I said, it is necessary to transfer powers to Secretary of State, now that NHS England is to be abolished, but I have a couple of questions. NHS England published a direct commissioning update on 2 March, which describes a new commissioning structure. At the moment, NHS England commissions regional NHS England bodies and the ICBs at a more local level. The update suggests that we will have the ICBs commissioning services, and the Secretary of State instead of NHS England, but that each of the seven regions will have an office for pan-ICB commissioning, known as an OPIC, to support ICB commissioning services—both standard commissioning and at-scale commissioning in some instances.
How is that more efficient than the old structure? Are we just going to see the people working in the regions of NHS England get made redundant, at a huge cost to the state, only to be re-employed by the OPIC? What is the estimated cost of that? Is that the intention? We are going to either lose the expertise of the regional advisers in NHS England or end up re-employing them having paid them redundancy. Can the Minister explain which she thinks it is?
There is a hugely long list of specialist nationally commissioned services. Can the Minister guarantee that those services will not be moved locally? The ICBs only have so much capacity. It will be a challenge for an ICB to deal with conditions that may affect only one or two people in its area in a given year, particularly given the 50% budget cut; obviously, it will prioritise things that affect more of its population. People who have the rare conditions that are currently commissioned nationally may be worried that they will not get the same level of service that they are getting at the moment.
The direct commissioning update talks about prisoners and the justice system. At the moment, NHS England works directly with the Ministry of Justice to commission healthcare for those in the justice system. That includes adults in the custodial system, children in secure children’s homes, non-custodial care, sexual assault and abuse centres, and abuse referral centres.
There are eight high-security category A prisons in England. Instead of being specially commissioned as one batch, they are going to be commissioned specially by their local ICBs. Where are the ICBs going to get the advice and expertise to do that? Dealing with category A prisoners is about not only managing the prisoner and providing them with healthcare, but keeping the people providing that healthcare safe while they are working. This is a specialist area. I am interested to understand why the Minister thinks it will be managed best locally. If, under her new system, it is to be managed locally and the prisoner’s home address ICB is different from the prison address ICB, where will the funding move from and to? Will the prison’s ICB be reimbursed by the prisoner’s home ICB or will it bear the brunt locally?
What will happen to the sexual abuse referral centres? It is perfectly possible, particularly in some areas of the country, that an individual is sexually assaulted in one ICB area, lives in another and reports a crime in a third. Will local commissioning have an impact on where the individual needs to go for their pretty intimate examination and assessment? Has the Minister considered that? What is her view?
What happens to healthcare for migrants? That is another area that is dealt with partly by the justice system at the moment. Can the Minister update us on that? There are over 100,000 people in asylum accommodation, including 30,000 in hotels, and many members of her party are keen to welcome even more. Who will be responsible for commissioning their care?
The Government are also delegating the child health information services, which are the record of whether children have been vaccinated and such like. Given that they are planning to have a single patient record and the electronic red book, why do they want the services to be commissioned locally rather than nationally? Do they expect commissioning for a uniform service, such as a screening service, to lead to differential outcomes—and if it does not, what is the rationale for it?
A particular example is blood spot screening. The Minister will be aware that there was a Westminster Hall debate earlier in the week on spinal muscular atrophy, in which blood spot screening was mentioned. Metachromatic leukodystrophy is another condition for which people want blood spot screening. If blood spot screening is to be commissioned on a local ICB level, will ICBs be required to do it in line with Government guidelines, or will they be able to vary the service they provide to those patients?
By delegating more to ICBs, Ministers are creating variation. On one hand, they want local differentiation and variation; on the other hand, they have put in a clause that requires the Secretary of State to limit local variation. Again, there is a tension there. Will the Minister talk about that?
Moving to some technical points, I noticed that “hospital premises” is defined in section 4 of the 2006 Act, but I cannot find it defined in the Bill. Under the original section 3B of that Act, the Secretary of State had to obtain appropriate advice before making regulations about commissioning services; when services were commissioned locally or nationally, the Secretary of State had to take expert advice. That seems like a sensible thing that we want the Secretary of State to do. One would hope that if the Secretary of State were doing his job properly, he would do that, but it seems a little odd that that requirement has been taken out, as though there is an intention for the Secretary of State not to do that. I would appreciate the Minister’s comments on that.
Proposed new section 3B provides that a direction can be given to a person other than a public authority regarding high-security psychiatric services. The Minister knows that high-security psychiatric services are currently provided at Broadmoor, Ashworth and Rampton, which are still stand-alone units run by NHS providers. Does she plan to ask a private provider—someone other than a public authority—to run those facilities? If not, what is the purpose of the clause? There is a secure children’s unit in Sleaford in my constituency. What will happen to those children if it is commissioned locally, and where will the money flow from?
We asked in a previous sitting whether the Minister thought that the new Prime Minister will want to continue with this Bill. When it comes to the OPICs, in essence the Government will be firing staff from one job, paying them redundancy, and rehiring them, potentially on different terms and conditions, to do a similar job in the OPICs. Is the Minister aware that the right hon. Member for Makerfield (Andy Burnham) used to speak out against firing and rehiring staff, and abolishing and recreating organisations? That is essentially what is happening, so will she have to abandon these changes?
Dave Robertson (Lichfield) (Lab)
We have heard a few times about Conservative fears about redundancy payments and so on. Why did they not add NHS England to the list of organisations covered by the modification order when they had the opportunity to do so? Is the hon. Lady aware of a reason why that did not happen when the Conservatives were in government?
Dr Johnson
I am afraid I do not know the answer to that question. The key point is that it is not logical to abolish a three-tier structure and recreate it with taxpayers’ money to do exactly the same thing. If NHS England is replaced by the Secretary of State, the regional NHS England is replaced by the OPICs and the ICBs are at the bottom—the more local tier—what has changed? The middle tier will be doing the same thing.
Dave Robertson
The modification order is a piece of legislation that is often used in the public sector. It means that when people from a lot of public sector organisations are made redundant and find alternative employment at another state-funded organisation, they are not entitled to a redundancy payment. During their 14 years in power, it would have been entirely possible for the Conservatives to add NHS England to the list of organisations covered by the modification order. That would have prevented the costs that the hon. Lady has mentioned several times. It just seems like they did not take the opportunity to do that, and now they are saying that they should have done that when they were in government.
Dr Johnson
But we were not planning to abolish NHS England, so we had no reason to worry about redundancy. We were not planning a large-scale abolition—the largest that has ever happened in this country.
Amendment 57 would require the Secretary of State to publish and consult on commissioning transition plans before making regulations under proposed new section 3B that alter which services are commissioned nationally. It is a very reasonable amendment that would just mean that people get answers. It would mean that vulnerable people with unusually rare or highly complex conditions requiring regional or even national treatment could understand any changes the Government planned to make. We know that some services are delivered in only three or four centres in the UK. If a patient lives far from a centre, and suddenly that centre is closed, that can have huge travel and service implications, which can create huge distress and worry and make care worse.
Helen Morgan (North Shropshire) (LD)
It is a pleasure to serve with you in the Chair, Ms Lewell. In general, the Liberal Democrats support clauses 12 and 13. We think that local decision making and community empowerment in the NHS, including on commissioning decisions, is the right thing to be doing.
However, I echo some of the concerns of the shadow Minister, the hon. Member for Sleaford and North Hykeham, particularly on specialist commissioning. I declare an interest as vice-chair of the spinal cord injury all-party parliamentary group. We are concerned that expertise in low-volume, very specialist concerns will be lost if the commissioning is pushed out to multiple ICBs. My understanding is that specialist commissioning sat with NHS England in the first place because of concern that multiple commissioning groups would struggle to deal with low-volume, complex issues.
The president of the Royal College of Psychiatrists warned earlier this month that the new commissioning structure lacks mental health experts, with only one senior mental health lead across the seven new regional commissioning hubs taking specialised services from NHS England. Equally, the chief executive of the Derby and Derbyshire, Lincolnshire, and Nottingham and Nottinghamshire ICB cluster has said that it does not look like there will be a requirement for senior mental health expertise in reorganising ICBs. Will the Minister reassure us that when the Department designs which specialist services will be pushed back down to ICBs and which will be retained centrally, it will be minded to listen to representations from experts in the sector?
There are excellent services located geographically by accident—for example, the orthopaedic hospital in my constituency and the veterans service that goes with it. Both are highly valued, but they need specialist commissioning at national level to be utilised properly and to provide the best outcomes for patients. I would be grateful for the Minister’s reassurance on those points.
Dr Johnson
I agree with much of what the hon. Lady has said. Does she therefore support amendment 57, which would ensure that such a consultation takes place?
Helen Morgan
Yes, we would support the amendment, which is a reasonable way to get there, but an assurance from the Minister that the Department will consider specialist commissioning and really think that through properly before the powers are delegated to ICBs would be sufficient.
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship this morning, Ms Lewell.
It is right that Ministers are ultimately responsible to the House for the performance of the health service and subjected to the scrutiny of Parliament for its execution, but there is an important distinction between accountability and operational control, which I fear the clause risks eroding in some cases. The national health service has over many years developed a structure that seeks to balance political accountability with operational independence, and that balance exists for a reason. Decisions on what services are commissioned, where they are delivered and how resources are allocated are not purely political judgments; they are complex, technical decisions that ought to be guided—primarily, in my view—by clinical evidence, patient need and professional expertise. Transferring commissioning functions directly to the Secretary of State, as the clause will do, risks drawing those operational decisions more directly into the political sphere, even if that would not happen in every case.
The more that Ministers are involved in determining which services are commissioned nationally and which are not, the greater the risk that over time those decisions will be influenced by short-term considerations and short-term pressures rather than long-term patient outcomes. Even when no such influence is intended, the perception that that could occur will be damaging. As I said in discussions on previous clauses, the NHS depends heavily on public trust, and that trust rests in part on the belief that decisions are being made in the best interests of patients and on the basis of evidence, rather than political expediency. We should therefore be cautious about any measure that threatens to blur that line.
Despite the Minister saying that the stated intent in the Bill is to decrease centralisation, the clause appears to move some parts of the system closer towards centralisation, rather than maintain that balance. I do not believe that the Committee should take that step without careful consideration of the potential consequences.
There is also a practical dimension to this issue. Under the clause, the Secretary of State potentially assumes direct responsibility for any and all decisions currently exercised at arm’s length. That raises legitimate questions about capacity and focus. As I said previously, the health service, as we all know, is vast, complex and complicated, and decisions, especially about specialised commissions, are technical and require detailed expertise and understanding. What is not immediately clear from the clause is that such decisions are best taken by the Secretary of State rather than by bodies with dedicated expertise and a degree of operational independence.
Both my hon. Friend the Member for Sleaford and North Hykeham and the Liberal Democrat spokesman, the hon. Member for North Shropshire, spoke about highly specialised services, where essentially there is a capacity issue and a need to be able to look at the demand as a whole. They both raised the danger that, if those commissioning decisions are taken at local level, those at that level may not have the expertise, the finances or indeed the capacity to truly understand those highly complex, low volume specific needs.
I have some sympathy for the Minister, because the danger that we have seen in the NHS is that everything becomes more and more specialised and the ICBs push it away. I understand why the Government are proposing some of these changes, but we must not throw the baby out with the bathwater. We must ensure that services continue to be commissioned by experts at the national level if they need to be; and that if they need to be commissioned by experts at ICB level or even more locally, it is done through the neighbourhood health schemes that the Government are pushing, which I support in principle.
For those reasons, if the Committee is minded to support the shift in responsibility, I suggest that we put in place some robust safeguards to ensure we have transparency, consultation and evidence-based justifications for decisions. Without those safeguards, there is a risk that the centralisation of power on the one hand and the devolution of specialist services on the other will unintentionally make a system that is less transparent and less robust.
That is why I support amendment 57 in the name of my hon. Friend the Member for Sleaford and North Hykeham. The powers in clause 12 need to be bounded by checks and balances, because these are not minor administrative changes, but a significant shift in responsibility. We must ensure that decisions to move service commissioning are made as transparently as possible. In those circumstances, it is entirely right that Parliament should be able to scrutinise those decisions.
The amendment would achieve that. Subsection (4A) would require the Secretary of State, before making regulations, to prepare and publish a commissioning transition plan and to lay that before Parliament. Subsection (4B) would require the plan to set out, in detail, the services being changed and the reasons for the changes. It would also require clarity on which bodies will assume the responsibility and why they are considered capable of doing so. That level of transparency is essential if Parliament is to exercise meaningful oversight. Subsection (4C) would establish a formal consultation requirement, and subsection (4E) would require the Secretary of State to publish a response to that consultation, setting out how concerns have been addressed. That is vital, because there is no point having a consultation if the Government just ignore it. Finally, subsection (4F) would ensure that no regulations can be made until a defined period has elapsed after that response, thereby providing a time for proper parliamentary and public scrutiny.
Those of us who sit on Select Committees, especially the Health and Social Care Committee, often receive responses to our recommendations from the Department that, as my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) said in evidence, give the veneer of acceptance, but then no meaningful action is taken. The amendment would allow meaningful scrutiny and ensure that the Government actually respond to that request.
Taken together, the provisions would ensure that decisions are not only made, but made openly, transparently and accountably to those who are elected in this place to represent our constituents.
Liz Twist (Blaydon and Consett) (Lab)
I wish to speak on clause 12 in the context of specialised commissioning. In my parliamentary work, I deal with a great number of rare disease communities and other specialised groups. Specialised commissioning is important to them to ensure that they get the service they need and deserve. Will the Minister explain how we can ensure that there is patient involvement in a more dispersed system of commissioning, and that there is national oversight and clinical leadership for all these things? How will she ensure that specialised commissioning groups are monitored and that effective services are being provided to those in the communities who need them?
The Minister for Secondary Care (Karin Smyth)
Clause 12 inserts new section 3B into the National Health Service Act 2006, re-establishing the responsibility of the Secretary of State to commission services. Although we intend ICBs to commission the vast majority of services, as we discussed this morning, we will use this regulation-making power to set out the small number of specialised services that the Secretary of State will be responsible for. That may include, for example, proton beam therapy, alongside a small number of other specialist services not currently suitable for ICB commissioning, such as gender dysphoria services and clinical genomics. By their nature, those are services to which national commissioning is appropriate because, for example, they have fewer patients or providers, greater or changeable costs, or they require specialist clinical expertise and input. Having a regulation-making power allows us to future-proof the system and update the regulations when new services or treatments emerge, or when services become cheaper or mainstream and therefore sit better with ICBs.
I now turn to amendment 57, which was tabled in the name of the hon. Member for Sleaford and North Hykeham. I recognise that any change to the way these services are commissioned matters enormously to the patients who depend on them. The hon. Lady used the word “worried”, and I understand that. Any change must be made with the greatest of care. However, the amendment would require the Secretary of State, before any regulations are made that alter the range of nationally commissioned services and regardless of the scale of the change, to publish a transition plan covering seven prescribed matters, to consult five prescribed categories of persons for a minimum of 12 weeks, to publish a response to that consultation and then to wait a minimum of 60 days before the regulations can be made.
As I have said, I understand and share the concern about continuity of care and the careful allocation of responsibility that lies behind it, but the proposals in amendment 57 are not the right way to address that concern. It proposes a fixed sequence of steps with minimum time periods that would apply to every change without exception. Taken together, the prescribed steps would add the better part of half a year to any change, including changes that are minor or technical, or that, for reasons of clinical safety, need to be expedited. That would create delays for patients and uncertainty for the wider system over where commissioning responsibility sits.
I would like to offer assurance on some of the concerns raised today. I commend my hon. Friend the Member for Blaydon and Consett, who has spoken to me regularly about her concerns, for the work that she does in this area. I also commend the Lib Dem spokesperson, the hon. Member for North Shropshire, for her work on spinal cord injuries. I have met the chair of the APPG on spinal cord injury to discuss this topic. I would like to thank Bristol Councillor Kelvin Blake, who has a spinal cord injury and who for many years has impressed on me the difficulties faced by people with spinal cord injuries who are wheelchair dependent. I commend the work of people with these conditions who, as the hon. Member for Sleaford and North Hykeham said, struggle through a system that they should not have to struggle through. We want to make sure that these changes are assured, and I commit to working with hon. Members to do that as the Bill goes through.
I can assure the Committee that any significant change to nationally commissioned services will be accompanied by proportionate and appropriate engagement with patients, clinicians and the bodies affected. Change will always proceed according to appropriate transition arrangements. Each service, as hon. Members know, has very different patient needs and commissioning requirements, and demands different skills to commission effectively. The framework the Government are proposing will enable the Department to manage these processes flexibly and proportionately.
The hon. Member for Sleaford and North Hykeham asked about arrangements for new organisations. In a changing organisation where people are coming forward for redundancy and in a new organisation that is taking shape, it is important that the executive looks at all redundancy requests and changing needs with regard for critical business infrastructure and the retention of skills. That is what we are currently doing.
The hon. Lady also asked about funding. The Bill allows the Secretary of State to set out which ICB pays for whom, and there are clear rules for people in prisons and those not registered with a GP currently under the guidance of court, which is called “Who Pays?” There are also long-standing processes for ICBs to pay each other as needed. The hon. Lady also asked about high security mental health services; I can assure her that we have no plans to ask the private sector to provide services. The power to direct has been updated to ensure that directions would bite on non-NHS providers if that changes in future.
Clause 13, which is part of this group, is a technical clause that permits the Secretary of State or an integrated care board to confer on a person discretion in relation to anything that is to be provided under the commissioning arrangement. In practice, this means that they could undertake some activities traditionally carried out by a commissioner, such as reviewing how services are provided for a population and designing the way that those services will be delivered within the parameters set by the commissioner. These activities would be clearly set out and measured under the contract, and the commissioner would retain overall responsibility for the delivery of their functions. Currently, integrated care boards are already permitted to do this, and with the transfer of NHS England’s commissioning powers to the Secretary of State, we propose a similar approach for services that are commissioned nationally.
I hope that I have been able to reassure the hon. Member for Sleaford and North Hykeham, and that she will withdraw her amendment. I commend clauses 12 and 13 to the Committee.
Dr Johnson
Unfortunately, the Minister’s reassurances have not convinced me. In relation to change, “significant” means various things to different people. As for “proportionate”, what is “proportionate” to one person is not necessarily “proportionate” to another.
Amendment 57 makes reasonable provision for a situation in which there is a change from national to local commissioning, or from local to—mostly, it is from national to local commissioning. Therefore, I would like to push it to a vote.
Question put, That the amendment be made.
The Chair
With this it will be convenient to discuss the following:
Clause stand part.
Government amendments 14 to 18.
Schedule 1.
New clause 2—Right to a GP appointment—
“(1) The Secretary of State must by regulations, within six months of the passing of this Act, establish a scheme to provide every patient with the right to a GP appointment within seven days of seeking one.
(2) The scheme should include a right contained in the NHS constitution for a patient to receive a GP appointment within seven days, or 24 hours if urgent.
(3) The Secretary of State may review the scheme every three years from the day on which this Act is passed and amend it through regulations made by statutory instrument.
(4) A statutory instrument under this section may not be made unless a draft has been laid before and approved by a resolution of each House of Parliament.”
This new clause requires the Secretary of State to introduce a scheme to ensure that patients have the right to see a GP within seven days.
Government new clause 21—Dispensing medical practitioners etc.
Government new clause 22—Inadequate provision of pharmaceutical services.
Government new clause 23—Pharmaceutical services: appeals etc.
New clause 30—General Ophthalmic Services: national framework, tariff and protected funding—
“(1) The Secretary of State must by regulations establish and maintain a national service specification for the primary ophthalmic services referred to in section 115 of the National Health Service Act 2006 (in this section referred to as general ophthalmic services, "GOS"), setting out the minimum standards of access and provision that integrated care boards are required to secure.
(2) Regulations under subsection (1) must establish and maintain a national tariff for GOS, setting out the prices at which GOS must be commissioned by integrated care boards.
(3) An integrated care board must commission GOS in accordance with the national service specification and national tariff established under subsections (1) and (2), and may not exercise any discretion to vary, restrict or reduce provision below the standards so specified.
(4) The Secretary of State must ensure that funding for GOS is allocated to integrated care boards as a ring-fenced, protected funding stream, which—
(a) may not be applied by an integrated care board to purposes other than GOS; and
(b) may not be reduced by an integrated care board in order to meet expenditure requirements in respect of other services.
(5) In determining any expenditure limits or resource allocations for integrated care boards under the National Health Service Act 2006, the Secretary of State must calculate and separately identify the GOS component of each board's allocation.
(6) The Secretary of State must lay before Parliament a report in each calendar year assessing the extent to which integrated care boards have complied with their obligations under this section.”
Government new schedule 1—Pharmaceutical services: appeals etc.
New clause 52—Access to dental provision: Dental deserts—
“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must establish a scheme to improve access to dental provision (“the Scheme”).
(2) The purpose of the scheme is to end dental deserts.
(3) A dental desert is defined as any local authority area with fewer than ten active dental practices per 100,000 people.
(4) The scheme must make provision to support integrated care boards to—
(a) guarantee emergency access to an NHS dentist,
(b) provide free dental checks up for—
(i) children,
(ii) mothers within one year of having given birth,
(iii) pregnant women, and
(iv) low-income households, and
(c) guarantee dental appointments for persons commencing—
(i) surgery,
(ii) chemotherapy, or
(iii) transplant procedures.
(5) The Secretary of State must, before publishing the scheme, issue a reformed dental contract.
(6) The Secretary of State must, within six months of the establishment of the scheme, publish a dental workforce plan to support delivery of the scheme.”
This new clause would establish a scheme to support integrated care boards to end dental deserts.
Karin Smyth
Primary care is the front door to the NHS and is critical to delivering our neighbourhood health agenda. The neighbourhood health service will bring care into local communities, ending fragmentation and preventing unnecessary hospital admissions. To support that, alongside clause 14, which I will discuss shortly, we have tabled new clauses 22 and 23 and new schedule 1, to strengthen action in the event of local pharmacy challenges and streamline the appeals process.
On new clause 22, many hon. Members will know how the closure of a local pharmacy can significantly affect a community. Pharmacies close for a range of reasons: voluntary closure, business failure or emergencies affecting the premises or surrounding area. Even where a pharmacy remains open, unforeseen or unexpected events can disrupt access for local people.
The NHS Act 2006 sets out how ICBs should commission pharmaceutical services in normal circumstances and what can be done if those arrangements fail. Section 133 of the Act is intended to deal with exceptional situations where standard commissioning processes are too slow and rapid action is needed to restore provision while long-term solutions are put in place, if required. However, the current wording of section 133 is widely interpreted as applying only to large-scale national emergencies, as it refers to inadequate provision affecting a significant number of people. It is unclear whether that would cover more localised situations, such as a village cut off by flooding following a bridge collapse, or where the only pharmacy serving an area closes unexpectedly, creating an urgent unmet need, as we have seen happen. It is also unclear how the Secretary of State would authorise alternative arrangements.
To address those issues, new clause 22 ensures that ICBs can respond swiftly to exceptional circumstances, regardless of scale. It removes the unnecessary provision for the Secretary of State to make arrangements himself and clarifies that authorisation to ICBs should be given through directions. The directions will be limited to six months, with the possibility to extend further if required. This change maintains appropriate national oversight while preventing misuse of the powers. It is a sensible and proportionate amendment that gives the system the flexibility it needs in exceptional circumstances while retaining proper safeguards.
New clause 23 and new schedule 1 simplify the appeal framework for NHS pharmaceutical services by allowing appeals that are currently split between different routes to be heard by a single appeal authority. At present, where concerns arise about a pharmacy contractor, different appeal routes may apply depending on whether a case is characterised as one of fitness or of performance. In practice, however, that distinction is not always clear and the current system can create unnecessary complexity and duplication.
New clause 23 and new schedule 1 address that problem, providing for such appeals to be heard through a single route, which we intend to designate in regulations as NHS Resolution. It is a practical and proportionate change; NHS Resolution already has substantial experience in handling disputes involving NHS pharmaceutical services and is well placed to provide a clear, consistent and independent route of appeal. Importantly, this measure does not change the position in relation to the fitness to practise of individual pharmacy professions. Cases concerning individual practitioners will continue to be dealt with separately by the General Pharmaceutical Council.
By simplifying the framework, this measure will help to ensure that related issues can be considered more coherently, reduce fragmentation in decision making and support the effective oversight of NHS pharmaceutical services. In short, it aligns the appeal system more closely with operational practice, reduces unnecessary complexity and preserves the appropriate safeguards for individual practitioners.
The remaining Government amendments are consequential on those changes, or are technical changes that have emerged as necessary following drafting of the wider Bill. I will speak to new clause 21 in particular, as it updates section 132 of the 2006 Act so that the legislation reflects current commissioning arrangements for pharmaceutical services. Section 132 currently allows, in addition to retail pharmacy business, arrangements to be made with individual doctors and dentists for the provision of pharmaceutical services.
That wording reflects an early model of care. In practice today, arrangements for primacy medical services are made with GP practices, not individual general practitioners, and patient lists are held at practice level. New clause 21 therefore brings the legislation into line with the way services are already commissioned and delivered. It will mean that, where such arrangements are made with dispensing doctors, they are made with GP practices rather than individual GPs. It also removes provision to make such arrangements with dentists, to reflect the fact that that provision is redundant.
In summary, new clause 21 is a technical amendment, which does not change current practice but simply updates the statute book to reflect modern NHS arrangements. Patients in rural areas eligible to receive medicines from the dispensing doctors will continue to receive that service as they do now.
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I have received representations from rural dispensing practices in my constituency about the provision of vaccination services. I understand that dispensing general practitioners are having difficulty securing the funding to provide vaccinations, particularly the new meningitis vaccination for young people. Does the Minister envisage that the change being proposed will have any effect on that arrangement?
Karin Smyth
The changes here, as I have outlined, are bringing practices in line in terms of the regulation. I think the issue my hon. Friend really addresses is the arrangement between those local practices and the ICB as the commissioner on where the service is provided. Ordinarily a commissioner would seek to make sure that a rural area had provision from somewhere in particular; I am happy to talk to my hon. Friend outside the Committee if there is a problem in his local area.
Dr Johnson
Clause 14 is very straightforward: it states that schedule 1
“confers functions on integrated care boards in relation to commissioning primary care services…transfers related functions from NHS England to the Secretary of State, and”—
perhaps most interestingly—
“contains other amendments relating to primary care services.”
Schedule 1 essentially makes the following changes to the NHS Act 2006: it makes ICBs responsible for commissioning pharmacy services instead of NHS England; it amends section 99 to make ICBs responsible for commissioning dental services instead of NHS England; it amends section 83 to make ICBs responsible for commissioning primary medical services such as general practice instead of NHS England; and it amends section 115 to make ICBs responsible for commissioning ophthalmic services.
Largely, this change is formalising existing delegation and the risk of disruption is therefore relatively low. Local commissioners can tailor decisions to local need, and it is better if decisions are taken closer to users. However, there are a few other things in there as well. Paragraph 12(2) amends section 97 of the 2006 Act containing local medical committees, which are statutory committees. The way it is phrased,
“the whole or part of the ICB’s area”,
does not allow for overlap. Is that the Government’s intention? The Government, in a broader sense, talk about the strategic authorities and having the mayoral authority level involved in the ICB. But in Lincolnshire, for example, an area that I represent part of, the local medical committee could not work in conjunction with the mayoral authority under this legislation, as far as I read it, because it essentially covers two ICB areas and two regions.
The mayoral authority is the Greater Lincolnshire mayoral authority. That includes Lincolnshire’s upper-tier area, the Lincolnshire county council area. It also includes the areas around Scunthorpe, Grimsby and Immingham, which fall into the Yorkshire region as opposed to the midlands region, and therefore not a whole or part of any given ICB area. I wonder whether the Minister has any comment on whether that was the intention, because it is also the case with paragraph 24(2) of schedule 1, which amends section 113 of the 2006 Act on local dental committees. Again, although the ambition stated and discussed in the Health and Social Care Committee yesterday by the Minister for Care, who is responsible for primary care, was that ICBs were to be covered at strategic level, that would not be possible for local medical committees or local dental committees under my reading of paragraph 12(2).
Gregory Stafford
Does my hon. Friend agree that this Bill would have been the perfect time to align health commissioning services with local government structures and that the fact that these structures are being created totally without the new local government structures is not just an oversight, but a potential problem with the whole Bill? Does she also agree—I think that she was outlining this already, but I want to ensure that the Minister is clear on it—that the Government still have a chance to amend the Bill to ensure that the commissioning structures and commissioning areas outlined in the Bill neatly map out to the new local government areas? In relation to, for example, the current Hampshire and Isle of Wight ICB, Hampshire is potentially being split up into a number of local government areas. I am against the way it is being split up, but if the Government are pressing ahead with it, this would have been the perfect opportunity to align commissioning with those areas. The problem is that we will now have a situation in which they do not match up, and the problems that my hon. Friend has outlined in her speech thus far will come to the fore.
Dr Johnson
Of course, my hon. Friend is right. One challenge with the Bill is that although not all the measures are a problem individually, the way they are being brought in is a problem. The planning and organisation that has gone into it has not been coherent. A 50% cut has been made to the budgets of ICBs, which has required many of them to merge, but that has been done before the local government reorganisation has been finished, which means that ICBs have been melded together in a way that is not the same as the local government reorganisation.
Let me again give the example of Lincolnshire. Lincolnshire had an excellent ICB, run by chief executive John Turner. That has now merged with Nottinghamshire and Derbyshire. Nottinghamshire and Derbyshire form the East Midlands mayoralty, but Lincolnshire ICB, as was, forms part but not all of the Lincolnshire mayoralty—which, as I said, also includes part of what was the Yorkshire region. Because the cuts were done before the local authority reorganisation, and the left hand does not know what the right hand is doing, we have ended up with an incoherent pattern, which does not help, particularly for social care services that are delivered by local authorities. We will come back to that when we talk about who is on the ICB. The risk is that we end up spending money doing this twice—being forced to do it at short notice, because of the 50% cuts brought in overnight by Government, and then doing it again to try to sort out the mess and bring things back into line with the new local authorities as and when it is decided what they will be.
Going on to the pharmaceutical arrangements—I should probably declare at this point that my brother is a rural dispensing GP—I share the concerns raised by the hon. Member for Bury St Edmunds and Stowmarket in relation to rural dispensing GPs. Let me give the Minister an example from my constituency. The Cliff Villages medical practice was an excellent medical practice. However, there was a doctor retirement and the illness of a doctor, and as a result the service reduced in quality quite substantially.
The ICB was working alongside the surgery and the one remaining practice doctor—not swiftly enough, it must be said. What happened in the end was that the Care Quality Commission came in, found that the service was really not good enough and closed the surgery down overnight, in the middle of the week. It was closed with immediate effect and there were no appointments for any patients in my constituency. Then, because the surgery had been closed, the ICB worked very hard to get a new practice in straightaway, and it got that opened on the Monday, which was pretty quick in the circumstances; but people lost their dispensing GP.
Living in a rural area—I have a dispensing GP myself, living in a rural area—people can go to the doctor’s, see the doctor and, if the doctor perhaps says, “You need some antibiotics,” they can go back to the waiting room and sit there for 10 minutes, be given the antibiotics and then leave. That is significantly more helpful to a rural constituent than having to drive eight or nine miles into the centre of town, park the car, find somewhere to get the prescription and then go all the way home again, which would take much longer. People really value that service—I saw how much when I held a public meeting with the ICB and the new provider to talk about what had happened at the surgery, and 250 people turned up to an evening event in the village hall at short notice. It is hugely important to people.
Will the changes allow the Secretary of State to step in in such circumstances, where the medical contract has been lost due to that cut-off by the CQC? Will that sudden loss of service be able to be replaced with a new dispensing service? Could Ministers have therefore given dispensing rights to the new provider? At the moment, those rights are not transferable, and it means that the only way that my constituents who live in that area and attend that practice can maintain dispensing rights is either to move house—perhaps to next door and back again, but they have to move house—or to change practice immediately, that same day, to another dispensing practice. To be honest, that seems ridiculous. Could the Minister make any comment on how the provisions in the Bill will help that situation and what her views are?
I am confused by new clause 23 and new schedule 1; the Minister has introduced them later than the rest of the Bill, but they seem quite significant. They would move pharmacy appeals from the first-tier tribunal to an NHS body specified by regulations made by the Secretary of State. I presume the regulations are not yet written, so we do not know what form that would take, but the first-tier tribunal is part of an independent judicial system and the appeals will now be under political control, within the Department.
Could the Minister explain why they think that is fair? Why do the Government want to do that? Is it just about saving money? How will the judgments made by that new authority be properly enforceable and give people confidence, given the change from the first-tier tribunal in the judicial system to something more politically controlled?
I move on to new clause 2, which would require the Secretary of State to establish within six months a scheme to give patients the right to a GP appointment within seven days of seeking one, or 24 hours if urgent. I would be interested to hear the Minister’s comments on that and how she thinks it could be achieved.
Modelling by the Health Foundation suggests that 6,500 full-time equivalent GPs—37,800 in total—will be needed by 2030-31 to meet greater clinical need. We have already talked about the doubling of medical school places; I presume the Minister has sought correction since we last spoke on whether the Government have a plan to double those places or not, but the Government are not on track to have that number of GPs. Is it simply that they do not have the resources to deliver it? I would be interested to hear the Minister’s comments.
Helen Morgan
With permission, I will explain to the shadow Minister our votes on amendment 57, which she pressed to a vote. I was reassured by the commitment the Minister made to consult widely on those commissioning changes, so the Liberal Democrats switched our vote from support to abstain.
I move on to new clause 2, our amendment in this group, which the shadow Minister was just discussing. It would require the Secretary of State to introduce a scheme to ensure patients have the right to see a GP or another appropriate clinician within their GP practice within seven days.
The NHS constitution currently confers rights on patients when they are considered really important. There are, for example, rights within the NHS constitution around receiving cancer diagnoses and treatment. We felt that there was a gap on access to GPs. Given the Government’s stated aim of transferring more care into the community, which we fully support, and given the observation in the Darzi report that more and more money is being spent on secondary rather than primary care, we think it is really important to confer the right on patients to be able to access primary care when they need to.
As the hon. Member for Sleaford and North Hykeham pointed out, this measure would require a large number of additional GPs and would therefore not be achievable overnight, but over the course of a Parliament. The Liberal Democrat plan includes recruiting and retaining an extra 8,000 GPs, relieving pressure on the rest of the health service and enabling that shift into the community. When patients—
Sojan Joseph (Ashford) (Lab)
New clause 2 clearly states that everybody should have a legal right to an appointment with their GP “within seven days”, while the current provision is that patients are entitled to see a GP or other professional within 24 hours or two days for urgent care. Would creating this legal burden on GP practices not reduce their ability to prioritise, meaning that the people who need urgent treatment will be delayed further?
Helen Morgan
We do not consider the right to achieve a cancer diagnosis and treatment to be burdensome on the secondary care providers of those treatments; we consider that important enough to enshrine that right within the NHS constitution, and this would be a similar level of right. I would not imagine that a GP would be worrying about somebody taking them to court, but it would confer upon the Secretary of State the duty to ensure that primary care is adequately resourced in order to be able to meet that commitment.
Edward Argar (Melton and Syston) (Con)
I am very grateful to the hon. Lady for giving way; she is typically generous with her time. Can I just seek a little clarification in terms of the right to a GP appointment in new clause 2? Is her intention that that is an appointment with the practice—be that any clinically qualified individual within it—or an appointment with a GP, not with a practice nurse? Would, for example, a telephone appointment constitute an “appointment”, rather than specifically an in-person appointment? I just want to understand a little more about what is expected here.
Helen Morgan
The right hon. Gentleman asks an extremely important question, and I am happy to clarify. It would be an appropriate clinician within the GP practice, and it could obviously be a telephone appointment, because that might be more convenient for the patient. Lots of patients are really happy with telephone appointments and we should be using them wherever that is the patient’s choice, because we want—I think we all do—to see an NHS that is patient-led and not politician-led.
Helen Morgan
I am going to make some progress, actually, because I think I am going to be asked the same questions.
Helen Morgan
Well, I will just move on a little bit. The important question is: can this be achieved this overnight? Clearly not; we need additional clinicians in the service. The Liberal Democrat view is that the extra—I think 1,000 or 1,500—GPs that the Government have recruited so far is a welcome step forward, but that does not go far enough over the course of a Parliament.
As I was saying earlier, when patients cannot access their GP surgery, they end up, more often than not, in accident and emergency departments. That is no good for anybody. It overburdens the A&E department, leaves people who genuinely need urgent care getting a substandard level of care, and costs the NHS far more. We think it is really important that we put the resource in the right place.
Dr Danny Chambers (Winchester) (LD)
Just to reiterate what my hon. Friend is saying, in Winchester we are now putting an urgent treatment centre in front of the A&E, staffed by GPs to do the triage, because so many people who turn up are only there because they cannot get a GP appointment. So we now have hospital trusts paying for GPs to provide same-day GP appointments, and that is coming out of the secondary care budget instead of the primary care budget. That is obviously the most expensive place to treat patients for routine things.
Dr Johnson
We Conservatives share the hon. Lady’s desire to ensure that patients get their appointments as soon as they need them to be had, but she is talking about a difference between urgent appointments, within 24 hours, and non-urgent appointments, within a week. Who is going to make the decision about whether the appointment is urgent? Will it be the clinician? Will it be the patient themselves? Has she thought about where that responsibility lies?
Helen Morgan
Yes, I have thought about where that responsibility lies. It clearly lies with the triaging process within the GP surgery. I do not think any of us envisage somebody phoning up about a child with a cold and saying, “I consider this to be urgent,” and getting an appointment within 24 hours, but I would imagine somebody from the surgery saying, “Please describe the symptoms to me,” and then, if they detected something more serious, saying, “That is urgent and you do need to come in within 24 hours.” The point of new clause 2 is to clarify in the NHS constitution that some services require parity with others. We have already established legal rights under the NHS constitution for certain types of treatment, and this puts GP access on the same level. We think that that is important.
I am conscious of time, so I will move on to new clause 52, which is about dental deserts. Everyone is horrified by dental deserts and by “DIY dentistry”, a phrase that means—let us face it—people using pliers to extract their teeth and super glue to reattach crowns, and cavities filled with household adhesives. More than 5 million children did not see a dentist at all in 2025. That is a stark failure. Dental care is as important as care for other parts of the body, in particular when most of what goes wrong in dentistry is preventable. We should absolutely focus on prevention, and that is in line with the Government’s aims to move from sickness to prevention.
New clause 52 is about our £750 million dental rescue plan to guarantee access to an NHS dentist for anyone needing an urgent or emergency appointment, which I hope would end that awful DIY dentistry. The plan needs to be achieved through bringing dentists back from the private sector, fixing the contract, using flexible commissioning wherever necessary and introducing an emergency scheme. For example, the emergency dental scheme in Shropshire, operated by the community dental practice, enables people who have urgent need and cannot register with an NHS dentist to get the care that they need when they need it. I urge the Minister to take our new clauses on board and to ensure that people get the care they need when they need it.
Gregory Stafford
I will start where the Liberal Democrat spokesman, left off, with new clause 52 on dental provision. I have a lot of sympathy for what she is trying to achieve with the new clause. In my own constituency, as far as I can tell, looking earlier today, not a single dental practice is taking new NHS patients for dentistry, whether that be children or adults, and that is extraordinarily concerning.
Even more concerning—this somewhat relates to the changes that the Government are making in the clause through bringing the commissioning of dental services to ICBs—I have a fully equipped and fully functional dental surgery in Haslemere hospital in my constituency, but it has remained entirely unused for a number of years, because it sits within the hospital, which is run by the Royal Surrey NHS trust, but is commissioned by the ICB. That seems like an utter waste of resources. That is something that could be clarified through new clause 52 and, I hope, through the clauses tabled by the Government.
On new clause 2, about GP practices, I am disappointed that the hon. Member for North Shropshire did not want to take my intervention because she will not be able to answer my questions, unless she intervenes on me now, which I hope she will. Again, I sympathise entirely with what she is trying to achieve. We want to ensure that people have timely access to their GPs. I am sure that, like me, she has constituents who cannot get a GP appointment in any reasonable time. They can wait numerous weeks, upwards of five or six weeks, for something that they should be seen about.
A lot of questions are unanswered by new clause 2, however. I will not repeat the questions asked by my right hon. Friend the Member for Melton and Syston and by my hon. Friend the Member for Sleaford and North Hykeham, but I have some others. For example, the new clause states that the Government must
“establish a scheme to provide every patient with the right to a GP appointment”.
Although the hon. Lady clarified that that could be a telephone consultation, what is not clear is whether that is an appointment at the named GP practice at which the patient is registered, or is just with any GP, through something such as the NHS 111 service.
Helen Morgan
I would like to clarify that point. We envisage that being at the GP with whom the patient is registered. Our broader policy, which is not included in new clause 2, is to have named GPs for people with complex conditions and complex comorbidities. Absolutely, we would envisage that as being a part of the continuity of care, which is so crucial.
Gregory Stafford
That is a helpful clarification, but it raises a number of other questions. I entirely agree with the hon. Lady that named GPs are most appropriate; all the clinical evidence suggests that even for people with non-complex needs, having a named GP whom they can see regularly improves patient outcomes. I therefore support her on that, but does she believe that we currently have sufficient GPs for that to go ahead? Even the six-month lag in her new clause would not be enough time to recruit thousands more GPs. If she does not believe that there are enough GPs at the moment, when does she envisage that they would be in post? How much would that cost? Where would she get the money to fund those extra GPs? Rather than just expressing what I would call “motherhood and apple pie” statements about things that we all want, we in this House have a duty to be honest with our constituents about how we would achieve them—and, if we have to achieve them within six months, what funding and impetus will have to be put in place.
Helen Morgan
Let me clarify. The new clause is about conferring a duty on the Secretary of State to provide that level of care. It would require a significant number of additional GPs, and that would cost a lot of money. The Liberal Democrats’ 2024 manifesto had a fully costed pledge to recruit and retain an additional 8,000 GPs within the course of a Parliament. I think we can all agree that the world has moved on since then, but the hon. Gentleman will be aware that this week we proposed a significantly closer relationship with the European Union, which would grow our economy, increase our tax base and pay for a number of these things without having to subject people to additional, onerous tax hikes.
Gregory Stafford
I think that clarifies that there is no real concrete plan for how to fund this new clause. I do not mean in any way to demean what the hon. Lady is trying to achieve, because she is trying to achieve something important, and which we all want, but we have to be honest with our constituents about how we can do that, and some ethereal money to come through some ethereal plan at some point in the future—
Gregory Stafford
Let me finish this point. I am not in the mind of the current Prime Minister, and I am certainly not in the mind of the potential next Prime Minister, but even if the hon. Lady is right my understanding is that he—either is probably a he—is unlikely to have changed our relationship with Europe within six months.
The Chair
Order. We are straying slightly into a debate about European matters. Can we stick to the amendments before us, please?
Gregory Stafford
Thank you, Ms Lewell. You have certainly saved me from myself, if not anybody else. I think I have belaboured the point; I will leave it there. I sympathise with and indeed support the ambition of new clause 2, but I have a real problem with the lack of detail on how it would be achieved.
I turn quickly to clause 14. As my hon. Friend the Member for Sleaford and North Hykeham said, it has bits that we welcome, but there are some concerns about how the ICB structures fit over the local government structures, and cutting ICB administrative budgets by 50%, while asking them to take on more power and responsibility for commissioning services and many other things, is a real problem.
Likewise, we have welcomed, and I think both sides of the Committee agree, having neighbourhood health—however we want to describe it—and care closer to home, and having commissioning closer to home. It is therefore strange that my best performing ICB, Frimley ICB, has been abolished or merged with a number of other ICBs that have been performing far less well.
If the Government want to have the principle of place-based, locally responsive commissioning, they have to have a real focus on, actually look at, what fits with the current structures and to ensure that those ICBs that are performing best are encouraged and kept and that those that are not are dealt with. I have real concerns about, for example, the superstructure of the new Surrey and Sussex ICB. It is huge and, essentially, entirely antithetical to what the Government were trying to achieve by making stuff local—closer to home.
Dr Johnson
One thing that my hon. Friend mentions is the Government’s stated intention to bring things closer to home, as opposed to the reality of the Bill as drafted. Does he agree with me that the document that explains what will happen to the commissioning of specialist services, and that talks about seven regions and how ICBs could collaborate within those regions, might imply that the Government are looking forward to having seven areas in which most commissioning takes place? These are even larger areas than have been described in the mergers so far.
Gregory Stafford
It is for the Minister to clarify that point, but I share my hon. Friend’s concern. It is ironic that we seem to be heading back towards the strategic health authorities of an earlier age. Things in the NHS are neither created nor destroyed; they just go round and round and round. I think we may end up being back where we were 15 or 20 years ago, in an ever decreasing cycle of spending money on changes that are perhaps not wanted or needed.
I have touched on dental services, so I will not go any further on that. On pharmaceutical services, I agree entirely with what my hon. Friend said about dispensing GPs. That is a big issue. And I have touched on the Liberal Democrat new clauses. In conclusion, although Conservative Members support a number of the ambitions in relation to the group that we are debating, the questions that my colleagues and I have raised require more clarification from the Minister.
Edward Argar
It is a pleasure to serve under your chairmanship, Ms Lewell. My hon. Friends have addressed at some length the Government new clauses and amendments, so the Minister may get a slightly easy ride from me this time, but I want to pick up on new clause 2 and some of the points that my hon. Friend the Member for Farnham and Bordon raised.
The hon. Member for North Shropshire knows that I have huge respect for her. I have worked with her, across the health and social care space in this House, on a number of issues, so I can entirely appreciate where she is coming from on this. She raises an issue that is very important to all our constituents, which is access to primary care when people need it. For example, in Melton Mowbray in my constituency, there have been real concerns in recent months about very long waiting times to access primary care services. That has on occasion caused considerable distress for some patients, who have become more and more concerned.
I have to say that the practice has sought to do a lot to address that. It has brought on board a new annexe and additional services and been recruiting more GPs, but the challenges remain and the concerns are very real and would, I suspect, be shared by all our constituents. One of the key things in how the practice has been seeking to address the issue and how other practices locally, both rural ones and ones in some of the towns in my patch, have sought to address it has been a degree of flexibility and of clinical triage as to what is the most appropriate access point to primary care services for the individual, based on their symptoms and needs.
For me, despite the work being done in Melton Mowbray at the moment to improve waiting times, it remains a very significant concern that despite the integrated care board having a few years ago acknowledged publicly the need for additional GP provision in the town, whether a second GP practice or a new satellite service, it said a few months ago—despite the fact that in the intervening period there has been considerable housing development in the town—that it considers that there is no need at the present time for additional GP provision, and so it does not appear to have a plan to expand that provision. That is obviously concerning. All of us in this House will from time to time have these issues in our constituencies and, I suspect, sometimes get frustrated by the fact that ultimately we can press our ICBs and ask questions of the Minister—who, I have to say, always responds in a courteous and measured fashion—but ultimately the decision maker is the integrated care board’s board and it will do what it wishes to do when it comes to commissioning those services. There is a disconnect there.
My challenge with regard to new clause 2, despite my being in agreement with the need to improve access to services, is that there is a lack of clarity about how that will be done and there is the fear that it may raise expectations that are not necessarily deliverable on in the current context. The Liberal Democrat five-year plan for GPs is in their 2024 manifesto, and the hon. Member for North Shropshire alluded to the commitment to 8,000 additional GPs. It is not my usual habit, but I have read the Liberal Democrat website, which sets out the background. I appreciate that this is from 2024 and the hon. Lady may have moved things forward a little bit since then, but it states that the five-year plan
“gives patients the legal right to see a GP within a week or 24 hours if needed urgently”.
The hon. Lady may wish to respond on that.
Helen Morgan
I am sure the right hon. Member has enjoyed reading the Liberal Democrat website. If he had delved a little further into the policy paper that sits behind that manifesto commitment, he would see that that is with an appropriate clinician and not with a GP. I appreciate that the wording of the new clause says a GP, but it does indicate a GP practice, and would require the Secretary of State to establish a scheme that would achieve that. I expect that clarification could be made at that point.
Edward Argar
I am grateful for that, and the hon. Lady has that on the record. As we all know with political campaigning, the headline on the front page of the website may sometimes, although not always, contain the “conditions apply” caveat in the small print. The hon. Lady has read her explanation into the record of the House, and I, as always, take her at her word and accept that explanation.
My concern is how this measure would be paid for—8,000 GPs, of which half were to be new recruits and half were either through retention or by encouraging returners to the profession, with a costing of about £1 billion. That works out at about £125,000 a head, so it is not outside the realms of possibility. That was not going to be paid for through closer ties with the European Union; if I recall correctly, I think it was tagged against hikes in capital gains tax with three new bandings, rather than EU links.
Helen Morgan
I am happy to clarify. Clearly, the world has moved on since July 2024 when we put together our manifesto, but this was a fully costed plan with a number of different changes to tax regimes, including a tweak to capital gains tax and changes to the way that banks were taxed and digital services tax. Since then, we have proposed a number of other alternatives, but the principle of changes to capital gains tax, to the way that windfall profits of the big banks are taxed and to digital services taxes still stands. Plus, we also have a fully fleshed-out plan to actually grow our economy and deal with this problem in the long term.
Edward Argar
I am grateful for that clarification. I am conscious that we have to finish at 1 pm, so I will bring my remarks to a conclusion.
We can all see the intent behind new clause 2; we can all feel that intent in correspondence we get from constituents. Having taken legislation through the House, my concern is that often the challenge is in the drafting of such clauses: while the objective may be honourable, the opacity of them, or the lack of some detail, can risk creating an expectation while not actually setting out how that can realistically be met. My worry here is about the practicalities, in an era where expectations are being set and dashed and that is causing challenges for our democracy.
Dr Chambers
Even when the right hon. Gentleman criticises, he does so in a charming way.
None of this is moving the discussion to how we keep people healthy and treat them early. He may criticise our funding models and challenge the detail for achieving this measure, but if we flip that round, the previous Government promised 40 new hospitals, which were not hospitals and did not materialise. The entire focus of healthcare has been on treating people once they are sick, while people cannot get GP appointments.
I hope that the right hon. Gentleman would agree that the thrust of the argument is to try to keep people healthy and treat them early, before they end up needing hospital treatment, and that that is what we should all be focusing on. If he wants to help with the details in order to get 8,000 GPs by the end of this Parliament, he can submit his suggestions to the Liberal Democrat website.
Edward Argar
The hon. Gentleman makes his point in a typically reasonable way. Of course, he is right to talk about the need to shift, where we can, from acute settings to either community settings or, ideally, a preventive setting or focus. The Minister may well disagree with me, but I think that is a desire or thread that, however well implemented or otherwise, runs consistently through Governments. It ran through the Blair-Brown Government, the previous Liberal Democrat and Conservative coalition, the Conservative Government and into what the previous Secretary of State announced and what the Minister today is seeking to achieve. I do not think that anyone would disagree with that. We will always need those acute settings for particular treatments and cases, as well as for those very specialist pieces of work or for people with significant illnesses.
There has always been a desire to push the care into the local community. GPS are a central part of that, as are—to address the points raised by my hon. Friends earlier—our community pharmacists and other pharmacists. Pharmacies remain an improving but underused resource as part of that preventive picture. I do not disagree with the hon. Member for Winchester in that, but one can agree with the objective, but nonetheless gently push a little on the detail. As we know, the devil is in the detail, and people will want to see a deliverable plan.
That is one of the challenges that I have had in Melton Mowbray, where the ICB says it will do one thing and then says, “Actually, no, we can’t do that anymore.” Expectations go up and down and people are understandably frustrated. When we put such proposals forward we need to be robust in how we are going to achieve them and in their practicalities. The Minister may wish to make further observations.
Karin Smyth
I have enjoyed the “back to the good old days” of the Lib Dem-Tories. They tell us we live in fractured political parties, but I quite like the old days.
On new clause 2, I understand the intention that GP provision is important to us all and to our constituents. We have recruited over 2,000 more GPs since 2024—the highest number of qualified GPs since 2015—and there is provision to ringfence money for even more. We all know the importance of timely access to general practice, and patients need to be confident that they can get that care urgently and receive it promptly.
We are seeing improving signs. According to the ONS, the number of people who say it is now easy to contact their GP practice is up 14% since 2024, and that satisfaction is rising. Importantly, 69% of patients are seen within seven days and 44% are seen within the one day that they have requested an appointment, irrespective of urgency. That is the progress that we are encouraging, but we are not complacent; we recognise that there is more to do.
We also recognise that not everyone not seen within seven days is experiencing an unnecessary delay. Not every patient requires an appointment within seven days, and many people book appointments in advance for routine reviews, medication checks, to ensure that they see their preferred clinician or to fit around work and other life responsibilities. The new clause would cut across that flexibility by imposing a more rigid approach to appointment allocation, weakening both clinical judgment and patient preference. We do not believe that would be the best for patients or safe care. We must protect both clinical judgment and patient choice. We therefore cannot support the new clause.
We are clear that if someone is unwell and a doctor needs to see them urgently, they should be seen that same day. NHS England’s medium-term planning framework, which was published in October 2025, sets out an ambition for all clinically urgent appointments to be delivered on the same day, ensuring that patients assessed as needing urgent care are prioritised appropriately. We have made changes to regulations to require clinically urgent requests to be dealt with on the same day to support that ambition within the 2026-27 GP contract. We will publish data on that progress soon.
On new clause 52, we know that dentistry is broken and that we need to rebuild it. That includes ensuring an urgent care safety net across the country by reforming the dental contract and developing the 10-year workforce plan This new clause is unnecessary; we have delivered 1.8 million more dental treatments, and from April we began introducing a package of reforms to address some of the pressing issues that dentists and dental teams have been experiencing. Those reforms will prioritise those with the greatest need, shifting care away from clinically unnecessary check-ups. We are also including dental school places, and we will make more provision in our upcoming workforce plan.
The Government are committed to more fundamental contract reform by the end of this Parliament, which will include publicly consulting on future proposals. I make no apologies for taking the time to get that right. The issues are complex; this has not been done for a long time and there is no consensus on the perfect approach. On that basis, I commend clause 14 to the Committee.
Question put and agreed to.
Clause 14 accordingly ordered to stand part of the Bill.
Schedule 1
Conferral of primary care functions on integrated care boards etc
Amendments made: 14, in schedule 1, page 60, line 19, leave out sub-paragraph (2).
This is consequential on NC21.
Amendment 15, in schedule 1, page 60, line 26, leave out “(a), (b), (c) and”.
This is consequential on NC21.
Amendment 16, in schedule 1, page 60, line 36, leave out paragraph 46.
This is consequential on NC22.
Amendment 17, in schedule 1, page 65, line 5, leave out paragraph 65.
This is consequential on NS1.
Amendment 18, in schedule 1, page 75, line 1, at end insert—
“(4) In subsection (5), in the definition of ‘relevant area’, after paragraph (b) insert—
‘(ba) in relation to an integrated care board, in a case where a person has at any time provided or performed services by arrangement or contract with the board, means the prescribed area (at the prescribed time).’”—(Karin Smyth.)
This adds an amendment to section 259 of the NHS Act 2006 that is consequential on the transfer to integrated care boards of NHS England’s commissioning functions in respect of primary care.
Schedule 1, as amended, agreed to.
Ordered, That further consideration be now adjourned.—(Emma Foody.)
Health Bill (Seventh sitting)
Thursday 25th June 2026
(1 month ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 25 June 2026 - (25 Jun 2026)
The Committee divided: - Ayes: 3 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 4 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 5 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 5 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 5 / Noes: 9 - Question accordingly negatived.
The Chair
Before we begin, I remind Members to switch electronic devices to silent. Tea and coffee are not allowed during sittings, but there are copious amounts of water—blue is still and silver is fizzy.
Clause 15
Public involvement in commissioning by Secretary of State
Helen Morgan (North Shropshire) (LD)
I beg to move amendment 28, in clause 15, page 11, line 26, at end insert—
“(d) in the design of service and arrangement for service delivery (co-production).”
The amendment would explicitly require the Secretary of State to make arrangements for the co-production of any health service commissioned by the Secretary of State.
Helen Morgan
It is a pleasure to serve with you in the Chair, Dr Huq. I am moving this amendment on behalf of my hon. Friend the Member for Oxford West and Abingdon (Layla Moran), who is the Chair of the Health and Social Care Committee. She designed the amendment to explicitly require the Secretary of State to make arrangements for the co-production of any health service commissioned by the Secretary of State.
The Liberal Democrats support clause 15 more broadly, and particularly the plans to involve affected patients, carers and representatives in planning and commissioning arrangements. Carers are a priority for our party, so it is really important to us that they have a meaningful say in the design and delivery of their care. I would be grateful if the Minister could elaborate on what that might look like in practice.
The amendment would tighten up the clause to make some of its provisions more explicit, so that we can be confident that anyone involved in an individual’s care has the ability to influence it in an appropriate way.
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship, Dr Huq. I will speak briefly about clause 15 and amendment 28, tabled in the name of the hon. Member for Oxford West and Abingdon, the Chair of the Health and Social Care Committee, of which I am a member.
The amendment is clearly positively intended. We all want the co-production of services, and we have discussed it quite a lot on the Health and Social Care Committee. A number of amendments were tabled in the name of the hon. Member for Oxford West and Abingdon but were agreed on by the Select Committee. I think it is fair to say that there are a number of areas that the Committee could not agree on and that are obviously not in front of it, given its political make-up, but we all agreed on the ones she has tabled.
That being said, cross-party agreement often necessitates fairly non-partisan and perhaps non-specific wording, so while I agree with the intention behind the amendment, and while it is clearly important to have co-production when designing services, I am not entirely comfortable with the way the amendment has been drafted. This goes back to comments I made on the Liberal Democrat new clause 2 about how the requirement would operate in practice or how such an approach would be applied consistently across different commissioning functions. Although I am very keen on the principle, I am concerned about the intention.
Edward Argar (Melton and Syston) (Con)
I will not detain the Committee for long, and I will speak primarily to clause 15. I am broadly supportive of what the Minister seeks to achieve, as I understand it, with the clause. It is absolutely right that service users and communities are engaged by their integrated care boards—those commissioning services—in the design of services as well in individual care.
As I alluded to before we adjourned for lunch, however diligent an ICB may be in doing formal consultations or conducting surveys, it is all too easy for that to appear to the actual users of the service as a box-ticking exercise, with the board none the less determined to follow through with the strategic plan that it conceived and consulted on in the first place. We have seen that challenge on a number of occasions in my Melton and Syston constituency, with the recent closure of St Mary’s birth centre in Melton Mowbray. There was a consultation and engagement with the public, but we always feared that, ultimately, a decision to close was what the ICB wanted and, lo and behold, that is what happened. Similarly, the ICB decided to pull away from accepting the need for a second GP practice or enhanced GP services in Melton Mowbray. There was a consultation and discussion, but ultimately the conclusion that we feared at the outset of the process was indeed what was reached at the end of it.
The clause will not necessarily address all that, but it is a step forward in putting pressure on an ICB, or on those commissioning services, whoever they may be, to engage with local communities in a meaningful way.
Gregory Stafford
My right hon. Friend is making an absolutely correct point, which I made when we were talking about the Secretary of State’s ability to remove, by sacking or otherwise, the chief executives of ICBs. There is a tension between us as Members of Parliament trying to lobby the Secretary of State for changes in our constituencies when he currently has no power to actually make those changes. The clause will potentially give him the power to make those changes, but being able to sack a chief executive is probably a step too far. How does my right hon. Friend see the powers in the clause, which are probably correct, balancing with the local decision-making process and clinical expertise? There will clearly be a tension between the two.
Edward Argar
My hon. Friend comes to this with significant knowledge from his work on the Health and Social Care Committee. He is absolutely right, but that is a tension and a balance that I fear runs as a thread throughout this legislation, between local decision making and tailoring and the genuine need for a Secretary of State to have effective powers. We lobby Secretaries of State; on occasion I have lobbied the Minister, and she has always been very responsive—she does not always agree with me, but she has always been very responsive to me. As Members of Parliament, we do that on behalf of our communities.
My argument is that ICBs need to be more responsive, even when they do consult, to make it clear that the decision is not predetermined by the board and that they are going through the process. In the context of this clause, that also needs to be true of the Secretary of State: it needs to be not simply a formulaic approach but a genuine engagement and consultation. My question for the Minister, in that context, is about how we make sure of what she is seeking to do in the clause. The Secretary of State or those undertaking commissioning on their behalf must pay heed to something, but how do we make sure that that consultation, engagement and feedback genuinely have some teeth in what emerges in the final decision?
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
My right hon. Friend the Member for Melton and Syston and my hon. Friend the Member for Farnham and Bordon have covered my points so effectively that I will be very brief indeed. How do we ensure that the consultation is not just well meaning and ticking the legal boxes, but actually listened to, so that people’s voices are incorporated into the plans? Also, I appreciate that amendment 28 is a well-meaning intervention, but how do we ensure that all voices are heard in a co-production, not just those who are the most articulate or the most able to engage with a process that they see online?
The Minister for Secondary Care (Karin Smyth)
Patients and the public have a critical role in shaping our health services. I am grateful to the hon. Member for Oxford West and Abingdon for tabling the amendment, as moved by the hon. Member for North Shropshire. I will discuss the amendment with the wider question of whether the clause should stand part of the Bill.
To be clear, the Government are committed to engaging with patients and the public about the services they use. Services shaped together with the people who rely on them are better services. We want to see deep and collaborative ways of working between patients, public and the NHS. Across the country, there are good examples of that from which we want to learn. That is why the clause requires the Secretary of State to involve patients and the public in the planning of commissioning arrangements, the development and consideration of proposals for service change, and decisions that may affect how services are delivered or the range of services available.
The clause is intended to encourage early engagement and meaningful involvement in service change, thereby helping to build legitimacy, trust and better-informed commissioning decisions. As a duty, it covers the entire end-to-end commissioning cycle. I have been a commissioner myself, so although I will not detain the Committee too much on that, it is indeed part of the job of a commissioner to do that at a very early stage.
I also draw attention to the fact that the clause places a statutory duty on the Secretary of State to make arrangements to ensure the involvement of individuals who use or may use health services, together with carers and representatives, where appropriate, in commissioning activity. That duty is purposely broad, covering both existing service users and those who may reasonably rely on services in future, and will support preventive approaches and enable the consideration of wider population health impacts.
We made the deliberate choice to include specific references to carers and representatives, recognising that some individuals may require support to participate effectively in engagement and decision-making processes. That is particularly important where barriers such as disability, communications needs, sometimes age, vulnerability or unequal access may otherwise limit participation. We are ensuring that involvement is inclusive and meaningful, which I think is what all hon. Members want to see.
Specifically on amendment 28, I gently caution against creating an implication of different approaches to patient involvement for different parts of the system, leading to a two-track approach and unnecessary confusion. Instead, we propose a Government commitment to ensure meaningful consultation. We support co-production and will continue to champion it, but we do not think it necessary to put it on the face of the Bill.
The Government support involving patients and the public at every stage, and we recognise that working closely with the people and communities affected by commissioning decisions brings valuable insight into service quality, accessibility, equity and effectiveness. We will use the duties and powers available to Ministers to ensure that that principle is embedded across the work of the NHS. I hope, therefore, that the hon. Member for North Shropshire has some reassurance and will withdraw her amendment. I commend the clause to the Committee.
Helen Morgan
I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 15 ordered to stand part of the Bill.
Clause 16
Regulations about commissioning by integrated care boards
Dr Johnson
I beg to move amendment 51, in clause 16, page 12, line 10, at end insert—
“(3) The regulations must ensure that integrated care boards may not impose operational policies requiring patients to wait a minimum number of weeks before they may access treatment.”
This amendment would prevent minimum waiting times for NHS treatment.
The Chair
With this it will be convenient to discuss the following:
Amendment 35, in clause 16, page 12, line 10, at end insert—
“(3) Regulations under this section must make provision requiring integrated care boards to make arrangements which ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services.
(4) For the purposes of subsection (3)—
‘community equipment and wheelchair services’ means equipment, aids, home adaptations or appliances provided to support a person’s independence, safety, care or daily living at home or in the community, including hoists, hospital beds, pressure-relieving mattresses, commodes, shower chairs, walking frames, grab rails, ramps, specialist seating, postural support equipment, associated mobility equipment, and wheelchairs.”
This amendment would require the Secretary of State to make regulations which would require integrated care boards to ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services.
Amendment 63, in clause 16, page 12, line 10, at end insert—
“(2A) Regulations under subsection (2) must make provision requiring integrated care boards to—
(a) assess whether sufficient capacity exists to meet current and projected patient demand for cancer treatment, including radiotherapy treatment,
(b) maintain plans to ensure that workforce, equipment and estates capacity are sufficient to reduce waiting times for cancer treatment and improve access to treatment, and
(c) monitor and address geographical variations in access to cancer treatment, including radiotherapy treatment, with a view to reducing inequalities in patient outcomes the provision of satellite units.”
Amendment 52, clause 16, page 12, line 10, at end insert—
“(3) The regulations must include a requirement for the Secretary of State to publish the number of patients validated off of treatment waiting lists each month, and the reason for which they have been removed.”
This amendment would require publication of the number of patients validated off waiting lists each month and the reason for their removal.
Amendment 32, clause 16, page 12, line 22, at end insert—
“14Z45BA Patient choice: community services substituting for consultant-led elective care
(1) The Secretary of State must by regulations make provision to enable patients to make choices in respect of non-consultant-led community services where those services are commissioned as a direct substitute for, or to prevent a referral to, consultant-led elective services.
(2) For the purposes of subsection (1), a service is to be regarded as a direct substitute for, or intended to prevent a referral to, consultant-led elective services if it—
(a) provides assessment, treatment or management for a condition that would otherwise be referred to a secondary care specialist; or
(b) is commissioned by an integrated care board for the purpose of reducing or managing demand on secondary or elective care.
(3) Services to which this section applies include, but are not limited to—
(a) community audiology services;
(b) community glaucoma management and monitoring services; and
(c) Minor eye conditions services.
(4) Regulations made by virtue of this section must ensure that—
(a) patients are offered a choice of any clinically appropriate provider commissioned under a qualifying NHS contract for the relevant service;
(b) no limitation on the number of providers from which a patient may choose is imposed solely on grounds of cost or demand management; and
(c) patients are provided with information enabling them to make an informed choice, including information about waiting times and quality.
(5) An integrated care board must not commission a community service of a kind falling within subsection (2) in a manner which has the effect of restricting patient choice below the standard that would apply to an equivalent consultant-led elective service.”
Clause stand part.
Schedule 2.
New clause 35—Community equipment and wheelchair services: standards, performance and outcomes—
“(1) Each integrated care board must publish standards which apply in its area in relation to the assessment for and supply of community equipment and wheelchair services.
(2) Each integrated care board must monitor its performance against the standards under subsection (1).
(3) Each integrated care board must publish an annual report including—
(a) its performance against the standards under subsection (1),
(b) waiting times for the assessment for and supply of community equipment and wheelchair services,
(c) the number and proportion of people waiting longer than 18 weeks for such equipment or services,
(d) outcomes achieved for people by the provision of community equipment and wheelchair services, and
(e) steps taken by the integrated care board to improve the assessment for, and supply of, community equipment and wheelchair services.
(4) For the purposes of this section—
‘community equipment and wheelchair services’ means equipment, aids, home adaptations or appliances provided to support a person’s independence, safety, care or daily living at home or in the community, including hoists, hospital beds, pressure-relieving mattresses, commodes, shower chairs, walking frames, grab rails, ramps, specialist seating, postural support equipment, associated mobility equipment, and wheelchairs.”
This new clause would require each integrated care board must publish standards which apply in its area in relation to the assessment for and supply of community equipment and wheelchair services and publish an annual report on their adherence to these standards.
Dr Johnson
The Government say they are firmly committed to cutting waiting times and meeting the NHS’ 18-week target. It seems odd that, despite that, it is necessary for me to table an amendment to prevent systems from forcing patients to wait artificially longer for their care through the imposition of minimum waiting times.
Last year, The Times reported that at least eight local ICBs had introduced policies to pay healthcare providers for treatments only once patients have waited 12 weeks or more. I cannot think of any clinical reason why someone should wait for 12 weeks before having any treatment. At the time, the Minister said that while there was
“no formal national policy supporting minimum waits”,
local areas may
“choose to include minimum waiting times in Activity Planning Assumptions to ensure delivery of targets within agreed financial allocations…to support commissioners in managing activity to ensure they can sustainably manage within their budgets”.
I do not understand why we would want to make people wait longer than necessary.
The Royal College of Surgeons has expressed concerns and made clear that minimum waits prolong “pain and anxiety” for those made to wait longer, saying that it is
“counterintuitive…to give commissioners the green light to impose 18-week waits, while simultaneously working to ensure patients begin treatment within 18 weeks.”
Age UK deemed it a “rationing approach” that is
“potentially harmful to the health and wellbeing of older people.”
NHS England has made it clear that ICBs cannot introduce minimum waits of more than 18 weeks—that is longer than the target, so that makes sense—but waits between 12 and 18 weeks are permissible. Will the Minister explain why that is a good idea?
Amendment 51 seeks to ban ICBs from introducing any operational policies requiring patients to wait a minimum number of weeks before they may access treatment. There are safety risks involved in introducing minimum waiting times. They distort clinical priorities and may make patients wait in unnecessary pain and anxiety. Treatment should be delivered when possible, based on clinical needs. If a patient has a high level of clinical need, they might need to be treated earlier than the minimum waiting time because of the suffering they are experiencing.
Minimum waits are not only detrimental to patient experience by forcing people to live in greater pain and discomfort; in some cases, the delay may make the patient’s condition worse, and the treatment they need may be more extensive and even more expensive. Their condition may even become life-limiting or life-threatening as a result of the delay. The introduction of arbitrary minimum waiting times that do not have any relevance to patient clinical need raises worrying issues, clinically, professionally and ethically.
Minimum waits will also hinder the NHS’ ability to cut waiting lists and get waits to within 18 weeks. Some providers will have a list of people who can be available at short notice for a procedure, who they can call on if there is a cancellation on the day. If that person has not waited the minimum, that may be left as a gap, and that operation or appointment may not happen. That is wasted NHS resource.
Each month that goes by, many people are added to the waiting list, and some are removed from it. We are aware that there seem to be a lot of unexplained removals from the waiting list, and that has spiked recently. Among the people treated by NHS providers in April, around 600,000 were treated within eight weeks of referral, versus 74,000 who were treated between 14 and 18 weeks. The introduction of a minimum waiting time will therefore push back many people’s treatment by as much as 10 weeks.
Minimum waits also worsen and entrench postcode lotteries, because patients who have differential waits, based on whether their ICB has decided to implement minimum waiting times, may experience differential levels of care because of where they live. They are also another way of undermining patient choice, because patients may want to be treated in one area or one hospital because of the waiting time. If they all have different minimum waiting times, that distorts patients’ ability to choose.
Minimum waits are also completely contrary to the 10-year plan for health, in which choice and productivity were considered central features, along with the Government’s wider commitment to keep people healthy. I hope the Minister will agree with amendment 51, which would ensure that minimum waiting times cannot be instituted.
Amendment 52 also concerns waiting times. You will no doubt have seen, Dr Huq, the many newspapers articles about the Government fiddling the figures on waiting times, and there has been a spike in removals from waiting lists. People have found themselves removed from lists or going back on lists, or have suddenly found out that their waiting time started more recently than they thought. Amendment 52 would require the Secretary of State to publish the number of patients who are taken off treatment waiting lists each month and why they were removed. It is important that we are able to explain to our constituents why the Government have decided to remove them.
Helen Morgan
I want to speak to amendment 63, tabled by my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron). As hon. Members know, he has campaigned passionately and for a long time on the provision of radiotherapy. His amendment seeks to ensure that there is sufficient and equitable access to radiotherapy. Radiotherapy is required by half of all cancer patients, and it is incredibly cost-effective, but England has fewer radiotherapy machines than comparable European countries, and thousands of people have to travel long distances and over 45 minutes for their treatment, particularly in my hon. Friend’s Cumbria constituency, as he has noted on many occasions.
The Darzi review noted that radiotherapy services are on their knees. They have some of the longest waiting times for treatment and vast parts of the country are classed as radiotherapy deserts, because of lack of accessibility. Radiotherapy currently has the worst 62-day performance of all main cancer treatments, and if we are serious about ensuring that all cancer targets are met by 2029, then we need the infrastructure, people and equipment to deliver them.
Cancer cases are expected to rise 30% by 2040, meaning that radiotherapy centres must be able to keep pace. Importantly, radiotherapy can also be used at an earlier stage in treatment, potentially saving lives, saving money and meeting important waiting time targets. We really ought to be leading the way on this and keeping pace with our European counterparts so that no one is left without the treatment they so desperately need. I add my support to amendment 52, because we do need to build confidence in the reduction of waiting lists, and more transparency around reductions would be helpful.
Gregory Stafford
Amendment 35 has not been moved, but it is very similar to new clause 35, which may be moved and concerns equipment. I will address both together. I think all in this Committee would agree that ensuring timely access to community equipment and wheelchair services is vital for patient independence, dignity and recovery. I have a number of constituents who believe that they are not getting access to that equipment in the time they would expect.
We also need to ensure that we give proper consideration to the efficiency and management of resources. In particular, we should look more closely at what happens after that equipment has been distributed. Too often, items such as crutches, wheelchairs or Zimmer frames are not reviewed after issue or returned when they are no longer needed. We are already seeing a massive financial consequence of that. It was reported last year that the Royal Berkshire NHS foundation trust is losing around £70,000 a year due to patients retaining unused mobility equipment. That might seem like a drop in the ocean for the NHS, but £70,000 could fund another nurse, if we include the on-costs. These things do have consequences.
Despite distributing thousands of items, only 38% of crutches and just 15% of Zimmer frames were returned in 2024. That represents a significant loss of reusable equipment and considerable pressure on NHS resources. It also gets into the mindset of how patients use and value those pieces of equipment and how NHS users think about resources. While I think that we all agree in this Committee that the NHS should be free at the point of use, one of the downsides of that is that patients rarely think about what the cost of their care contributes. I personally think that if people understood how much crutches or medicines cost, they would use them much more usefully. Plenty of times I have spoken to pharmacists in my constituency who tell me that once a patient has unfortunately died, their family then comes to the pharmacy with a sackload of drugs that have never been used. I think that if people understood the cost of those things, they would use them more effectively and with more caution.
This is not an isolated issue but indicative of a wider problem across the system. If we were to introduce firm timelines for provision, we would need to ensure that there is a robust process for recovery, reuse and proper management of that equipment. Therefore, while I am not supportive of amendment 35 or new clause 35, I ask the Government to consider how those proposals could be strengthened by embedding clear expectations about the return and reuse of that equipment so that public funds are used as effectively as possible.
I will now turn to the two amendments in the name of my hon. Friend the Member for Sleaford and North Hykeham. Amendment 51 is important because, while I understand the Government’s intention in clause 16, as my hon. Friend has mentioned, her amendment will prevent any artificial delays in treatment by ensuring patients are seen as soon as clinically appropriate, rather than being required to wait a minimum period. It simply protects the principle that care should be based on medical need—which I think we would all agree on—rather than some administrative target. It helps avoid situations where waiting times are managed on paper rather than reduced in reality. That ultimately safeguards patient outcomes and timely access to care.
Moving on to amendment 52, I add my strong support to this amendment, because it goes to the heart of trust, transparency and patient safety in the health system. I have been speaking to constituents and individuals from across the country who have contacted me after a video I posted on my social media that contributed to the exposure of the removal of 351,000 patients from waiting lists in March of this year. The stories I have heard are deeply troubling. Those include patients who have waited years for potentially life-changing treatment only to receive notification late—or in some cases not at all—that they have been removed from the list. For many it came as a shock, while for some it came after months or years of uncertainty. This is not some trivial administrative matter. I would sum up the Minister, when responding to questions on this point, as: “Nothing to see here, this is what always happens.”
There has been such a significant jump over a period of two months that there has to be something going on here. The experiences of patients who have spoken to me about this suggest that that is happening. For those patients it is the difference between treatment and deterioration, between hope and abandonment. It is also undoubtedly affecting more vulnerable and less technologically savvy pockets of society, such as the elderly.
Dr Johnson
I should say that I am on a waiting list for treatment myself. The validation process seems to involve phoning people to check if they still need treatment, which after a long period is perhaps not an unreasonable thing to do. However, if they then say yes, they are phoned again a few weeks later; and if they say yes again, they are again phoned a few weeks after that. That puts pressure on people to say, “Okay”. If they are then asked, for example: “Would you be happy to see the consultant so that he can check that you are still listed for the right procedure, given that your condition may have changed and you may want to do something else?” it feels entirely unreasonable to say anything other than “Yes” to that. Would my hon. Friend be surprised to hear that when some people do that they find that they do indeed need the same procedure, but that their waiting time has now gone back down to zero?
Gregory Stafford
My hon. Friend makes two important points. First, of course there has to be a validation process. There has been for a long time, and I do not think that anyone is objecting to that. However, it is a question of how it is being articulated and the people it is focused on. It is being focused on vulnerable people. I have anecdotal evidence from conversations with a significant number of people since I posted that social media video that they feel pressured into coming off the lists. It does not help that trusts have financial incentives to take people off lists. Earlier this month, the Health Service Journal said that three trusts are earning more than £1 million in having people taken off lists. There is no problem with giving trusts a financial reward to do due diligence and validate the lists, but there is potentially a perverse incentive for trusts to try to knock people off them.
Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I am not entirely clear why there is a problem with the financial incentive. People coming off lists that they have been on for a long, long time may well have a clinical condition that is changing. In my practice, I deal with the management of children with glue ear, who need to have grommets. From time to time, the condition fluctuates and the glue ear goes away.
Equally, the reason that we do a tonsillectomy is that people get recurrent acute tonsilitis, but it is actually quite a good idea for people to wait some time because often the recurrent acute tonsilitis simply settles down and they do not need their operation. Sometimes, when a patient comes into hospital for an operation on their tonsils and I ask them, “When did you last have an attack of tonsilitis?” they say, “I can’t remember.” We have to take account of the fact that the condition of the patient may fluctuate.
Gregory Stafford
The hon. Gentleman is entirely correct, and I think I said some moments ago that I am not against a validation of the list—I think I even said that I am not against some sort of financial incentive to clear the list. My concern is the extraordinary jump in the baseline in the last month or so: 351,000 people have been removed from the list for no apparent reason.
While I have been having anecdotal discussions with patients, my hon. Friend the Member for Sleaford and North Hykeham has been doing something a little more robust. It would be interesting to see the outcome of her endeavours and researches and to find out exactly what is happening in those areas. Anyone with a modicum of inquiry and common sense would say that the significant jump that we have seen in a single month deserves at least a level of interrogation, which the hon. Member for Bury St Edmunds and Stowmarket is not allowing in his comments.
Dr Johnson
Does my hon. Friend agree that when somebody—particularly a vulnerable person—receives a call asking them whether they would be prepared to see a consultant to see whether they still need treatment, they are aware of all the noise in the media? They are aware that other people are waiting. People do not want to waste NHS resources. The first time, they may think it is a routine process but, when they receive the second or third call, they may start to think to themselves, “They are trying to tell me that they want to do something else. Maybe I don’t need it as much as other people.” They feel obliged and pressurised into saying they do not need the procedure when they do.
Gregory Stafford
My hon. Friend is absolutely right. The danger in this process—especially the multiple instances of chasing within a period of weeks, which sometimes happens—is that pressure is put on patients. Again, I know anecdotally from patients who have been speaking to me that those who are most compliant—if I can put it like that—and do not want to make a fuss are generally older and vulnerable people, who feel that they are perhaps causing an inconvenience to the system. They see people with, in their view, more serious conditions or a greater need. We need to be very careful about creating perverse incentives, financial or otherwise, to try to take some of those people off the list. As I say, the significant jump that we have seen deserves more scrutiny and inquiry, and that is why I am very supportive of my hon. Friend’s amendment.
We need to understand whether patients are being removed because they no longer require treatment, as the hon. Member for Bury St Edmunds and Stowmarket said—which is, of course, entirely appropriate—or just to improve targets, present an improved picture of waiting lists, and unlock the financial benefits tied to performance metrics. There is a troubling echo here. We saw similar practices in the 2000s when patients were removed or reclassified in ways that reduced waiting list numbers without genuinely improving access to care; it damaged confidence in the system then and it risks doing so now. What concerns me most is that we may be repeating that pattern. If the Government find they cannot meet their waiting list targets, there is a real danger that the pressure to do so will translate into decisions that, intentionally or not, compromise patient safety and fairness.
Sojan Joseph (Ashford) (Lab)
We are in 2026. Social media and the media scrutinise everything that we do. Will the hon. Member confirm if there has been any report in the media that somebody, anywhere in the country, has had their condition made worse, or died, or did not get treatment?
Gregory Stafford
There have been a number of reports of situations where people have not received care and have died because of that, so I do not see the hon. Member’s point. I think that, with amendment 52, my hon. Friend the Member for Sleaford and North Hykeham is trying to ensure that when the statistics are published, we can scrutinise the reasons behind them. The hon. Member for Ashford may be entirely right; let us imagine that is the case, and there is no gamifying or pressure going on. Why not allow the public to see that? Why not put to bed the HSJ stories that say there is something fishy going on? He should welcome that level of transparency and scrutiny to back up his argument if he is correct.
Dr Johnson
The hon. Member for Ashford talks about social media and social media comments. I wonder if, where the DHSC or the Government have put that waiting lists are falling, my hon. Friend has read any of the comments that come in from the general public below such proclamations.
Gregory Stafford
My hon. Friend tempts me to be political; I will rise to that briefly. Yes, I have seen them and she is right. There is a clear concern that when the Government make all these proclamations about how brilliant the NHS has suddenly become, the reality on the ground does not meet that for many patients. However—I am being gentle now—that is probably not exclusively a problem with this Government. My right hon. Friend the Member for Melton and Syston might kill me, but I am sure other Governments have done something similar.
I will go back to amendment 52 because I think it is really important. Let me be clear: it would not prevent people being removed where appropriate; it would simply require the Government to be honest about why. It requires the Secretary of State to publish the number of patients removed from waiting lists each month and, crucially, the reasons why. If everything is being done properly there should be nothing to fear from such transparency, but if there are problems, sunlight is the best disinfectant and the amendment is exactly what we need. We owe it to our constituents and to every patient in the country to ensure that waiting lists are not improved just on paper, or in a press release, or in a social media tweet, or at the expense of the care of real people but actually improved.
If we are to strengthen patient choice, particularly in relation to community services that substitute for or prevent hospital admission and treatment, there are some good measures in clause 16. However, as my hon. Friend the Member for Sleaford and North Hykeham said, there are concerns, so I hope the Minister will be able to pick those up in her comments when she winds up.
Karin Smyth
There are a number of amendments in the group. Amendment 35 was not moved but as the hon. Member for Farnham and Bordon spoke to it, I will comment on that amendment, which is in the name of my hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis). Community equipment and wheelchair services are really important to us and—to allay the concerns of the hon. Member for Farnham and Bordon—that is why the medium-term planning framework requires that, from this year, all ICBs and community health services must actively manage and reduce waits over 18 weeks and develop a plan to eliminate all 52-week waits. I assure the Committee that we will hold the ICBs for their performance. The community health services situation report has a specific monitoring line, covering children and young people and covering adults, for the wheelchair, orthotics, prosthetics and equipment category. We intend to continue that work following NHS England’s abolition. Consistent national standards will help us to identify the best and the weakest-performing areas, to identify what improvements need to be made and to tackle the longest waits.
Amendment 52 was tabled by the hon. Member for Sleaford and North Hykeham. We are committed to ensuring that all patients receive the NHS care they need in a timely manner, and I recognise the importance that Committee members have placed on that matter. The NHS constitution sets out that patients should start consultant-led treatment within 18 weeks of referral, and it is imperative that the system continues to work towards returning to and then upholding that standard.
I listened with great care to the comments from Members on the Opposition Benches, but I was here—as were you, Dr Huq—during the last couple of Parliaments; I was here as waiting lists rose and rose after 2012, under the previous Government’s stewardship, until they reached 4 million people, all waiting an inordinate amount of time. That Government had no kind of approach to reducing the numbers; they were quite content to have 4 million people on waiting lists, and to never bring forward measures to change that. They were quite content not to challenge NHS England or trust boards about why people across the country in all our constituencies were languishing on those lists. We are determined to resolve that situation.
Karin Smyth
I will move on. It is absolutely right that integrated care boards, as local commissioners, retain the ability to manage their services and waiting lists effectively, given the shocking numbers that they have inherited. This is complicated, difficult work: commissioners have to balance demand, capacity and clinical need, and a prohibition such as the one set out in the amendment would threaten to remove legitimate flexibilities that are required at the local level to ensure that services are delivered safely and efficiently.
We are clear that systems should not be setting minimum wait times that exceed the 18-week constitutional standard, but hon. Members will appreciate that not all elements of waiting are inappropriate. In many cases, they reflect clinical pathways, sequencing of care or the need to prioritise the most urgent patients. It is imperative that clinical judgment and urgency remain the key drivers of prioritisation, which is something the amendment threatens to remove.
Turning to amendment 52, I recognise that Members across the House are committed to ensuring that all patients receive the NHS care they need in a timely manner. Validation is a routine and long-standing part of waiting list management by providers. It ensures that patient records are accurate, that patients are on the best pathway to meet their needs and that they still need their appointments. Routinely validated waiting lists will support a return to the 18-week NHS constitutional standard.
Reasons for removal as a result of validation include a patient no longer needing their appointment or there being a duplicate appointment. The previous Government left behind some systems and trusts in such a poor condition that they give out duplicate appointments, and we need to resolve that as part of our work. Other reasons for removal include a patient’s record not being properly updated following treatment or a clinical decision—another sign of the inefficiency that the previous Government left behind.
Dr Prinsley
I am interested to hear what the Minister has to say, but does she agree that this is yet another reason why we must go full speed ahead to get the single patient record sorted out?
Karin Smyth
Once again, my hon. Friend is absolutely right. He is expert on this issue and has outlined to us some excellent clinical examples. I look forward to debating the single patient record further in Committee.
Importantly, any patient removed from a waiting list should be notified alongside their GP. Data on the total number of removals from waiting lists is published by NHS England. That data includes, but cannot separately identify, patient pathways removed as a result of validation. The Department remains committed to the transparent publication of official waiting list statistics following the abolition of NHS England, although there are no plans to publish more detailed breakdowns. NHS staff are delivering record levels of elective activity, which has enabled us to meet our interim target of 65% of patients being seen within 18 weeks.
Dr Johnson
If a person has been waiting more than 18 weeks, the trust calls them and asks them to see a consultant to check whether they still need the appointment or whether they need a different treatment. If, after having that appointment, they are told that they still need the treatment, that same day they go back on the waiting list as if it were day one. Therefore, they have not waited less than 18 weeks, even though the Minister’s statistics might suggest they have. Does she accept that?
Karin Smyth
The hon. Lady outlines a particular case, and if she wants to raise that separately, I am happy to come back to her with a fuller answer. As she knows, and as the hon. Member for Farnham and Bordon also knows from his work with Getting It Right First Time, there are complications in some of this. I do not accept the hon. Lady’s point, but if there are particular or anecdotal examples of what she referred to, I am absolutely prepared to look at them.
Patients, with their GP, need to understand what is happening. That is a key part of our elective reform plan. If patients are on the list for a long time, they should be told why, and what alternative provision can be made for them. We are taking an active approach to supporting and empowering patients with information and knowledge, and being transparent about how we get down the shocking lists that the Conservatives left us, which stood at 4 million people before the pandemic.
Karin Smyth
We know that in some areas of Scotland and Wales that are near the border with England, the way that health services are planned and commissioned in England can have implications for the people who live in Scotland or Wales. That is why clause 17 inserts new section 14Z45E into the 2006 Act, to place a duty on integrated care boards, when exercising their commissioning functions, to
“have regard to the likely impact of those decisions on the provision of health services”
to persons in Scotland and Wales living near the English border.
I assure the Committee that the clause will operate solely in relation to the exercise of ICB commissioning functions in England. It will neither confer functions on ICBs in relation to the commissioning or provision of services outside England, nor affect the responsibilities of devolved Administrations for the organisation and delivery of health services in Wales and Scotland. I commend the clause to the Committee.
Helen Morgan
I want to draw the Minister’s attention to some of the difficulties relating to cross-border healthcare in a border area. I represent an area on a border. North Shropshire has a very wiggly, for want of a better word, border with Wales, which means that some English constituents are registered with a GP surgery in Wales but receive their secondary care in England. That causes significant difficulties for them because of the lack of joined-up communication between the two Administrations. I seek assurance from the Minister that as ICBs in England will have to pay regard to people who live near the border in Wales, conversations are going on with the commissioners in Wales to ensure that that process is as smooth as possible.
Edward Argar
The hon. Member for North Shropshire makes the point very well. Back when I was a Minister, and subsequently shadow Secretary of State, she raised that point with me. The clause is sensible. The Minister articulated concisely and reasonably why it is necessary. It is the nature of any devolution arrangements that a little bit of cross-border co-operation is required along the border to make sure that services work effectively for people. This may have changed, but in my experience the majority of those crossing the border were people from Wales coming for secondary care services in a hospital on the English side of the border, so I think the clause is entirely reasonable.
I echo the hon. Lady’s request: I would be grateful if the Minister updated the Committee on what conversations she has had, particularly with the Welsh Government, but also with the Scottish Government, to ensure that there is reciprocity and that they will put an equivalent provision into their laws to ensure that patients in England are taken into consideration in their healthcare planning.
Dr Johnson
The clause imposes a duty on ICBs to have regard to the likely impact of their commissioning decisions on areas of Wales and Scotland close to the border. In some respects, this is like other parts of the Bill—a statement of the obvious regarding a person’s job. Are we suggesting that the Secretary of State, and in particular ICBs, would not consider the effect of their decisions? I hope that they would, but, given that the clause is there, what teeth does it have? What if they do not? Is there any consequence in the Bill if they do not? As others have said, will the Minister confirm whether there is a reciprocal agreement with Wales and Scotland? If there is not, what negotiations has she entered into and what progress are they making?
Karin Smyth
As an MP in Bristol, which is not quite on the border, but is pretty close, I absolutely understand. We have relationships with our Welsh colleagues and I have been involved in debates on this matter. The clause ensures that, with the abolition of NHS England, regard is had to to arrangements with our colleagues across the border. We all understand that devolution means that different arrangements will be made in the constituent parts of the United Kingdom. It is not for the UK Government to determine what those are, because they are devolved. However, I assure members of the Committee that across the piece in the Department, and indeed across the Government, regular meetings and conversations on these and other matters with regard to the devolved functions are a regular part of the work that we do.
Question put and agreed to.
Clause 17 accordingly ordered to stand part of the Bill.
Clause 18
Transfer schemes in connection with integrated care boards
Question proposed, That the clause stand part of the Bill.
Karin Smyth
The clause gives the Secretary of State the powers to make transfer schemes where an ICB is being abolished or established, or where the area covered by an ICB is being amended. A transfer scheme ensures that all the staff, property rights, responsibilities and liabilities, other than criminal liabilities, of the ICB being abolished are transferred to another ICB. That ensures that the ICB taking over has the appropriate information and resources to continue to arrange healthcare services for their population. In the past, that has been used to support the restructuring of ICBs to achieve geographical boundary alignment with strategic authorities, as set out in the 10-year health plan. The power also allows transfers to the Secretary of State and, when a new ICB is established, allows the transfer of staff from an NHS trust or foundation trust or from a special health authority.
Following the abolition of NHS England, we expect that Ministers will continue to need to be able to make transfers between ICBs. The clause allows that as needed. I therefore commend the clause to the Committee.
Dr Johnson
I have one question for the Minister. Which ICBs does she envisage being abolished, or is this just a precaution for the future?
Karin Smyth
It is precautionary to give the power in the event—future-proofing the Bill.
Question put and agreed to.
Clause 18 accordingly ordered to stand part of the Bill.
Clause 19
Integrated care boards: power to provide assistance
Question proposed, That the clause stand part of the Bill.
Karin Smyth
The clause relates to the power for integrated care boards to provide assistance and support in relation to the health service. It replaces section 14Z48 and, in part, section 12ZA of the National Health Service Act 2006 with a clearer and more flexible power. At present, the various ICB assistance powers are narrower and more confusing. Section 12ZA provides for certain forms of practical assistance in connection with ICBs’ commissioning functions, while section 14Z48 provides a more limited power to make grants or loans. Other specific assistance powers sit elsewhere in the legislation, including in sections 96, 112, 124 and 147, which allow assistance and support for primary medical services, dental, ophthalmic and pharmaceutical services.
Clause 19 replaces all those separate powers with a general power for ICBs to provide assistance or support. The clause will make it clearer when an ICB may support providers, prospective providers or other activity connected with the health service. It will allow an ICB to provide assistance or support to a person who is providing or proposing to provide services as part of the health service. It will also enable an ICB to support a person who is carrying out or proposing to carry out activities that the ICB considers to be conducive to the health service. The assistance may include financial assistance, making available the services of ICB staff, or making available any other ICB resources. The clause also allows assistance to be provided on agreed terms, including terms about payments by or to the integrated care board.
The clause supports ICBs in their role as strategic commissioners. ICBs need to be able to support the development, improvement and resilience of services for their populations. They need to be able to cultivate their provider sector to meet the needs of the people they are responsible for, and they need to be able to do so in innovative and flexible ways. The clause gives them a clearer statutory basis for doing so. This is only an enabling power; it does not require an integrated care board to provide assistance and it does not create any entitlement for a person to receive assistance, nor does it disapply the ordinary legal and financial controls that apply to integrated care boards, or any other element of the usual way in which NHS bodies are overseen and regulated.
The clause should be read alongside clause 9, which creates a broadly analogous assistance power for the Secretary of State. In combination, the clauses support the move to a simpler, more flexible statutory framework that enables everybody, from the centre to ICBs, to discharge their responsibilities in ways that can be adapted to the complexity and multiplicity of circumstances they will inevitably encounter. I commend clause 19 to the Committee.
Dr Johnson
The Government’s explanatory notes state that the clause is intended to give ICBs the ability to provide a broad range of support to those involved in providing or administering the health service. The flexibility there aligns with the Government’s stated vision for more autonomy across the system. I have a couple of questions. If the ICB were to provide support in a way that was out of line with good practice or what is expected by the Department, what would be the recourse? Where will it be possible for right hon. and hon. Members to see the financial expenditure that ICBs make in any such circumstance?
Karin Smyth
I thank the shadow Minister for her questions. ICBs are part of the accountability outcomes framework, so they will be monitored in the usual way, and any expenditure by the ICB—and, indeed, by the Department—is recorded in the departmental accounts.
Question put and agreed to.
Clause 19 accordingly ordered to stand part of the Bill.
Clause 20
Performance assessments of integrated care boards
Question proposed, That the clause stand part of the Bill.
Karin Smyth
The clause transfers the requirement to conduct annual assessments of integrated care boards from NHS England to the Secretary of State and focuses the assessment on the statutory functions of the organisations. To do that, it removes a prescriptive list of duties to be assessed that was inserted by the Health and Care Act 2022.
ICBs are essential to delivering our health mission. They are responsible not only for arranging healthcare services, but for planning how those services will focus more on prevention, digital innovation and delivery in the community. It is therefore entirely appropriate that the Secretary of State should hold ICBs to account and undertake a meaningful assessment of their performance.
Currently, NHS England assesses the performance of ICBs annually, reviewing how well they have performed against a list of duties prescribed by the current legislation. The process for those assessments is set out in guidance each year and is driven by both publicly available performance data and local insight. The results are published online and form part of the ongoing performance conversation between NHS England and each ICB.
Although NHS England can choose to assess more than those statutory duties as part of that process, the duties form a static list of requirements that are already expected as part of the ICBs’ statutory functions. Having such a list may inadvertently skew attention away from other priorities in the 10-year health plan and our mission. As we reform the NHS, the ICB performance assessment will need to adapt to the evolving role of ICBs as strategic commissioners and reflect new models of commissioning. The list of duties will therefore become too prescriptive to provide the accountability intended. The clause allows a more nimble and flexible approach, ensuring meaningful assessment of ICB performance.
Edward Argar
The Minister has saved me from having to give a speech on this clause, so I will ask her a couple of questions instead. Does the Secretary of State intend to publish the list of criteria against which he will require assessment to take place, so that it is transparent what is being considered? Notwithstanding the Minister’s point about the 2022 legislation, the Secretary of State will define the list, so will he publish those criteria? Within what period following the end of the financial year will the Secretary of State commit that the results will be published?
Karin Smyth
I recognise the right hon. Gentleman’s expertise as a former Minister in this role. I do not want to mislead him, so I will come back to him in writing on both those points, if that is acceptable. He tempts me to be more prescriptive than I think we intend to be at this point, but I will ensure that he gets a proper answer to both questions. I commend the clause to the Committee.
Dr Johnson
As has been said, the clause replaces the part of the NHS Act that requires NHS England to carry out performance assessments of the ICBs and rewrites it so that the Secretary of State has to carry out those assessments. That makes some sense, but, as the Minister said, it takes out the criteria against which the ICBs will be assessed.
I accept what the Minister says—she wants those criteria to be set out more flexibly than can be done in primary legislation—but it is not reasonable or fair to assess people against criteria that they do not know in advance. It will be important, will it not, that ICBs know in advance what those criteria will be? Given what she said to my right hon. Friend the Member for Melton and Syston about writing to him, will she commit to writing to us to say not only what the criteria will be at the moment, but how far in advance ICBs can expect to receive them before they are expected to work to them and then be assessed against them?
Will variation be a factor in whether an ICB is deemed to have been performing well or not? We know that there is a tension in the Bill between the Secretary of State’s need to equalise provision and the ICBs’ desire and intention to vary it and innovate. Given that the Secretary of State is a political individual, how will the assessment process be conducted in a way that gives ICBs and their leaders confidence that there will not be political interference in it?
Karin Smyth
Of course ICBs will know how they are going to be assessed; that will be in guidance in the usual way. In the last two years, in planning terms, we have brought forward all that work for the system—including on the finances—in order that the system works more efficiently, and we will continue to seek to do that.
The hon. Member, as she has several times in the Committee, returned to the question of variation. When there is devolution and local systems are different, there will be a degree of variation, as I have said. In performance management terms, where there is unwarranted variation, we will seek justification and understanding of that. Sometimes, there is variation for geographical reasons. There may also be historical structural reasons in a local system, or temporary reasons why performance is variable. We would look at that as part of that general work.
Question put and agreed to.
Clause 20 accordingly ordered to stand part of the Bill.
Clause 21
Membership of integrated care boards
Dr Johnson
I beg to move amendment 46, in clause 21, page 15, leave out from line 33 to line 6 on page 16 and insert—
“(2) The constitution must provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include—
(a) at least one person nominated by one or more NHS trusts or NHS foundation trusts which provide services under arrangements made by the integrated care board, in accordance with regulations made under sub-paragraph (2A);
(b) at least one person nominated by a body representative of providers of primary medical services whose area falls wholly or mainly within the area of the integrated care board, in accordance with regulations made under sub-paragraph (2A);
(c) at least one person appointed by a local authority whose area falls wholly or partly within the area of the integrated care board; and
(d) at least one member nominated by the mayor of each mayoral strategic authority whose area coincides with, or includes the whole or any part of, the integrated care board's area (if any).
(2A) The Secretary of State may by regulations make provision about the nomination of ordinary members under sub-paragraph (2)(a) and (b), including provision about which NHS trusts, NHS foundation trusts or representative bodies are entitled to make nominations.
(3) The constitution must set out the process for making nominations under sub-paragraph (2).
(4) A person making a nomination under sub-paragraph (2) must have regard to any guidance published by the Secretary of State as to the selection of candidates.”
This amendment modifies Clause 21 so that, rather than replacing the existing mandatory membership requirements in Schedule 1B to the National Health Service Act 2006 with a requirement for mayoral representation alone, the new sub-paragraph (2) reinstates and consolidates the full range of required ordinary members.
The Chair
With this it will be convenient to discuss the following:
Amendment 25 in clause 21, page 15, line 38, at end insert—
“(2A) The constitution must also provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include at least one member nominated jointly by the local authorities whose areas coincide with, or include the whole or any part of, the integrated care board's area.”
This amendment would require integrated care boards to have a member jointly nominated by local authorities from within the board's area, as is currently the case but would otherwise be removed by clause 21.
Amendment 45, in clause 21, page 15, line 38, at end insert—
“(2A) The constitution must provide for the ordinary members as mentioned in sub-paragraph (1)(b) to include at least one member nominated by local primary care providers.”
This amendment would ensure that ICBs have to have representation from primary care providers.
Amendment 26, in clause 21, page 16, line 3, leave out from “mayor” to “sub-paragraph (2)” on line 4 and insert
“or local authority nominating an ordinary member as mentioned in sub-paragraphs (2) and (2A).”.
This amendment is consequential on amendment 25 and would require a local authority involved in nominating a member of an integrated care board to have regard to guidance published by the Secretary of State.
Amendment 27, in clause 21, page 16, line 9, at end insert—
“‘local authority’ has the meaning given by section 2B(5);”.
This amendment is consequential on amendments 25 and 26 and defines the term “local authority”.
Clause stand part.
Dr Johnson
At present, integrated care boards will have a chair, a chief executive and at least three further ordinary members. Those three ordinary members will include a representative of the NHS trusts and NHS foundation trusts in the area, someone from the primary medical services in the area and someone nominated by the local authority areas within the ICB area. Under the clause, the requirement for those individuals is replaced with a requirement to have someone from each of the mayoral authorities.
Because of the order in which the Government have done this—removing half the budget from the ICBs, which has caused them to merge in a way that is not coherent with the Government’s not-yet-complete local government reorganisation—we have a situation where representation is not even. For example, in my ICB area the Mayor of Greater Lincolnshire and the Mayor of the East Midlands will each be able to choose someone to represent them on the board, but the proportions of the population are not even. Lincolnshire will be over-represented, which is not an issue for my constituents, but it may be for those from Nottinghamshire and Derbyshire. Likewise, the northern part of Greater Lincolnshire, which is in a different region, has a small population relative to its ICB. Some mayors will therefore have representation that is not proportionate to their population size.
There is surely a risk that the next step will be for the Government to say they want to make things more even, with ICBs working in relation to mayoral authority areas. Yesterday, the Minister for Care suggested at his appearance before the Health and Social Care Committee that the ICBs should be aligned with strategic authorities, but the only way in which that can happen once the Government have decided where the strategic authorities will be is if things are changed once again.
That brings ongoing costs—financial costs, opportunity cost for service development, and cost to the people delivering these services. The people working hard to try to deliver the Government’s plan find themselves and their jobs threatened and chopped and changed all the time. We heard evidence that the concentration on reorganisation rather than service delivery, provision and development is causing distress to those people.
We also heard about the effect on social care, which, certainly in Lincolnshire and in other places, is delivered by the upper-tier local authority, but not all mayors have any responsibility for health—our mayor does not. We will therefore have someone who is not responsible for health on the ICB while someone responsible for delivering social care will have their seat on the ICB removed. I am afraid that I simply do not understand that. I watched through several times the Minister for Care’s Select Committee appearance, and I still do not understand the rationale. I will be grateful if the Minister for Secondary Care could explain that.
Dr Danny Chambers (Winchester) (LD)
We have a few concerns about the clause in general, especially about the removal of local authority and primary care representation on the ICB. Some ICBs are already stepping back from joint commissioning arrangements with social care and the health and wellbeing boards, and it is vital that social care has a seat at the table. We have talked about this extensively in many Committees and in the Chamber, but the Liberal Democrats have been emphatic that we cannot solve any of the problems in the NHS without solving social care. At any given point, our hospital in Winchester certainly has 160 people in it who are well enough or would be better cared for in the community with a social care package; instead, they are stuck in a hospital, obviously affecting flow through the whole hospital and even affecting A&E waiting times.
Combined with the changes to the pooled budgets that will affect the better care fund, we are seriously concerned that the Bill is increasingly separating the NHS and social care just at a time when the service and experts are screaming out for greater integration and collaborative working. We discussed GPs this morning. They have long-standing concerns about getting their voice heard, given their unique place in the health system. They are the front gate to the NHS and they have the most patient contact of any NHS service. Removing the duty seems to be a step in the wrong direction in that regard.
Finally, the change will leave in limbo areas such as Hampshire that do not yet have a fully functional mayoral authority—our elections will be in the next couple of years. There has not yet been sufficient clarity about what the interim arrangements will be.
Gregory Stafford
The clause will replace the constitutional requirements contained in paragraph 8(2) to (4) of schedule 1B to the 2006 Act so that “ordinary members” must now include at least one member nominated by the mayor of each mayoral strategic authority whose area coincides with or includes the whole or any part of the ICB’s area. The ICB’s constitution must set out a process for making such a nomination, and a mayor nominating an ordinary member must have regard to any guidance published by the Secretary of State, following the abolition of NHS England, as to the selection of candidates.
The definition of a local authority in paragraph 8(7) of schedule 1B to the 2006 Act will be replaced with the definition of a mayoral strategic authority. Sub-paragraph (1), outlining the process to determine the appointment of an ordinary member, and sub-paragraph (6), specifying that one ordinary member must have knowledge and experience in mental health services, are both retained. The clause therefore represents a clear shift in the structure of integrated care boards and, in my view, an unwelcome one, by removing the requirement for representation of GPs, local authorities and NHS trusts, while introducing a requirement for representation from mayoral authorities.
Those are not minor features of the system. The inclusion of local authorities in particular was designed to ensure that decision making reflected local needs and supported genuine integration between health and social care.
For as long as I can remember, Governments of all colours have talked about bringing health and social care together. Some have been more successful at that than others, but there should be agreement across the House that much more needs to be done. With this clause, the Government seem to be taking at least one step back—I would say numerous steps—from trying to bring health and social care together. Like my hon. Friend the Member for Sleaford and North Hykeham, I watched the Health and Social Care Committee’s discussions with the Minister for Care yesterday, and I too cannot fathom why the Government are doing it. I hope that it is an oversight and that, once the Minister goes away and reflects on it, she will look to table some amendments further down the line—I am sure that she will vote against ours today—so that we can bring these matters back.
I am especially concerned about the removal of local authority representation. We are effectively asking local authorities to continue to deliver vital services while removing their voice in the room where strategic decisions about health and social care are made. That raises a fundamental question about how the integration is intended to work in practice. There is also a broader concern about the direction of travel. We are moving away from place-based representation towards a model that places greater emphasis on these mayoral structures, yet the legislation is not prescriptive about who the mayors appoint, and colleagues within and without this Committee have already raised concerns that there is a gap in the understanding at the centre about how local authorities operate in practice.
That brings me to the point raised by my hon. Friend the Member for Sleaford and North Hykeham and the hon. Member for Winchester. I apologise; the Minister said that she did not want a geographic tour of our constituencies, but I am afraid that she will get one now. Part of my constituency sits in Hampshire in the Hampshire and Isle of Wight ICB, and as the hon. Member for Winchester said, we may or may not have mayoral elections in a year’s time. Hampshire county council has launched a judicial review against the proposed local government reorganisation; if that is successful, or even if it delays the process, this Bill will come into effect without our having a mayor, and there will be no representation for anybody on this board. We need clarity from the Minister on who will represent the people on the board if there is no mayoral authority. I would say that local authorities—Hampshire county council in this case—should remain on that board, at least until there is a mayoral authority.
Dr Johnson
Where a mayor is from one political party and local authorities are run by different political parties, the mayor, as part of the ICB, will be able to make decisions about spending done by authorities that are run by different parties. That will surely create a political conflict, or at least the potential for one.
Gregory Stafford
My hon. Friend makes an interesting point that I had not considered before, but she is absolutely right. The upper-tier authorities and strategic mayors might be from different parties, and, where the mayor does not have an actual responsibility for health, there essentially could be democratic deficit there that I had not thought about. My hon. Friend makes an interesting point.
That democratic deficit will potentially be exacerbated in the other half of my constituency, which is in Surrey. As I have already alluded to, the Surrey ICB has taken on Frimley but is also now merging with Sussex. As far as I can tell, the Government have absolutely no plans to introduce a mayoral authority in Surrey; however, my quick googling suggests that there will be a mayoral authority in Sussex in 2028, so the mayor of Sussex could be sitting on a board where there is no representation from the Surrey side. That is a complete democratic deficit. There would be the Surrey and Sussex ICB, with representatives for the people of Sussex but not for the people of Surrey. That must be an unfairness. I hope the Minister, if she cannot answer now, will at least go away and think about how that democratic deficit will be avoided. I suggest that she dumps the whole idea and goes back to having the people who actually run health and social care in our country on the board.
That is why I am very supportive of amendments 45 and 46, tabled by my hon. Friend the Member for Sleaford and North Hykeham. Reducing the representation to a single mayoral representative is a problem. Reinstating and consolidating the full range of required members and thereby giving the breadth of representation within ICBs that we have all talked about, is essential. It would strengthen the legislative framework, ensuring decision making remains multidisciplinary and balanced and that it incorporates both the clinical expertise, which we are going to lose, and the local authority political input, rather than having a one-sized, over-politicised mayor in charge.
By maintaining that membership, the amendments would help safeguard overdominance by a single actor, support a much more informed and locally responsive decision-making process and, crucially, reinforce the collaborative foundation between health and social care that I thought was a given among all parties in this House. I urge the Minister to reconsider what she is proposing in this clause. She should, at least, give us some clarity on what will happen in the interim period or, at best, go back to the drawing board and ensure proper representation of the people who are actually delivering health and social care in our constituencies.
Edward Argar
I agree entirely with my hon. Friend the Member for Farnham and Bordon. At risk to my political career, such as it is, I also agree entirely with the hon. Member for Winchester, who made a very good point in drawing the Committee’s attention to something that should not need to be said, which is that the provision of healthcare and social care go hand in hand, and if either part of that equation does not function, the other part will not. He highlighted a good example, and I visited Winchester hospital when I was a Minister.
If we do not have a functioning social care system, or a social care system that is closely integrated in and working closely with the NHS, we see the knock-on effects pretty swiftly in terms of the large numbers of people medically fit for discharge who are unable to be discharged, which then impacts on the flow through an acute hospital setting. That is one of the big factors we see in A&E backing up, because people cannot be discharged, people cannot get into beds because the beds are full and then the ambulances are queuing up outside. The hon. Gentleman illustrated that point extremely well.
Dr Chambers
On the economics, it costs around £850 a night to keep someone in a hospital bed and a fraction of that for a social care package. This is an absolute false economy, even if we ignore patient experience and patient recovery.
Edward Argar
The hon. Gentleman is absolutely right from the financial perspective. As he mentioned, there is, of course, the human perspective and the impact on someone’s recovery and their health, as well as their psychological health, if they are in hospital when they simply want to get home, because they have no medical need to be in hospital.
My worry about clause 21 is that it essentially seeks to undermine the whole concept that ICBs rest upon. ICBs were conceived to bring together all the NHS services in a particular area, but also, as my hon. Friend the Member for Farnham and Bordon highlighted, to make sure that the NHS footprint mapped on to the geographical footprint of the upper-tier local authority delivering social care, so that the ICB is looking at the same geographical area for the two key parts of the system and they neatly map on to one another.
With changes, mergers and acquisitions—as well as a whole range of other changes—that link is already breaking and weakening, as ICBs start covering larger areas and look in different directions. As my hon. Friend the Member for Farnham and Bordon set out, and as I think the hon. Member for Winchester highlighted in an earlier sitting, because we do not know what local government reorganisation will look like in the years to come, we increasingly run the risk of creating something that again will not map on to a geographical footprint and may have to change.
In a number of areas—take my area, Leicestershire—we do not have a mayoral authority. At present, there is no plan or proposal before us for one. Yet the ICB is merged with Northamptonshire, which does not have one either. We will see a real gap in representation.
We are moving away from what we sought to do with ICBs. During the passage of the 2022 legislation, I always used the phrase—the Minister probably heard it until she wished to hear it no more—that we were seeking to be permissive, not prescriptive, where we could be. However, this was one area where it was not just us in the then Government who were trying to put a bit of a guardrail around the membership of ICBs. We were pushed by the now Government, then Opposition MPs, to go further in what we prescribed for the membership of an ICB.
Dr Prinsley
I am listening carefully to what the right hon. Member has to say. I wonder whether he could present us with a concrete example of where precisely elected local government involvement in the commissioning of services in ICBs has been essential, because it seems to me that what an ICB needs is expertise in commissioning. We need people who know how to commission services. Although I understand the importance of representation, I think that what we really need is expertise in commissioning.
Edward Argar
I take the hon. Gentleman’s point to a degree, but I would refute a chunk of it. We need within the organisation people who have those technical skills and know how to commission, draw up a specification, put it out to tender, or work out what is needed and ensure that what is delivered reflects what was commissioned and that the performance is what is sought to meet the needs of the local area. At board level, we need representation from local authorities and others, because it sets the strategic direction.
The board members are not the people who are going to sit there and write the commissioning document. They will probably approve it, but they are not the experts who will be drafting it. We are talking about two different functions, and I argue that when a board-level decision is being made, we want those voices in the room to ensure that those different perspectives are reflected and there is that critical challenge to what is proposed by the executive directors. We essentially have non-executive directors who are there to challenge, to question—perhaps to agree, but perhaps to push back on things. That is how many boards operate.
In what is proposed, we lose some powerful voices from round the table. They may not carry the day, but those voices should be heard. Having sat where the Minister is sitting now, I appreciate that she may not be willing or in a position to accept the amendments, but I hope that she will take away and reflect further on the challenges of representation.
Karin Smyth
I absolutely recognise that this is an area of huge interest to hon. Members across the piece. I assure colleagues that officials and I have been working with representatives of the Local Government Association and mayors throughout the development of the Bill and the future architecture, and we will continue to do so. We will continue to have discussions and to make sure we get this right, because it is complex and complicated. Given that we are all politicians, we understand. Many of us have been councillors and local representatives, and have spent a lot of our time—sadly, for officials—knocking on doors, going out and persuading individuals to vote for these people. We understand that it is quite personal and we want to get it right.
If I may, I will not take any interventions so that I can address the amendments and our approach to ICB membership. As my hon. Friend the Member for Bury St Edmunds and Stowmarket said, ICBs are commissioners. This is a fundamental shift, which I will come on to, and it is different from the 2022 work. I now want to outline the board membership set out in clause 21, but I think we will be discussing this for some time.
Lord Darzi’s review found inconsistency in the roles being undertaken by ICBs and concluded that the health and care system would work better if each organisation had greater clarity and focus on its particular role. That is our starting point, and we set out to do that in the 10-year health plan. In future, all ICBs will discharge their common statutory duties through best-practice approaches, getting better at allocating their budgets to meet the population’s needs and securing the best outcomes. The new focus for ICBs is strategic commissioning. All ICBs will, in future, operate at a minimum efficient scale, with a population of around 1.5 million people covering multiple partner local authorities.
Effective partnership working is core to strategic commissioning and is aided, rather than diminished, by replacing ambiguity in roles with clarity and focus. That is why we are altering the membership requirements for ICBs. We are adding a requirement for strategic authority mayors, or a nominated representative, to be appointed to ICBs operating within their footprint. Strategic authorities will increasingly become key bodies for growth and prosperity in their localities. Mayors, or their nominated representatives, will highlight opportunities to improve health outcomes through a joined-up approach to their other devolved responsibilities, such as transport, housing and employment.
Although we recognise that the coverage of mayors and strategic authorities varies across the country, we will provide guidance to ensure that no area is disadvantaged, regardless of how advanced its local devolution arrangements are. In all cases, ICBs will have an obligation to ensure that their boards have a suitable membership to discharge those functions properly.
Given the larger geographical footprint of ICBs in the future, we are also removing the requirement for ICBs to have at least one member jointly nominated by local authorities. At present, local authorities collaborate with ICBs by sitting on health and wellbeing boards and local integrated care partnerships. The multitude of plans, committees and measures have resulted in confusion, siloed working and, too often, inaction. I think many of us would recognise that in our own areas.
I emphasise that we want to ensure a strong voice for local government in the work of the NHS. Our preferred approach is for local authorities to work with the NHS through health and wellbeing boards, co-commissioning and local authority health scrutiny. Those are likely to be more fruitful forums in which to resolve issues, agree joint approaches and tackle the needs of a local area.
As ICBs become more focused on effective commissioning, it is right that we remove any potential conflicts of interest. That is why the 10-year health plan and the Bill propose removing the requirement for one member jointly nominated by primary medical care providers and one member jointly nominated by NHS trusts and foundation trusts. The clause will provide ICBs with memberships that are best equipped to fulfil their commissioning responsibilities and role in health planning.
On amendment 45, which was tabled by the hon. Member for Sleaford and North Hykeham, I assure her that the Government fully appreciate the importance of general practice and primary care more broadly, and the role that they play in informing ICB decisions. However, as I have said, health and wellbeing boards should be the key forum for resolving local issues and making planning decisions for their neighbourhoods. GPs are well placed to contribute to those discussions and also vital to them. We expect health and wellbeing boards to ensure that they involve relevant stakeholders, including GP practices and primary healthcare providers, in their work.
There is an opportunity for health and wellbeing boards to play a much more proactive and important role in the local economy. To respond to the point made by the hon. Member for Winchester, we absolutely recognise that place is important in those arrangements. Although I agree that the experience of primary care is important, I hope that I have reassured the Committee that having a member nominated by primary care on the board of an ICB is not necessary.
A similar argument applies to amendment 46, which would require a local government representative on the ICB. I should start by saying that I wholeheartedly recognise the important role that local authorities play in the health and care system. As we have discussed, their work in social care and public health, and their influence on the wider determinants of health such as housing and employment, mean that they have a fundamental role in supporting the delivery of our ambitions to improve the health and wellbeing of the population and implement the three shifts identified in our 10-year health plan.
Rather than one local authority attempting to represent the interests of many on an ICB board, however, we think that it is more effective for local government to use health and wellbeing boards to address local barriers to joint working and support the development of neighbourhood health plans, which will shape the commissioning plans of the ICBs. I assure the Committee that we expect ICBs to work effectively with every one of their partner local authorities in the local authority footprint to deliver the neighbourhood health service and progress the integration of health and care services at that level.
I should stress that our changes are not designed to weaken democratic accountability in the NHS. ICBs are NHS statutory bodies that are governed by a unitary board that is jointly responsible for ensuring that the ICB discharges its legal duties. Given that specific role, the ICB board is not the forum in which democratic leaders hold the NHS to account; rather, that is conducted through the local authority health scrutiny functions and Parliament. Again, this is a good opportunity for those health scrutiny functions to be much more robust and proactive at local authority level.
Amendment 46 also proposes retaining provider representatives on the ICB board. As I said earlier, we think that an ICB should have a core focus on commissioning, so it is right to remove the requirement to have providers on them. That will also support the avoidance of potential conflicts of interest.
We debated these issues many times—the right hon. Member for Melton and Syston referred to it—in this Committee Room, or one very similar to it that was not quite as hot, during the passage of the Bill that became the Health and Care Act 2022. These are difficult and complex issues. I mean no disrespect to him—he had a difficult job to do at the time—but the architecture has not worked. It is confusing, and I do not know any area that particularly thinks it has worked. We think that clarifying the roles will make the system much more effective.
I think we agree that adding requirements for strategic authority mayors to make nominations to their ICB boards is a good thing. It will be an effective tool to harness the benefits of joint planning between an ICB and strategic commissioners and strategic authorities, who will have increasingly significant roles in shaping their areas. I ask hon. Members not to press their amendments, and I commend clause 21 to the Committee.
Question put, That the amendment be made.
Health Bill (Eighth sitting)
Tuesday 30th June 2026
(3 weeks, 6 days ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 30 June 2026 - (30 Jun 2026)
The Committee divided: - Ayes: 9 / Noes: 6 - Question accordingly agreed to.
The Minister for Secondary Care (Karin Smyth)
The clause updates the National Health Service Act 2006 to abolish the requirement for integrated care boards and their partner NHS trusts to prepare and publish a joint forward plan and a joint capital resource use plan. The 10-year health plan aims to simplify local healthcare planning, and the Bill delivers that objective by removing legal requirements for integrated care partnerships, integrated care strategies, joint forward plans and joint capital resource use plans. Planning will now begin with the joint strategic needs assessment, developed by health and wellbeing boards. The assessment will inform a new neighbourhood health plan, replacing the joint local health and wellbeing strategy. ICBs will produce population health improvement plans, aligning multiple joint strategic needs assessments, neighbourhood health plans and local priorities across their wider populations. As a result, the planning process will be streamlined and less bureaucratic, and will deliver healthcare for local people based on local planning and strategy. I commend the clause to the Committee.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
As the Minister said, the clause removes the need for ICBs and their partner trusts to produce a joint forward plan. The existing legislation requires ICBs and their partner trusts to prepare a plan setting out how they propose to exercise their functions over five years, which is reviewed and/or revised each financial year.
Joint forward plans address objectives in the Government mandate regarding the ambitions in the NHS long-term plan and planning guidance. Section 14Z52 of the 2006 Act sets out that an ICB and its partner trusts have to prepare such a plan before the start of each financial year and specifies what the plan must give regard to, including the ICB’s discharge of its duties—general duties and financial duties—under other sections of the Act. The plan must also cover steps that will be taken to implement the local health and wellbeing strategy, the particular needs of young people, and the particular needs of victims of abuse. ICBs and their partner trusts must publish the plan and give it to a set of specified authorities, and NHS England may give directions for that. Section 14Z54 sets out that an ICB and its partner trusts must consult people when developing such plans and that health and wellbeing boards must be involved. Section 14Z55 sets out that the relevant health and wellbeing board may give an opinion, and that when it does so, it must provide it to the ICB and its partner trusts.
Section 14Z56 sets out that an ICB and its partner trusts must prepare a joint capital resource use plan before the start of each financial year, and that the period may be determined by direction from the Secretary of State. Section 14Z57 sets out that an ICB and its partner trusts may revise the joint capital resource use plan, but if it is revised significantly, it must be published and given to the list of specified authorities.
Section 14Z58 sets out that an ICB must produce an annual report on how it has discharged its functions. It must explain how it has discharged its duties under other specified sections of the Act, review the extent to which it has exercised its functions in accordance with the forward plan and its capital resource use plan, review the extent to which it has exercised its functions consistently with NHS England’s views, and review steps it has taken to implement any joint local health and wellbeing strategy. The report must include details of expenditure and be given to NHS England by a specified date and then published.
In essence, the clause deletes sections 14Z52 to 14Z57. In some respects, it is legislative plumbing, to remove plans that are no longer necessary. The Government’s impact assessment notes that
“there is some duplication across planning documents. For example, the Joint Forward Plan covered the integration of services, which the Better Care Fund plan also considers, as does the Joint Local Health and Wellbeing Strategy.”
It goes on to note that duplication delivers an administrative burden, as staff
“complete parallel planning returns and fulfil competing data requests,”
so that is a positive aspect of the clause.
Will the Minister please address the following points? Section 14Z52 contains specific requirements to address the particular needs of young people and of victims of abuse. Where do they fall now? The NHS has a large maintenance backlog. What is the new mechanism for transparency of capital prioritisation decisions between the ICBs and the trusts? Can the Minister remind me and the Committee of other areas in which local democracy will be able to input into ICB planning once these planning documents are no longer required?
Under the Government’s strategic commissioning framework, ICBs have to develop population health improvement plans. Essex ICB published a document that is 148 pages long, with a particular focus on inequality. Is the Minister concerned about the length of some of the plans, the time it takes to produce them and the amount of bureaucracy involved, or does she think this is an improvement? What is the key objective in delivering these plans? Do the Government plan to introduce population health improvement plans through legislation? If they do not, Parliament will have scrutiny of the bureaucracy being removed but not of the bureaucracy that the Government replace it with. As the Minister once said:
“Local taxpayers deserve to know how their money is being spent.”—[Official Report, 13 June 2023; Vol. 734, c. 122WH.]
Karin Smyth
I thank the shadow Minister for her comments. I largely agree about legislative plumbing—that is a nice phrase. As she rightly highlights, and as is clear in the explanatory notes and so on, the duplication and administrative burden on all these bodies is considerable. On her question about objectives, we certainly want to streamline that so that ultimately, as well as organisations knowing the objectives they are pursuing, the local population—importantly to her concluding point—can readily see and address that, follow it through and hold people to account. I do think that 150-page documents are not always the easiest to see.
Young people will obviously be part of the joint strategic needs assessment, and ICBs will be mindful of the Government’s wider policy objectives, as we have discussed previously. With regard to maintenance and prioritisation of capital schemes, since coming into office we have already done a huge amount of work to streamline the relationship between NHS England and the Department of Health and Social Care—and, indeed, our friends over at His Majesty’s Treasury—in respect of the approvals process, making better use of capital and making that more transparent at local level so that individual organisations are involved in the prioritisation that comes forward to the ICBs.
Question put and agreed to.
Clause 22 accordingly ordered to stand part of the Bill.
Clause 23
Abolition of integrated care partnerships and strategies
Question proposed, That the clause stand part of the Bill.
Karin Smyth
The clause abolishes the requirement for ICBs and their partner local authorities to form an integrated care partnership. It also abolishes the related requirement for that partnership to prepare and publish an integrated care strategy.
These abolitions address the policy objectives of the 10-year health plan by streamlining the number of plans that must be created by local health systems and supporting key local stakeholders to work together more flexibly and effectively. The changes recognise that in many areas, integrated care partnerships have not had a positive impact on local health outcomes and have come with significant opportunity costs. Alternative planning approaches proposed elsewhere in the Bill and more broadly will enable local health bodies to plan for their patients in a way that is tailored to their strengths. However, I can reassure the Committee that where existing arrangements are working well, nothing in the Bill will prevent local areas from coming together to consider how best to integrate services and plan their approach to tackling the challenges they face. I commend the clause to the Committee.
Dr Johnson
In essence, the clause abolishes integrated care partnerships and strategies, which are where ICBs come together with local authorities to discuss how they can make their services more integrated. We know that many of the challenges facing the NHS are caused by difficulties in social care provision and some of the difficulties in social care provision are caused by issues with health provision, and that if those commissioning services in those two areas work together, we can see an improvement in both.
The Local Government and Public Involvement in Health Act 2007 made changes to local government structures and enhanced public involvement in health services. Section 116 requires local authorities to produce joint strategic needs assessments for the local authority and its partner ICB. When preparing the assessment, the local authority and its partner ICB must
“co-operate with one another…have regard to any guidance issued by the Secretary of State…involve the Local Healthwatch organisation”,
and involve local people and the relevant district councils. I note that later in the Bill we will also come to the abolition of Healthwatch.
Section 116 of the 2007 Act has been modified by the Health and Social Care Act 2012 and the Health and Care Act 2022 to ensure that references match the current NHS structure. For instance, in 2008 there were primary care trusts, rather than ICBs. Section 116ZA of the 2007 Act requires ICBs and local authorities whose areas coincide or overlap to create integrated care partnerships, which consist of a member appointed by the ICB, one from each responsible local authority and any other members that they choose to add; to some extent, they can determine their own procedures.
Section 116ZB of the 2007 Act requires ICBs to prepare an integrated care strategy
“setting out how the assessed needs in relation to its area are to be met by the exercise of functions of…the integrated care board…NHS England, or…the responsible local authorities”.
When developing that integrated care strategy, the integrated care partnerships must have regard to NHS England’s mandate and any guidance issued by the Secretary of State. Clearly, that would now apply only to guidance issued by the Secretary of the State, because NHS England is also being abolished. An integrated care partnership must publish its integrated care strategy and give it to each local authority and partner ICB. Integrated care partnerships must reconsider and, where necessary, revise the strategy each time they receive a new needs assessment.
Clause 23 deletes section 116(5A) of the Local Government and Public Involvement in Health Act 2007. That subsection required the local authorities to give a copy of the needs assessments to the ICBs, which is of course no longer necessary because they are being abolished. Clause 23 also deletes sections 116ZA and 116ZB of the same Act, which established ICBs and defined integrated care strategies respectively.
As Conservatives, we believe that streamlining bureaucracy is sensible, and I am sure that this is a well-intentioned reform. However, a survey conducted by the NHS Alliance in November indicated that a quarter of integrated care system leaders are likely to keep the integrated care partnerships anyway on a non-statutory basis, and 40% plan to fold them into health and wellbeing boards and working partnerships with the authorities. It is not really a ringing endorsement of the policy if a sizeable number of people intend to keep it anyway.
Like many other elements of the Bill, these changes are uncosted—if we read the impact assessment, it says “N/A” for the cost. Clearly, there will be a cost incurred by the abolition of the process, but there will also be an opportunity cost to services if ICBs and commissioners are not working together in the provision of social care as effectively as they were before. That will cost people in social care, and it will cost people in healthcare.
As recognised by the impact assessment that the Government have produced themselves, there is a risk of reduced focus on the wider determinants of health at system level. Committee members on both sides of the House have already stressed the impact that other health determinants can have on the health service and social care, and we have previously considered amendments to that effect.
Overall, it is regrettable that local government does not have the direct feed into ICBs that the design of those integrated care partnerships provided. Whether or not I agree, I can follow the theory or principle behind making the area covered more local, in line with the strategic authority. However, if the Government wanted to do that, I do not understand why they did not decide the mayoral areas first. At the moment, we do not know where the mayors will be, and where they are now is not where the ICBs are. The Government have decided to cut ICB budgets and force mergers before they have decided where the mayoral authorities will be in some cases. Even where there are mayoral authorities already, the Government have not mandated that the ICBs be coherent with them, and, therefore, in many cases, they are not. We have a very confusing pattern emerging, which may require further reorganisation of ICBs to line them up, with a further cost down the line.
Joe Robertson (Isle of Wight East) (Con)
Will my hon. Friend reflect on the fact that, even if the Government get through the combined mayoral authorities they are trying to in this Parliament, there are still great swathes of England where there are no active plans for a mayoral authority at all. Even if the Government get their own way, some areas will not have a mayor for many years—if they get one at all.
Dr Johnson
My hon. Friend is, as ever, correct. The mayors are also not all responsible for health and social care—the local authorities are, in most cases. There could therefore be a mayor directing proceedings with the ICB who is a political opponent of those actually democratically elected to look after social care. ICBs are supposed to be apolitical commissioners accountable to the Secretary of State, but now, instead of working with social care directors, they will work with an elected mayor instead.
I can see a positive to that in terms of democratic accountability, but what happens if they all disagree? There is some incoherence about who is in charge. We have the local authority tasked with delivering social care, which may be led by one political party; the mayor directing the ICB, who may be of a different political party; and the Secretary of State who can also direct the ICB, who may again be of a different political persuasion. How does it work if they disagree? Does the mayor actually have authority, given that the Secretary of State can override them anyway? How does the Minister see that working in practice? It feels like some people will be in power without responsibility and others will have responsibility without the power to exercise it.
Helen Morgan (North Shropshire) (LD)
I will raise some similar concerns about the abolition of integrated care partnerships and integrated care strategies, which clause 23 brings about. Before I do, I should declare my interest as a vice-president of the Local Government Association.
The removal of integrated care partnerships, as well as the extension of ICBs to cover multiple local authorities, raises unanswered questions about the future of social care planning, which is very important to the Liberal Democrats, as the Minister knows. We feel that it removes the voice of charities and others in the voluntary sector who are crucial to meeting the range of needs in health and social care.
Throughout the Bill there is a theme of separating social care and the NHS, at a time when greater integration and closer working are clearly needed. We heard Sir Andrew Dilnot say in evidence that we cannot deal with some of the challenges that arise in the NHS—particularly around flow through hospitals and long waits in corridor care in accident and emergency—without improving the discharge of patients into social care. Separating the organisations that deliver those things is clearly problematic. If we think about it, as the shadow Minister just outlined, we have lost the local authority representative on ICBs. The Bill also changes the way the better care fund is administered. With those changes, we are really concerned about the separation of these two responsibilities.
I want to draw the Minister’s attention to an example in Shropshire. Shropshire council spends almost 80% of its budget on social care. It is an extremely challenged council because of those funding pressures. Shropshire, Telford and Wrekin ICB has also been one of the most financially challenged ICBs. That is partly because of its small scale and its merging with Staffordshire—which, for the record, is unlikely to be the combined mayoral authority that Shropshire ends up in, as is my current understanding, although we are a long way off resolving that problem.
Edward Argar (Melton and Syston) (Con)
Does the hon. Member share my concern that what often gets billed as simply streamlining or efficiencies is in fact slimming down, decoupling and weakening?
Helen Morgan
We cannot see the resources allocated, so we cannot confirm that, but it is clearly a concern. We are not yet discussing the part of the Bill that deals with Healthwatch, so I should keep my powder dry, but we know that local authorities will get some additional funding to deal with their elements of Healthwatch, while ICBs will not. There is a concern that that streamlining is, in fact, slimming down.
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship, Sir Jeremy. I want to pick up where the shadow Minister left off. Essentially, she said that the cart is being put before the horse in terms of mayoral authorities.
As my hon. Friend the Member for Isle of Wight East outlined, many areas have no plans for a mayoral authority; our area of Hampshire and the Isle of Wight is some way down the track. As I expressed last week in Committee, we have a strange anomaly in the new Surrey and Sussex ICB, because Sussex will get a mayor and Surrey will not, so Sussex residents will have representation on the ICB whereas Surrey residents will not. I hope that the Minister has had a chance to reflect on that strange paradox over the weekend and that she will now be able to answer specifically, as she did not last week, how that lack of representation for Surrey residents will work locally.
The abolition of the integrated care partnerships and their allied strategies continues a theme whereby the Government, under the veneer of slimming down, are actually decoupling—or weakening or whatever terminology Members wish to use—health and social care. For many years, all parties have regarded the bringing together of health and social care as essential, but the Bill not only looks like it is not trying to encourage that bringing together, but in fact is doing the opposite of that—it seems to be looking to pull them apart and decouple them. That is strange, because it does not appear to be the expressed policy of the Government, but it is the only logical explanation for many parts of the Bill, including the abolition in clause 23.
The shadow Minister pointed out that a number of areas will keep the ICPs in some form or other. I ask the Minister, does the Government support that feature? Was it the Government’s intention to remove the statutory footing of the ICPs and strategies in the hope and expectation that they would continue on a non-statutory footing? If so, we come to the paradox: if the Government support local authorities and health services continuing to work together in informal ICPs, why is the Minister trying to get rid of them? If they do not support that, is it now stated Government policy to separate social care and health services?
Joe Robertson
It is a pleasure to serve under your chairmanship, Sir Jeremy. There is a consensus—not just in this room, but within Parliament and going back several decades—that we want more integration and partnership working, particularly to bring together health and social care services, but this clause drives a coach and horses through that, and does so in a way that weakens rather than strengthens the Government’s plans to replace the system.
Local authorities bear responsibility for social care and public health in their areas, but they will no longer have a direct voice when it comes to integrated care boards. What we have seen to date is not an ideal system, or even a system that works particularly well, so I understand that the Government want to strengthen it, but we should not do that by removing the local government voice or making it indirect via a mayor who does not have the direct responsibility for delivering social care locally. Mayors may have some strategic oversight, but that is different.
Just last week, the Minister of State for Care appeared before the Health and Social Care Committee and was questioned on this very issue by me and others. His view was that the mayoral strategic partnership would be more than sufficient to make up for the local authorities losing their seat, but he faced particular scrutiny from the hon. Member for Chelsea and Fulham (Ben Coleman), who made some excellent points, which I will not repeat or paraphrase as they are on public record.
The gist of his argument was that local authorities have been ignored for too long when it comes to joining up health and social care services. This measure puts local authorities in an even weaker position and threatens what the Government are trying to achieve with social care, particularly for areas such as mine that have an older population and a relatively small unitary authority with so much responsibility to deliver on.
As my hon. Friend the Member for Farnham and Bordon has already said, the combined area of Hampshire and the Isle of Wight—or the Solent, as the Government like to call the Isle of Wight, despite the fact that fish cannot vote—is not set to get a mayor for a couple of years, but it will be at the vanguard of the Government’s plans. What about those areas for which there is no date, or even no plan for a mayor at all? It seems extraordinary that the Government would do away with the current set-up, imperfect as it is, and replace it with something that does not yet exist.
The Government have time deal with this problem. I am sure they quietly understand that there could be a problem. It is now on their shoulders to deal with it. I welcome the Minister’s reflections.
Karin Smyth
There has been a wide-ranging discussion on this clause. I remind Members that the abolition of ICPs is about reducing that complex legal framework, allowing for local decisions and putting partnership work in place in the most effective way. That is what the measure seeks to do. I do not think anyone has disagreed with the notion that the landscape is complex, and that people are producing a lot of reports. In future, health and wellbeing boards will be the focal point for the collaboration between ICBs and local authorities. They are statutory committees that bring together the NHS, local government and relevant community partners; set the strategic direction for health and care services; and oversee joint working in their area, which we are of course committed to making work in local areas. I do not think many people will disagree with that; I hope that is clear.
There is also an enhanced role, not only for the health and wellbeing boards—as I said last week, I think they have been underutilised in most areas; again, I do not think people generally disagree with that point—but for health scrutiny. Again, across the country, that has not been pursued to the greatest extent to create links with elected councillors in local areas.
We are clear that the role of local authorities is crucial at a local level—as the name describes—and particularly in working on our commitment for neighbourhood partnerships and developing the neighbourhood plan; most of that was covered in our sittings last week. I accept that there are a number of concerns about how that will work in different geographies. I think the Opposition said last week that a survey suggested a quarter of areas will keep those partnerships, which is absolutely fine. That is up to them.
On the one hand, the Opposition say that there is centralisation and a power grab in this Bill; on the other, they complain—I should not say complain, because it is their right and their job to do so—about the move to devolution and the freedom to allow, or indeed encourage, local leaders to work together across authorities on behalf of the populations they serve, even where some of them are politically divided, because the populations they serve voted for different people. It is incumbent on all of us as individual elected politicians to work with people—whoever the population around us voted for. These provisions provide for that.
Edward Argar
Can the Minister set out how she envisages health scrutiny committees having genuine teeth? Our cross-party health scrutiny committee in Leicestershire universally condemned a decision by the ICB—totally disagreed with it—and the ICB basically said, “Thank you; noted,” and carried on anyway.
Karin Smyth
We all have examples of decisions that are made in our constituencies that we do not like. Again, that is part of the democratic process, but I go back to my earlier point: either there is a centralised unaccountable body like NHS England making decisions, or the Secretary of State devolves those responsibilities.
It is incumbent on people and elected leaders locally, and the ICB, which is not elected, to work with local leaders on these decisions. ICBs will be held accountable through mechanisms in the Department of Health and Social Care. There will be decisions that people do not like—that is a consequence of some of these things—but the clause simplifies the landscape.
Karin Smyth
I will not; we need to move on from this point. Of course, if people want to keep the partnerships, they are totally able to do so. That will be up to local leaders to decide.
Question put, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss new clause 70—Duty to engage primary care providers in integrated care boards—
“(1) An integrated care board must take all reasonable steps to secure the meaningful involvement of primary care providers in the exercise of its functions relating to—
(a) service redesign,
(b) integration of health services,
(c) development of neighbourhood health services, and
(d) population health planning.
(2) In this section, ‘primary care providers’ includes—
(a) providers of primary medical services,
(b) community pharmacy contractors,
(c) providers of primary dental services, and
(d) providers of ophthalmic services.
(3) Under subsection (1), ‘meaningful involvement’ includes—
(a) involvement at an early stage in the development of ICB proposals,
(b) provision of sufficient information to enable informed participation of primary care providers in ICB functions,
(c) opportunities for primary care providers to influence ICB decision-making, and
(d) opportunities for primary care providers to deliver feedback on how their views have been taken into account in the delivery of ICB functions.
(4) An integrated care board must publish an annual statement describing—
(a) how it has complied with this section, and
(b) the impact of primary care providers’ involvement on decisions taken by the ICB.
(5) The Secretary of State may issue guidance about the application of this section to which integrated care boards must have regard.”
This new clause ensures a certain range of primary care providers are consulted by integrated care boards in the development of their healthcare plans.
Karin Smyth
Clause 24 abolishes the requirement for health and wellbeing boards to prepare and publish a joint local health and wellbeing strategy. Instead ICBs, local authorities and their partners must work together through the health and wellbeing board to develop a neighbourhood health plan, in line with this Government’s commitment in the 10-year health plan. The neighbourhood health plan should be updated regularly to reflect the needs of the local population, unless all partners consider the existing plan is sufficient.
In developing their neighbourhood health plans, responsible local authorities and partner ICBs must involve the people who live or work in the area of the responsible local authority. The neighbourhood health plan will cover most of the topics previously considered by joint local health and wellbeing strategies, but will also encourage a deep focus on tackling the challenges facing individual neighbourhoods. That may mean applying different geographical focuses to different elements of the plan, to ensure that planners are addressing the real and different needs of the diverse communities they serve.
These plans will outline how the NHS, local government and local partners intend to improve the health of people in their locality and reduce health inequalities through a joined-up neighbourhood health approach. The plans will consider how local services can help realise national NHS priorities, further public service reforms, and improve performance against the adult social care outcomes framework and the local outcomes framework metrics. To support this work, the Government also intend to provide local areas with guidance and we will work with systems to ensure this addresses the needs of local planners and local communities.
Dr Johnson
Clause 24 puts neighbourhood health plans on a statutory basis. Currently, section 116A of the Local Government and Public Involvement in Health Act 2007 requires local authorities and partner ICBs to prepare a joint local health and wellbeing strategy once they have received their integrated care strategy. Essentially, that means that the ICBs and local authorities produce their overall strategy, then it devolves down, and then the joint health and wellbeing strategy looks at how it will be delivered. The local authority and its partners must give regard to the integrated care strategy, the NHS England mandate and any guidance issued by the Secretary of State. The strategy must be published and local people and the local Healthwatch must be involved in its development.
Section 116B of the 2007 Act places a duty on local authorities and partner ICBs to have regard to various strategies when exercising their function, specifically, a joint strategic needs assessment, an integrated care strategy and a joint local health and wellbeing strategy. NHS England also has regard to these when providing healthcare for a specific area.
Clause 24 changes the JLHWS to a neighbourhood health plan. In many ways, that aligns with the shift in the Government’s 10-year health plan from hospital to community. As they have described it, more care in the neighbourhood will allow hospitals to focus on the more specialist care that may be needed, so more people can be cared for closer to home, which seems a reasonable aim.
However, if local authorities and partner ICBs have to give regard to what the centre is doing when developing neighbourhood health plans, to what extent does the Minister envisage that being directed? Local authorities and partner ICBs giving regard to the centre could mean there being a very loose requirement from the centre to provide for the local population, and then they get on with it; it could also be very prescriptive—my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) has talked about the pros and cons of having targets—with a whole litany of targets in the plans. Whether that squares with the Government’s claim to be devolving power, or whether it strikes as a centralising power, depends on how that is done and to what extent the Secretary of State plans to direct it. I would appreciate it if the Minister could talk about that.
As has been said, Sir Andrew Dilnot told the Committee that
“we cannot really address many of the fundamental problems facing the NHS if we do not sort out social care.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 84, Q131.]
The Government have asked Baroness Casey to review social care, but they have developed this measure in the meantime. Is that because they have been talking to her and know that it is the sort of thing that she will recommend—or are they putting the cart before the horse, as my hon. Friend the Member for Farnham and Bordon suggested?
Later in the Committee’s considerations, we will come to Healthwatch, its benefits and the concerns that I and, I am sure, many other Committee members have about its abolition. What mechanisms does the Minister envisage there being for local people—local patients—to contribute to the neighbourhood health plans? A local Healthwatch currently contributes to the equivalent, the joint local health and wellbeing strategy, as a way of ensuring that it captures patient and community voices. How will that be done otherwise?
Some 80% of the Government’s new neighbourhood health centres that will deliver these plans are expected to be funded through public-private partnerships. Does the Minister have any comments on that, particularly in the light of the expensive private finance initiative that the last Labour Government entered into and left us stuck with?
In March 2026, the Government produced a neighbourhood health framework policy paper, which identified the goal of reducing non-elective admissions for those with severe frailty. Given that goal, why are the Government not on track to deliver the fracture liaison service improvements that they promised?
The policy paper also commits to what it calls
“a diversion rate of at least 25% by March 2027 for at least 10 high volume specialties”.
What is a “diversion rate”? It essentially requires more GP referrals to be rejected, so let us be clear about what that means. When someone, either hon. Members or constituents, goes to see their GP, they are referred to a consultant for care; I should declare an interest as a consultant in the NHS. The consultant will then review that referral and decide whether they think it is clinically appropriate to see the patient, whether a different specialty may be more appropriate, or whether they can give advice or make suggestions about treatment that could be given in primary care instead.
When a patient is given an appointment in secondary care, it essentially means that the GP has decided that they clinically need it, and the consultant has decided that they clinically need it too. If the Government want a diversion rate of at least 25% by March 2027 for at least 10 high volume specialties, are they suggesting that patients who the GP and consultant agree clinically need an appointment should not get one? If so, why?
Dr Danny Chambers (Winchester) (LD)
It is an honour to serve under your chairship, Sir Jeremy. I have been itching to speak on this new clause, tabled in the name of my hon. Friend the Member for Epsom and Ewell (Helen Maguire)—I am not sure how to pronounce that, but I am sure it is a very beautiful place; I have never been. It would ensure that a certain range of primary care providers were consulted by integrated care boards in the development of the healthcare plans.
The recent King’s Fund report, as well as many others, showed that over 90% of NHS contact with patients is in primary care in all its forms. New clause 70 relates to new clause 60, also tabled by my hon. Friend, which is about having GP representation on integrated care boards. This is an extension of that, so that dentists, pharmacy contractors and providers of ophthalmic services can all feed into integrated care boards’ healthcare plans. That is how most people come into contact with the NHS, which means that those providers have a close and deep understanding of the healthcare issues facing the demographics in their communities.
Dr Johnson
New clause 70 talks about a certain range of primary care providers being consulted by the ICB. Can the hon. Member clarify whether it is his intention for all providers of those services in a defined area to be consulted, or would it be a representative selection? If it is the latter, how would they be chosen?
Dr Chambers
The hon. Lady makes a good point. The purpose is to ensure that those who are deeply embedded in community care are consulted by the ICBs, so that they do not miss obvious localised issues in their demographics when developing care plans.
Just to give a brief example from a surgery I held recently, Joanne Cook is an occupational therapist who is campaigning for occupational therapists who have received specific training to be able to prescribe, and crucially de-prescribe, medications, in the same way that trained paramedics can. Often, occupational therapists see patients on a daily basis. They give them intimate and regular care, and are even better placed than GPs to notice small changes and adjust medications to keep people out of hospital.
If integrated care boards are not drawing on the experience, knowledge and data from primary care providers in all their forms, any healthcare plans they come up with will not be relevant to those demographics. We will not be keeping people out of hospital or treating them as effectively in the community, and the whole system will not be as efficient or as targeted as it could be. I would appreciate it if the Minister considered accepting the new clause.
Gregory Stafford
I am not convinced that clause 24 delivers the transformation that the Minister claims. At its core, it appears to be little more than a rebranding exercise. It replaces joint local health and wellbeing strategies with neighbourhood health plans, but does remarkably little to strengthen the underlying duties on local authorities or integrated care boards. Merely changing the name of a document does not improve patient outcomes, reduce waiting lists or deliver more integrated care.
The duty created by the clause is also remarkably weak. Local authorities and ICBs need only prepare a plan and then “have regard” to it when exercising their functions. That is one of the least demanding obligations available in legislation. It requires consideration, not compliance. An ICB could acknowledge the plan, but decide to depart from it and still satisfy the legal test. If neighbourhood plans are genuinely intended to drive local health policy, the Bill should do a lot more to require decision makers to act in accordance with them, or at the very least to explain publicly why they have chosen not to.
I am also concerned that the clause creates additional bureaucracy without any clear accountability. It requires the production of another planning document, another consultation exercise and another set of reporting expectations, but provides for no—for want of a better phrase—enforcement mechanism or measurable outcomes against which success can be judged. There is a risk that local systems will spend their time drafting plans rather than delivering services. Public involvement is of course essential, and indeed welcome, as we have heard, but the clause offers no detail about what meaningful involvement looks like and contains nothing to prevent a token consultation from satisfying the statutory requirement. If the objective is genuine neighbourhood-led healthcare, the legislation needs to be drafted much more tightly.
Moving on to new clause 70, I do my absolute best not to be flippant when it comes to Lib Dem amendments and new clauses, but once again we have an idea that is fine in principle—in fact, I think we would all support it in principle—yet the hon. Member for Winchester could hardly articulate how the new clause would work and whom it would involve.
Helen Morgan
The hon. Member will be aware that the new clause is a probing amendment. It is designed to push the Minister to describe how we will ensure that this range of expertise is taken into account when the plans are put together. We will not press the new clause to a vote, but we want to use it as a discussion point to probe how the range of expertise in the health service will be fully utilised, so that the plans are the best they can be.
Gregory Stafford
I thank the hon. Lady for that clarification. It is helpful to understand that the Liberal Democrats will not press the new clause to a vote, but if we are to use probing amendments effectively, they need to be drawn much more tightly, so that a Minister does not have the opportunity—I am sure that today’s Minister would not do this—to wriggle out of it because it is so poorly drafted.
Dr Chambers
What we are desperately trying to do is ensure that we are drawing on the expertise of primary care providers. The hon. Member seems not to understand that talking about 40 new hospitals the whole time with no plan to deliver them is looking at the wrong end of the health service. We need to try to keep people healthy and in the community. The new clause is an attempt to refocus thoughts on keeping people healthy in the community, rather than talking about hospitals that never existed.
Gregory Stafford
We can go back to the record in Hansard, but I do not remember mentioning anything to do with hospitals in what I just said; I may have had some sort of amnesia at that point. If the hon. Member is referring to the plan of the last Government, which was fully costed, for 40 new hospitals, then I am afraid I did not mention that. On his wider point, Conservative Members want to understand how local authorities and deliverers of primary care—dental services and so on—will be included and can have influence over the plans and strategies that ICBs draw up. I fully support that ambition; I just feel that, if we are to have that ambition, we need to table amendments and new clauses that the Minister might actually accept, so that we can go forward.
Karin Smyth
I thank hon. Members for their comments. I accept those made by the hon. Members for Winchester and for North Shropshire. I offer the Liberal Democrats the assurance that the Government fully appreciate the important role that primary care plays in informing ICB decisions, which is why we have retained the requirement that ICBs engage with their system partners, including primary care services, in the exercise of their planning and commissioning activities.
It is universally recognised that full engagement with providers, including primary care, is fundamental to good commissioning, and this is reflected in the strategic commissioning framework. The neighbourhood health framework sets out how neighbourhood health plans should be developed through health and wellbeing boards and with the involvement of system partners. We expect primary care to be fully involved in the process.
In addition, ICBs will continue to engage local representative primary care committees, such as the local medical committees. ICBs must comply with their duty to obtain appropriate advice from persons who have broad professional expertise in prevention, diagnosis or treatment of illness and the protection or improvement of public health. Primary care practitioners will remain key sources of such advice. Although I agree that experience of general practice is fundamental—as a commissioner, I worked very closely with general practitioners, who deal with 90% of patient contacts—I do not believe that placing an additional requirement on ICBs to engage specifically with primary care providers is necessary.
I will take this opportunity to clarify matters. We are moving between the roles of ICBs and local authority health and wellbeing boards. I know this is a subject of great interest and will continue to be debated in relation to those bodies’ commissioning and providing functions. The planning structure will be improved under clause 24, reflecting our commitment to neighbourhood health and making it a reality.
Planning begins with a joint strategic needs assessment developed by health and wellbeing boards; that assessment informs the new neighbourhood health plan, replacing the joint local health and wellbeing strategy. Meanwhile, ICBs will produce population health improvement plans, aligning multiple joint strategic needs assessments, neighbourhood health plans and local priorities. Patient and local voices must, of course, be embedded in ICB decision making and in the planning process. ICBs are being supported to do that. The strategic commissioning framework published on 4 November 2025 clearly set out that user involvement is key to strategic commissioning.
Having proper plans that address the needs of neighbourhoods will help the NHS to deliver for every community in our country. That is where the patient focus is and where people experience healthcare the most, and it is why we have made these commitments in neighbourhood health plans. I commend clause 24 to the Committee as the means to make that a reality.
Question put and agreed to.
Clause 24 accordingly ordered to stand part of the Bill.
Clause 25
NHS trust accounts
Question proposed, That the clause stand part of the Bill.
Karin Smyth
Clause 25 makes focused but important changes to the accounting and audit arrangements for NHS trusts by amending schedule 4 to the National Health Service Act 2006. It does not put additional burdens on NHS trusts; instead, the aim of the clause is to align the requirements for trusts with the updated accounting arrangements for foundation trusts made elsewhere in the Bill. The changes are needed as a consequence of the abolition of NHS England and the removal of the requirement for foundation trusts to have councils of governors and members.
The amendments the clause makes replicate trusts’ existing duties to keep proper accounts and records about those accounts, and to prepare annual accounts for each financial year. The clause also replicates the Secretary of State’s current power to direct an NHS trust regarding the form of its annual accounts, but extends that power of direction so the Secretary of State may also direct a trust to prepare accounts for a specified period—for example, when part-period accounts are needed. That will help to ensure a consistent approach to financial reporting while retaining the flexibility to keep requirements up to date.
The clause also sets out and strengthens how the audit arrangements for NHS trusts should operate, mirroring the approach for foundation trusts and integrated care boards. It provides that NHS trust annual accounts are audited under the Local Audit and Accountability Act 2014, as is the case currently, but it also provides that part-period accounts may be audited in accordance with that Act where the Secretary of State so directs.
The clause also enables the Comptroller and Auditor General to examine the accounts and related auditor reports, as is currently the case. To reflect the fact that the Secretary of State will have oversight of providers once NHS England is abolished, it requires the accounts and audit reports to be sent to the Secretary of State.
Taken together, these measures support transparency, consistency and robust financial assurance. They will help to reduce unnecessary divergence in accounting requirements across different types of NHS provider, while maintaining clear oversight of public funds. That is consistent with the Bill’s broader intent to support effective governance and clear accountability for providers.
Clause 26 makes minor technical amendments to ensure that the statute book remains clear and coherent as the Bill aligns the approach to audit and accounts across NHS trusts and foundation trusts. It sits alongside the provisions in the Bill that update the arrangements for the audit of foundation trusts following the abolition of NHS England and the removal of the requirement for NHS foundation trusts to have councils of governors and members.
The clause does that by amending or removing outdated transitory provisions relating to the audit of NHS trust accounts in two places: the NHS Act 2006 and the Local Audit and Accountability Act 2014. Clause 26 therefore supports the effective implementation of the wider measures in this part of the Bill by ensuring that the legislation is up to date, accurate and internally consistent. I commend clauses 25 and 26 to the Committee.
Dr Johnson
As has been said, clause 25 specifies how NHS trusts should handle their accounting. Paragraph 11A of schedule 4 to the NHS Act 2006 sets out the current obligations, which are that the trust must keep proper accounts, that the Secretary of State may give directions about how the accounts are held, and that the accounts must be prepared annually, may be examined by the Comptroller and Auditor General, and must be submitted to NHS England.
Clause 25 replaces paragraph 11A entirely. Under the new provisions, the reporting goes to the Secretary of State, instead of NHS England—which seems sensible, because the Government are abolishing NHS England—and the Secretary of State may give directions about “methods and principles”, as well as the “form and content”. The Secretary of State may also give directions about specified periods in which accounts are to be prepared.
Will the Minister explain why those provisions are felt to be necessary? There will be suspicion among some more cynical people that the power to specify periods could be used to be more flattering for the Government, or that methods and principles could be used to change the perception of the position. Can the Minister give an example of where she thinks such periods would be useful, and also say why she thinks it is necessary to enable the Secretary of State to give directions about methods and principles, and form and content, in a way that is not done at the moment?
The exception for charitable trusts of which the NHS is a trustee is being removed. Will the Minister explain why she thinks that is important, and in what situation she thinks that power would be used? Finally, will she say whether the financial directors of NHS trusts have been consulted about these changes? If so, what was their feedback?
Clause 26 tidies up relevant provisions in two pieces of legislation, as the Minister has described.
Karin Smyth
If there are specific examples that are helpful, I will write to the hon. Lady—I am not entirely sure I got the point about charities, but we will pick that up in Hansard.
As I outlined in my opening remarks, these clauses are about standardising the key requirements across the NHS provider landscape in relation to annual and other accounts and records in relation to those, and audit and reporting requirements, including keeping those up to date and having a consistent approach across all NHS provider types. Of course, we worked closely with NHS England colleagues and directors of finance in seeking to bring forward those provisions.
Question put and agreed to.
Clause 25 accordingly ordered to stand part of the Bill.
Clause 26 ordered to stand part of the Bill.
Clause 27
Special Health Authorities: establishment and exercise of functions
Karin Smyth
Clauses 27 and 28 make amendments to the legal framework around special health authorities to give the Secretary of State the flexibility to best manage the reliable delivery of healthcare for patients and the public. As the Committee knows, special health authorities are independent bodies established by the Secretary of State, by order, to perform specific functions. They play a key national role in the health system, carrying out specific functions on behalf of the Secretary of State.
Clause 27 does two key things to the special health authority legal framework. First, it amends section 28 of the NHS Act 2006 to increase the scope of functions that a special health authority could be established to deliver. Currently, the Secretary of State can create a special health authority only for the purpose of exercising functions under the 2006 Act. The clause allows a special health authority to be established to exercise functions under any other Act as well.
Secondly, the clause amends section 29 of the 2006 Act, which currently enables regulations to provide for the functions of a special health authority to be carried out flexibly, by another special health authority or jointly with one or more other special health authorities. That applies only to functions that the Secretary of State has directed the special health authority to exercise under section 7 of the 2006 Act. The clause removes that limitation, so that those arrangements can be made for any functions of the special health authority, not just those that it is directed to carry out under section 7.
These changes are needed because the health and care system is underpinned by a range of statutory functions that do not sit exclusively within the 2006 Act. The Secretary of State needs to be able to establish special health authorities to carry out those wider functions, and to give those functions to existing special health authorities. The clause ensures that the Secretary of State has the modern, adaptable tools required to place specialist functions in the right national body, with the appropriate governance and accountability. Equally, special health authorities need to be able to work with other special health authorities across all their functions in a way that best serves the needs of the wider health and care system.
On occasion, it is necessary for Ministers to merge, alter or abolish special health authorities, either because of changing circumstances or to ensure the smooth and effective running of the system. Clause 28 provides the flexibility to transfer and redeploy staff. It allows regulations to be made to enable staff to be transferred to an integrated care board or another special health authority. These changes ensure that staff can be transferred where they may be needed most, allowing for flexibility to direct resources in the health system.
The clause also allows for arrangements to be made for a special health authority’s staff to be made available to another special health authority, a local authority, the Secretary of State or an integrated care board. That may be necessary during an emergency or to provide specialist support to help an organisation achieve a particular outcome. The clause also allows the Secretary of State to give directions to a special health authority to make staff available to another special health authority or integrated care board or the Secretary of State.
Clause 28 also amends the existing power to make regulations about the sharing of information with other bodies, to allow information to be shared with integrated care boards in addition to the Secretary of State and other special health authorities. That allows for information to be shared across the system so that national and local functions can be successfully fulfilled and supports a more joined-up health system.
Clauses 27 and 28 provide for future-facing updates that will support effective administration and ensure the more reliable delivery of healthcare for patients and the public. I commend them to the Committee.
Dr Johnson
Special health authorities are, in essence, specialist health authorities set up by the Secretary of State, usually to provide an England-wide service of some form. Examples include NHS Blood and Transplant, and the NHS Business Services Authority, which provides NHS pensions—I should declare that I have an NHS pension—admin for prescription exemptions and other such business-type functions. We also have NHS Resolution, which deals with clinical negligence claims, and the NHS Counter Fraud Authority.
In principle, special health authorities are useful in some cases, but they are effectively a form of quango. Can the Minister explain when she thinks the Government might want to set up a special health authority, rather than using a department within the DHSC to deliver the same thing? There are plenty of other nationally delivered services, and although the Government have suggested that some services, such as screening, will become localised as part of the Bill, some things will remain national. Can the Minister give some examples of what the new provision will be used for?
I can see there is provision for flexibility, but the special health authorities would require setting up, and there are set-up costs and costs associated with branding and those sorts of things. How does the Minister envisage those costs being provided for, and when will it be necessary for the Government to use them rather than just using the Department?
Special health authorities have been created, reconfigured and shelved many times. For example, the National Treatment Agency for Substance Misuse became part of Public Health England in 2013, and the NHS Institute for Innovation and Improvement was closed in the same year. The functions of the National Patient Safety Agency went to the NHS Commissioning Board Special Health Authority, later known as NHS England, in 2012 and then to NHS Improvement in 2016. Widening the scope could leave us with more quangos than are necessary.
Which specific functions do the Government plan to move into special health authorities under this widened power? Have the Government just decided that they need this power and are increasing the scope because they are abolishing NHS England without a proper plan? Is this power just to cover themselves in the event that, as they start to make a plan, they find out they need it?
Clause 28 enables the Secretary of State to make regulations for the transfer of staff from one special health authority to another, or to an ICB. Paragraph 3(8) of schedule 6 to the National Health Service Act 2006 states:
“Regulations may provide for the transfer of officers from one Special Health Authority to another”,
or to NHS England,
“and for arrangements under which the services of an officer…are placed at the disposal of another Special Health Authority”,
or NHS England, or a local authority. Paragraph 3(12)(a) states that the Secretary of State may give directions
“to place the services of any of its officers at the disposal of another Special Health Authority”,
or NHS England. Paragraph 13 states:
“Provision may be made by regulations with respect to the recording of information by a Special Health Authority, and the furnishing of information by a Special Health Authority to the Secretary of State, another Special Health Authority”,
or NHS England.
Clause 28 modifies that paragraph such that regulations can now provide for the transfer of an officer to an ICB—that is a new power—as well as a special health authority and a local health authority, but no longer to NHS England because NHS England is being abolished. Regulations can now provide for an officer’s services to be placed at the disposal of the ICB and the Secretary of State, which is a new power, as well as the special health authority or local authority, but no longer NHS England. The clause modifies paragraph 3(12)(a) of schedule 6, so that directions may be given about placing the services of officers at the disposal of the special health authority and, newly, the Secretary of State or an ICB, but not NHS England. As the Minister said, the clause also modifies paragraph 13 of schedule 6, so that a special health authority can be required by regulations to pass information to integrated care boards, which is a new power, but no longer to NHS England.
NHS England is to be abolished, so it is sensible to say that staff can no longer be placed there—that seems an entirely reasonable exercise—but the legislation providing for special health authorities essentially contains open-ended spending power. Remuneration of the special health authority chairman and staff can be determined by the Secretary of State, with the approval of the Treasury. Does the Minister foresee an upper limit to those sorts of salaries?
People will essentially be able to transfer from one special health authority to another, or to an ICB—or be placed at the disposal of another special health authority, an ICB, a local authority or the Secretary of State. Will the Minister talk about the location, pension and salary of those individuals? We heard yesterday that the future Prime Minister, the right hon. Member for Makerfield (Andy Burnham), may want to move a whole load of civil servants from London up to Manchester. That will clearly be within his gift if he becomes Prime Minister, but for individuals who work in one location to be asked to move to another is disruptive to their family and social lives, and involves significant relocation costs. If people are moved in the way that clause 28 describes, particularly by transfer, what choice will they have? What will happen to their pension, salary and other terms and conditions, and will they have a choice of location or not?
Gregory Stafford
Very briefly, on clauses 27 and 28, I am sure the Committee is aware that special health authorities were initially established under the National Health Service Act 1977. Since then the number of special health authorities has expanded and contracted a number of times over the years to leave us with, currently, NHS Blood and Transplant, and the Business Services Authority, which covers pensions, as my hon. Friend the Member for Sleaford and North Hykeham mentioned—I should declare that I have an NHS pension, albeit a very small one—as well as the NHS Litigation Authority, also known as NHS Resolution, and the NHS Counter Fraud Authority.
The mood music and the direction of travel, certainly since 2006, has been to reduce the number of special health authorities. On my reading, clauses 27 and 28 suggest that the Government are potentially looking to expand the number of special health authorities, given the Secretary of State’s direction under clause 27 and the practical steps for staff transfers in clause 28. Is the Minister looking at, for example, a special health authority to deal with artificial intelligence? Clearly that is something the NHS will have to embrace—or deal with, depending on which end of the AI argument one is on—rapidly over the coming years. Is that a potential area for a special health authority? Perhaps the Minister could outline where she sees the special health authorities acting and what their remits might be.
Karin Smyth
To be clear, in response to the comments of the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham, it is not currently our intention to set up any new special authorities to deliver any specific functions. We are taking this opportunity to update the legislative framework and ensure that in future the functions that a special health authority could carry out are less limited. The current legislative framework limits the remit of such authorities to their functions under the NHS Act 2006, which is outdated and does not reflect changes since that time. There are functions of the Secretary of State under the Health and Social Care Act 2012 that we may want special authorities to carry out in future. I agree with the Opposition spokesperson that the situation is complex. We have had a lot of changes over many years, as both she and the hon. Member for Farnham and Bordon said. I agree that we need flexibility for future provision, and that is what the clauses provide.
We have no immediate intention to delegate specific functions of the Secretary of State. However, following the abolition of NHS England, a range of functions may need to be established, as the hon. Member for Farnham and Bordon outlined. Those functions could, as an example, include the data and information functions in part 9 of the Health and Social Care Act 2012, which currently sit with the Secretary of State.
I assure the Committee that the clauses do not change the existing processes or scrutiny that exist around setting up a special health authority. They are, as I think the Opposition spokesperson said, about future-proofing. I commend the clauses to the Committee.
Question put and agreed to.
Clause 27 accordingly ordered to stand part of the Bill.
Clause 28 ordered to stand part of the Bill.
Clause 29
Constitution of NHS foundation trusts
The Chair
We now come to group 24, and amendment 73 to clause 29 tabled by Charlie Maynard. Does any Member wish to move amendment 73? With that not being so, the question becomes that clause 29 stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
Amendment 74, in schedule 3, page 80, leave out paragraphs 5 to 8.
This amendment would retain the requirement for NHS Trusts to have a Council of Governors.
Amendment 75, in schedule 3, page 80, leave out paragraph 14.
This amendment would retain the requirement for NHS Trusts to have a Council of Governors.
Government amendment 19.
Amendment 36, in schedule 3, page 82, line 3, at end insert—
“(1A) The function under sub-paragraph (1) must be exercised by a person employed in the civil service of the State, and a Minister of the Crown or a special adviser must not be involved in any decision relating to such an appointment, suspension or removal.”
This amendment would ensure that civil servants are responsible for the decision making and appointment processes for trust and ICB leaders, rather than Ministers or Special Advisers.
Schedule 3.
Clause 30 stand part.
New clause 59—Independence of appointments—
“The Secretary of State must make provision to ensure that operational decisions regarding the appointment, suspension or removal of—
(a) chairs and directors of NHS trusts and NHS foundation trusts, and
(b) chief executives of integrated care boards,
are made exclusively by persons employed in the civil service.”
Karin Smyth
Amendment 19 reinstates in primary legislation the requirement in schedule 7 to the National Health Service Act 2006 for an NHS foundation trust board to include one executive director who is a medical or dental practitioner, and another who is a registered nurse or midwife.
I want to be clear to the Committee from the outset that there was never any intention to change the policy on the clinical membership of NHS foundation trust boards. Foundation trusts would still have been expected to have appropriate clinical leadership on their boards, but we had heard from ambulance foundation trusts that the current framing of the requirement for clinicians is not always helpful, and greater flexibility was therefore required. However, we also heard from important stakeholders, including the Royal College of Nursing, that removing the requirement from primary legislation has been perceived as deprioritising clinicians, which is absolutely not the case. We have therefore tabled amendment 19 to remove any doubt.
These roles provide valuable clinical oversight of board governance in decision making in foundation trusts, and are essential to ensuring the safety and quality of patient-facing services in the NHS. At the same time, some providers may need different clinical expertise at board level. For example, in ambulance trusts, an experienced paramedic may be better placed to provide the relevant clinical guidance and oversight. The amendment therefore gives the Secretary of State a regulation-making power to create exceptions to the requirement following engagement with relevant stakeholders. That preserves the current position in primary legislation while allowing for targeted flexibility for ambulance or patient transport-focused foundation trusts where appropriate. I commend amendment 19 to the Committee.
Clause 29 introduces schedule 3, which makes changes to the governance and constitution of NHS foundation trusts. It removes the various statutory roles of foundation trust members and councils of governors, and repeals the requirement for FTs to have them. Amendment 73 to 75 look to oppose that, but I do not think that we are discussing those.
The Chair
Order. Forgive me; let me interrupt to explain. I asked if anyone wished to move amendment 73, and no one did. We will come to amendments 74 and 75, so the Minister is welcome to speak to those amendments now or at the end of the debate if she wants to. Other members of the Committee may wish to move those amendments subsequently.
Karin Smyth
Thank you for the clarification, Sir Jeremy. I will come to amendment 75 at the end of the debate.
The Bill’s removal of councils of governors from NHS foundation trusts is part of delivering the 10-year health plan goal of hospitals putting patient experiences and outcomes at the heart of their decision making. That is not because we want to rid the system of local voices in democratic accountability—far from it. Although governors have provided helpful advice and oversight for some foundation trusts, we expect the next generation of NHS foundation trusts to put in place more responsive and flexible arrangements for drawing on patient, staff and stakeholder insight.
Rather than a one-size-fits-all model, providers should develop engagement arrangements that reflect their local populations, geographies and healthcare needs. Foundation trusts will have the option to retain aspects of their engagement model where it is working well, but can take a different approach if needed. Following Royal Assent, foundation trusts will be expected to have those arrangements in place and will be assessed as part of the non-statutory advanced foundation trust process.
Schedule 3 makes related changes to governance and decision making, in line with the Government’s policy to streamline oversight of providers and reduce duplication in the system. For example, the legal powers to appoint chairs and non-executive directors of foundation trusts and NHS trusts will, in future, both sit with the Secretary of State while supporting the effective use of talent across the NHS. Other functions of the council of governors, such as reviewing plans and major transactions, currently duplicate existing NHS England responsibilities, which will transfer to the Secretary of State through this Bill. Removing those requirements will therefore reduce duplication in the system.
Schedule 3 will also give the Secretary of State responsibility for approving changes to foundation trust constitutions and material changes to private patient income, and deciding chair and non-executive remuneration. The Secretary of State will take on the oversight role currently exercised by NHS England, and previously Monitor, including monitoring foundation trust performance, use of resources and governance. That will support system alignment and ensure that appropriate accountability arrangements are in place. Can I seek clarification, Sir Jeremy, that I can speak to clause 30 at this point?
The Chair
Yes, we are debating all the provisions in this group together, so the Minister is welcome to speak to clause 30 now or later, when she winds up.
Karin Smyth
Thank you, Sir Jeremy. Clause 30 clarifies how NHS foundation trust status will be applied for and granted following the abolition of NHS England and the removal of the council of governors model. The Government are committed to reinvigorating the foundation trust sector by granting high-performing providers greater freedoms and autonomy. The power to authorise foundation trusts originally sat with Monitor and passed to NHS England in 2022. The clause, alongside schedules 3 and 11, sets out how that power will operate when it transfers to the Secretary of State. It also makes consequential amendments to the authorisation process, including removing requirements linked to recruiting members and electing governors. The Secretary of State will also set the criteria for becoming a foundation trust. I commend the clauses and the schedule to the Committee.
Dr Johnson
This is quite a large group. First, clause 29 introduces schedule 3, which will make changes to the constitution of NHS foundation trusts. Currently, chapter 5 of the National Health Service Act 2006 establishes NHS foundation trusts as public benefit corporations in accordance with schedule 7 to the Act. That schedule, “Constitution of public benefit corporations”, sets out, among other things, the requirements for a constitution, the eligibility for membership, and the council of governors.
Schedule 3 to the Bill, introduced by clause 29, has a number of functions. First, it modifies the 2006 Act so that a foundation trust will no longer be a public benefit corporation, but will now be a body corporate—I would be interested in the Minister’s explanation of that change. It also modifies section 33(4) of the 2006 Act to remove reference to councils of governors, so that trusts no longer need to set those up, and modifies section 37 so that an NHS foundation trust can amend its constitution with the approval of the Secretary of State, where previously, that would have required a vote of more than half the members of the board of directors and more than half the members of the council of governors.
The schedule also deletes section 39A of the 2006 Act, “Panel for advising governors”, because one presumes if there are no governors, they do not need advice. It modifies section 43, “Provision of goods and services”, so that if a foundation trust wishes to raise its non-NHS income by 5% or more, the Secretary of State must approve it—previously that would have required local decision making from more than half of the members of the council of governors. It also deletes section 51A, “Significant transactions”, which states that an NHS foundation trust may enter into significant transactions, as defined in its constitution, only if more than half the members of the council of governors voted to approve it.
The schedule also deletes sections 56(1A), 56A(2), 56B(2) and 57A(2) of the 2006 Act. That means that governors will no longer have to approve a trust merging, being acquired, splitting or being dissolved. The Bill’s explanatory notes say that the Secretary of State will take on those approvals via schedule 11. Schedule 3 also deletes section 59, “Conduct of elections”, section 60, “Voting and standing for election” and section 61, “Representative membership” of the 2006 Act, which set out the democratic machinery for foundation trusts.
Schedule 3 also substitutes schedule 7 to the 2006 Act with an entirely new version. Elements of that new schedule 7 are as follows: the Secretary of State will now be able to appoint, suspend or remove the chair and non-executive directors—previously that was a governor’s role—and they can set the pay, allowances and terms of non-executive directors, and may regulate their tenure. The chief executive will be appointed by the non-executive directors, and the other executives will be appointed by a committee of the chair, the chief executive and non-executive directors, but the Secretary of State may set when those powers may be used. As the council of governors and its membership will be abolished, there are no members, elections or constituencies anywhere in the new schedule. Constitutional amendments will need the Secretary of State’s approval, not the approval of members and governors. The Secretary of State may make regulations on director eligibility, beyond the standard disqualifications. Directors owe a duty to promote the trust’s success, to maximise benefits for the public, with respective interests, duties and registers of interest. Board meetings must be open to the public. Accounts and audits are aligned with NHS trusts and ICBs. The Secretary of State may direct the form, content and timing as we have talked about before. Annual reports and forward financial plans go to the Secretary of State in the form that the Secretary of State decides, and trusts must publish their constitution, register, accounts and annual reports and hold a public meeting on them.
The council of governors was intended to feed in democratic input. Does the Minister have any comment on where democratic input will be held? Will it be solely through the Secretary of State, or is there any intent for local patient voice, now Healthwatch is being abolished too? How will local decision making be informed, and how will they understand their local area, particularly if it is to be directed largely by the Secretary of State?
Removing the council of governors will save money on administration, as noted in the impact assessment. The impact assessment also notes the Secretary of State does not have the ability to intervene in serious instances of foundation trust failure. Could the Minister comment on that?
Foundation trusts were intended to be independent. If the council of governors is removed and many things, as I have listed, are put under the control of the Secretary of State, they become increasingly more like an ordinary NHS trust, pre-foundation. Will they be independent in name only?
Non-executive directors are meant to be there to hold the leaders of the trust to account, but the Secretary of State can now appoint, pay and fire every non-executive director so a foundation trust’s internal watchdog can now be controlled by an elected politician who is potentially quite remote from that area. Does the Minister have any comment on how she sees that working?
Foundation trusts may have failed to increase democratic involvement in so far as there has not been huge interest in some of these elections for chairs of governors. But the answer to that would be a better version of local involvement rather than removing local input entirely.
The theme right across the schedule and the changes I listed is that foundation trusts are looking up to the Minister rather than out to local communities. Many NHS inquiries have reported back that frontline concerns did not reach the highest tiers of leadership. The Government are now closing an independent channel for sounding the alarm. Will the Minister comment on that?
I welcome Government amendment 19 because the idea that you need medical expertise on the board of a trust that delivers medical care seems to me fairly obvious, because otherwise you will get decisions that are not grounded in medical knowledge. I do recognise what the Minister says about it was not having been her intention to demote the voice of clinicians, but that was the effect. This amendment will go some way to correcting that, by having an executive director who is registered medical practitioner or a dentist, and another who is a registered nurse or midwife. Could the Minister be clear if a foundation trust wanted a nurse and a midwife, perhaps because they had a specific issue with the midwifery area, or a medical practitioner and a registered dentist, could they have both?
The Minister suggested that an exemption would be ambulance care, but there are medical practitioners, consultants, with expertise in out of hospital care. Does the Minister feel their expertise is not useful in some way?
I will speak to amendment 36 once it is moved. On clause 30 stand part, that clause removes the requirement for NHS England to consult prospective members or governors of a prospective foundation trust before its authorisation. Getting a new foundation trust without NHS England because it has been abolished is a consequence of earlier clauses that we have already voted on. Therefore, I will not go further on that issue.
Helen Morgan
I wish to speak to amendment 36 and new clause 59, which are different ways of seeking to do the same thing. They are aimed at ensuring that “civil servants are responsible for the decision making and appointment processes for trust and ICB leaders, rather than Ministers or Special Advisers.”
In earlier sessions, we spoke about the risk of political capture; the amendment and new clause intend to deal with that. The Government’s intention is to give providers more freedom to design services around local needs, but we are worried that giving the Secretary of State the powers to appoint trust chairs and non-executive directors will undermine that local flexibility and agency. It risks creating a bottleneck in the Department for Health and Social Care, leaving foundation trusts waiting for approval to make their arrangements. In theory, the Secretary of State will be responsible for the appointment of 143 foundation trust chairs and roughly 1,000 foundation trust non-executives, who themselves will appoint the executive directors. Clearly, there is the potential for a bottleneck there.
We also think that in the hands of the wrong Secretary of State—I cast no aspersions about the current one—there is potential for mass manipulation of the make-up of future NHS leadership. I think everybody here would agree that NHS leaders should be the best possible people for the job, not those who best fit the political agenda of the Secretary of State of the day. We are worried that future Secretary of States could abuse their power, intervening unnecessarily and for non-clinical reasons in hiring and firing decisions. Their political views could heavily influence the make-up of trust and ICB non-executives across the country—who are themselves responsible for appointing the chief executive— and lead to the firing and hiring of those who suit their personal vision of what a leader should look like.
From speaking to chief executives and other senior NHS leaders, I know that many already feel that chief executives are subject to the political whims of the day and are too easily scapegoated for wider failures. Holding poorly performing leaders to account is extremely important when there are failures, but sometimes those concerns and the blame culture that can exist in those organisations stops capable, impressive NHS leaders from taking the next step up the ladder to becoming a chief executive. We think a safeguard is necessary there.
We recognise that someone has to hold that power and appoint those people now that NHS England has gone. That is why amendment 36 proposes that in order to ensure there is not political capture of those decisions, they are taken by impartial civil servants who are given a set criteria of what a good leader looks like, rather than by Ministers or their special advisers.
As I mentioned, new clause 59 broadly seeks to do the same thing, but uses a different mechanism for getting that into the Bill.
Helen Morgan
I had finished speaking, but I will give way and think of something else to say.
Dr Johnson
The civil servants will be under the direction of the Minister, so how does the hon. Lady envisage it working? Presumably, civil servants are there to deliver for their Ministers or Secretary of State? Is she suggesting that makes the decision more impartial? Can she give us some detail on how that will work?
Helen Morgan
As I mentioned in my previous remarks, one imagines that a Secretary of State would set out criteria to ensure that the best people for the job are appointed. We are in a situation where a current Parliament cannot bind a future one, but we do need to set a precedent that political capture of these important leadership roles is not an unintentional consequence of this legislation. I accept that it is unintentional; I think the Secretary of State and the Minister have drafted this legislation with the best of intentions, but this is something we should guard against.
Gregory Stafford
On clause 29 and the relevant amendments, the membership model and the council of governors were originally introduced to give patients, staff and local communities a formal voice in the governance of NHS organisations. I worry that by removing them the clause concentrates power in the hands of the trust board at a local level and, potentially, the Secretary of State at a national level, while reducing opportunities for local scrutiny and public participation. As my hon. Friend the Member for Sleaford and North Hykeham said, there is a real danger that organisations will be independent in name only.
That brings us back to the never-ending tension in the Bill between the centralisation of power in the Secretary of State, through the abolition of NHS England and all the other bodies we have talked about, and the Government’s stated desire to have more accountability for decision making at a local level.
Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I am aware of the role of governors in some of our NHS trusts and the way in which they are appointed, but governors have said to me that they are sometimes disappointed by the level of influence they can in fact have in their trust. Can the hon. Member think of examples of where governors have particularly influenced the activities of individual trusts? I have not found that to be the case in my experience.
Gregory Stafford
The hon. Gentleman’s intervention neatly brings me to my next point. I have some sympathy for his viewpoint—and apparently the viewpoint expressed to him by governors—that in many cases, if not most, governors do not have the teeth, the influence or the ability to change things in the way they would like. My argument is very similar to the one we will expand on later regarding the abolition of the Healthcare Services Safety Investigations Branch and Healthwatch: the Government’s response to something not working as effectively as it could is to abolish it, but why not give those organisations the teeth—the powers—to achieve the things they were set up to do, unless the hon. Gentleman and the Government feel that there is no need, in Healthwatch’s case, for that level of independent scrutiny or, in governors’ case, that level of independent influence on boards?
There is a fundamental difference here: the Conservatives would take something imperfect and make it better; the Government’s response is to take something imperfect and abolish it. That is the wrong way round.
Dr Johnson
Does my hon. Friend think that this leaves a bit of a gap? The Secretary of State will not have the level of local oversight that the governors had, so how will that local oversight feed into the Secretary of State so that he or she can make the decisions instead?
Gregory Stafford
My hon. Friend is right that there will be a gap in local decision making on these issues. It goes back to that tension I described some moments ago: the Government’s stated intention is to devolve powers locally, but they seem to be pulling so much power up to the Secretary of State that we will lose the ability to make local decisions for the benefit of local populations where appropriate. We have a stated ambition for neighbourhood health, but those neighbourhoods are rapidly expanding in this legislation to become areas of millions of people. Local people who are interested in their local health delivery or local hospital trust would not see that as local decision making, and there is the gap that my hon. Friend describes.
I do not think that amendments 74 and 75 have been moved, so I will not talk about them. Government amendment 19 will require
“NHS foundation trusts to have at least one executive director who is a registered medical practitioner or a registered dentist and another who is a registered nurse or a registered midwife.”
As also stated in the explanatory note, and as the Minister mentioned, regulations may create exception—for example, for ambulance trusts. That is the right decision, and it is important that we have medical experience on foundation trust boards. I am interested in understanding from the Minister, first, why she has chosen a medical practitioner or registered dentist. Does she see some equivalence in their expertise that could be substituted? I have great respect for doctors and for dentists, but they have potentially different clinical expertise. If a foundation trust does no oral healthcare or maxillofacial reconstruction, and does no dentistry or allied specialties, would it really satisfy requirements to have a dentist on the board? Likewise, given that the amendment also refers to a registered nurse or midwife, if a trust has no maternity services, would having a midwife on the board really satisfy the requirement of that trust to have nursing care input? I ask those questions, and I would be interested in the answers.
Likewise, there is the exemption for ambulance trusts. Like my hon. Friend the Member for Sleaford and North Hykeham, I would be interested to understand from the Minister why she thinks ambulance trusts do not need a medical practitioner on their boards, given that they are doing medicine. Plenty of consultants work alongside paramedics and in ambulances, so again I am not quite sure why she is making that exemption. I would be interested to hear from her on that.
I understand the intention behind Liberal Democrat amendment 36. Once again, it is trying to soften the Secretary of State’s power grab over decision making—like the hon. Member for North Shropshire, I am not saying anything against the current Secretary of State, but a future Secretary of State could be different. The aim is to try to temper that in some way. Unfortunately for the hon. Member—I have sympathy for the amendment—the stated intention of the Bill is to pull more power to the Secretary of State. The Minister may surprise me, but I fear that the amendment will not find favour with the Government, because the whole Bill is about pulling more power to the centre, certainly when it comes to appointments, and to the Secretary of State.
However, the Minister should think about how future Secretaries of State may have to go through some process whereby their decisions are checked and justified, especially at local level. If we want local people to have influence and say over their local health systems and trusts, there needs to be some sort of bridging legislation or bridging process to ensure that whatever a Secretary of State decides, it has the confidence and support of local people and local service providers.
Karin Smyth
I think I am almost going to agree with the hon. Gentleman on his final point. It is important that local people have confidence in how their local systems are run and managed and, clearly, in the outcomes.
I will come first to the issue of governors and boards and then move to the amendments. I think we have all had emails, as is quite right, from local board members. Let me say, as I did earlier, that that is with good intent; they are very good people, who have given public service to be part of their local health system. As I said, this provision is no judgment on them; it is, as we heard, about effectively making the really important patient voice and patient experience central to the functions of the organisations delivering our healthcare. As I said in previous sittings, a debate will continue to be had about where we most effectively have that, but our intention throughout the 10-year health plan and this Bill is about devolution to providers and to ICBs and about making boards, as I also said in a previous sitting, responsible and accountable for the outcomes.
Let me outline broadly, because I think this is of interest to people, the impact on governance and the role that governors had. Just to be clear, since the creation of foundation trusts in 2004, NHS England—and, before it, NHS Improvement and Monitor—has had a statutory role to oversee the governance of NHS foundation trusts, including holding the whole board to account and taking steps where it identifies weaknesses in how foundation trusts are being run. The regulatory function is underpinned by the NHS provider licence, which will continue when NHS England’s functions pass to the Secretary of State. That is why we do not consider that the removal of the council of governors will have a negative impact on the governance of FTs, as some hon. Members have suggested.
Karin Smyth
I will move on, if I may. I think my response will the cover the issues raised in the debate.
On amendment 36 and new clause 59, I note the concern that the Secretary of State could act inappropriately when making appointments to the boards of ICBs and NHS trusts and foundation trusts. We discussed democratic accountability in a previous sitting, and at the end of the day it is up to the British public whom they elect to Parliament and as the governing party.
Transparency and democratic accountability are at the heart of our reforms. It would not be right for the civil service to be given sole legislative responsibility for appointments to NHS trusts, foundation trusts or integrated care boards. Ministers are democratically accountable to Parliament, and civil servants act on their behalf under the Carltona principle. Civil servants serve and advise the Government, and act on behalf of Ministers, but it is for Ministers to take decisions and to be held accountable to Parliament for the performance of the NHS. The civil service will run fair, open and equitable campaigns to fulfil these roles and will recommend appropriate candidates to Ministers.
Ministers are under a duty to comply with public law principles and to act reasonably, and will adhere to the Nolan principles, including objectivity, transparency and integrity, in discharging this function. The practical arrangements for appointments are being developed as part of the transition planning for the integration of NHS England’s functions into the Department, and will be based on these principles. It would therefore be inappropriate to exclude Ministers entirely from the appointments process. I urge hon. Members not to push the amendments to a vote.
The Chair
I think the Minister has finished.
Question put and agreed to.
Clause 29 accordingly ordered to stand part of the Bill.
Amendment made: 19, in schedule 3, page 81, line 10, at end insert—
“(1A) Unless or except to the extent that regulations provide otherwise, the executive directors must include—
(a) at least one person who is a registered medical practitioner or a registered dentist (within the meaning of the Dentists Act 1984), and
(b) at least one other person who is a registered nurse or a registered midwife.”—(Karin Smyth.)
This requires NHS foundation trusts to have at least one executive director who is a registered medical practitioner or a registered dentist and another who is a registered nurse or a registered midwife. Regulations may create exceptions (for example, an exception could be created for ambulance foundation trusts).
Schedule 3, as amended, agreed to.
Clause 30 ordered to stand part of the Bill.
Clause 31
NHS foundation trusts etc: audit of accounts
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
Schedule 4.
Clauses 32 to 34 stand part.
Karin Smyth
I will address clauses 31 to 34 and schedule 4 together. Clause 31 ensures that NHS foundation trusts are subject to the same robust, transparent audit regimes as other NHS bodies. Together with schedule 4, clause 31 makes provision about the audit of NHS foundation trust accounts, which is needed as a consequence of the abolition of NHS England and the removal of the requirement for NHS foundation trusts to have councils of governors and members. Schedule 4 does that by removing the current bespoke provisions related to the auditing arrangements for the accounts of foundation trusts and amends the Local Audit and Accountability Act 2014 so that foundation trusts are subject to the auditing regime under that Act. This means that foundation trusts will in future be subject to the same auditing requirements as trusts and integrated care boards, ensuring a clear, consistent and transparent framework for local audit across NHS provider organisations. Taken together, these measures strengthen consistency in financial reporting and audit assurance across the NHS provider sector, while preserving the independence of the local audit process.
Clause 32 repeals provisions of the NHS Act 2006, requiring NHS England to maintain a register of NHS foundation trusts and a power to charge fees related to maintaining the register. The register formed a repository of documents that related to how foundation trusts were governed and regulated. However, removing the requirements does not mean there will be no transparency. NHS foundation trusts are already required to publish the information provided on this register, and where a foundation trust is placed into special administration the administrator is required to publish its report. As a result, the additional requirement to maintain a register is unnecessary, burdensome and duplicative, providing the public with no new information. For those reasons we are removing that bureaucratic duty in the Bill.
On clause 33 stand part, the Department of Health and Social Care, like all Departments of State, has a responsibility to diligently and responsibly steward taxpayer’s money in delivering services to the public. Clause 33 updates and strengthens existing legislation to make sure we have the statutory tools we need in order to effectively manage and oversee the finances of the NHS. It does that by updating sections 42B and 42C of the NHS Act 2006 so that the existing last-resort statutory capital spending limit for foundation trusts can also apply to revenue expenditure for a given year.
Foundation trusts account for a substantial proportion of NHS revenue spending, at around 40%, and continue to benefit from significant operational autonomy, including the freedom to retain and reinvest surpluses. We remain committed to seeing those freedoms expanded further through our advanced foundation trust programme. However, this strengthened power ensures we have a financial framework that makes it easier to consider additional freedoms. The Department must therefore ensure it has in place robust tools to oversee the finances of the health service, to reassure taxpayers and Parliament that public money is being managed effectively and to ensure that the Department can meet its financial obligations.
The power will remain subject to strong safeguards, including a mandatory consultation period with the foundation trust before any order is made, the requirement for any order made to be published, and detailed statutory guidance setting out the circumstances in which the power would be used and how limits would be determined. Crucially, this is a last-resort measure. This power would be used only in exceptional circumstances—for example, when the Secretary State thinks there is a risk of breaching a departmental delegated expenditure limit. I should note that the existing capital backstop on which it builds has never been used. The purpose here is not routine financial management, but assurance. By ensuring that foundation trust freedoms operate within a viable and sustainable framework, the clause helps protect those freedoms rather than undermine them.
Finally, clause 34 makes straightforward but important provision about financial accountability when NHS organisations change legal form. It requires an NHS foundation trust that has been newly authorised, or that has recently acquired an NHS trust or another NHS foundation trust, to prepare the final accounts for its predecessor organisation. As the Committee will appreciate, organisational change, whether through authorisation to foundation trust status or through acquisition, can bring real benefits for local services, but it can also create a practical issue at financial year end. The predecessor body will have ceased to exist in its previous form and so will not be in a position to complete and sign off its final set of accounts. Clause 34 addresses that gap by making clear where responsibility sits—
Health Bill (Ninth sitting)
Tuesday 30th June 2026
(3 weeks, 6 days ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 30 June 2026 - (30 Jun 2026)
The Chair
I remind the Committee that with this we are considering the following:
Schedule 4.
Clauses 32 to 34 stand part.
The Minister for Secondary Care (Karin Smyth)
I will start where I left off. Clause 34 addresses the gap by making it clear where responsibility sits, so that there is no doubt about who must produce the final accounts and ensure that they are completed properly, and about how those accounts should be audited. We think this is a proportionate provision to ensure continuity and clarity on how NHS money has been managed during organisational transition. I commend the clauses to the Committee.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Clause 31 introduces schedule 4, which essentially makes series of amendments to other Acts. It amends the Public Finance and Accountability (Scotland) Act 2000 to remove a cross-reference to other categories, and it amends the Audit and Accountability (Northern Ireland) Order 2003 and the Public Audit (Wales) Act 2004 for similar purposes. It also amends the National Health Service Act 2006 by deleting section 62 and schedule 10, relating to the audit of accounts of NHS foundation trusts, to end the old audit scheme.
Schedule 4 amends section 3 of the Local Audit and Accountability Act 2014 so that foundation trusts are now included in the list of bodies that must keep accounts in the standard way, it amends section 4 to specify which documents count as accounts of foundation trusts for the purpose of auditing, and it amends sections 8 and 10 so that the auditor appointment procedure and the auditor panel’s role now cover foundation trusts.
In addition, schedule 4 rewrites section 13 of the 2014 Act so that if a trust fails to appoint a local auditor, it is the Secretary of State’s job to step in. Previously, that was NHS England’s job; clearly, that needs to change, because NHS England is being abolished. The schedule also amends section 21 so that the auditors’ general duties now apply to foundation trusts too, and it amends section 30, relating to unlawful expenditure and activity, and section 32B, relating to the independence requirement, to remove a now-redundant item from the list.
Schedule 4 also amends schedule 2 to the 2014 Act to formally add foundation trusts to the official list of audited bodies; schedule 5 so that the rules on who can be a local auditor now cover foundation trusts too; schedule 6 to remove an outdated segment from the audit practice code rules; schedule 7 to tidy the reporting rules and extend them to foundation trusts; schedule 9 to realign data matching rules that apply to foundation trusts in the new system; and schedule 11, relating to the disclosure of information, to remove a reference to NHS England, which is no longer necessary because NHS England is being abolished. In general, clause 31 aligns the audit process for accounts of foundation trusts with those of standard trusts and integrated care boards.
Clause 32 removes the need for NHS England to maintain a register of foundation trusts and the fees associated with maintaining it. Section 39 of the NHS Act 2006 requires NHS England to maintain a current register of NHS foundation trusts and specifies what must be in that register. Section 50 states that an NHS foundation trust must pay NHS England a fee that NHS England may determine in respect of exercising its functions under section 39, which relates to keeping the register, and section 39A, relating to a panel for advising governors. Clause 32 deletes sections 39 and 50. The explanatory notes say that the requirement to maintain a register does not need to be transferred to the Secretary of State when NHS England is abolished because, the Government argue, the information will already be available centrally, and there is no need for a fee to keep that in place. That seems sensible to me.
Clause 33 enables the Secretary of State to impose limits on a foundation trust’s annual capital or revenue expenditure. Section 42B of the 2006 Act allows NHS England to make an order imposing a limit on the capital expenditure of a foundation trust in a single year. Section 42C sets out that NHS England must publish guidance about the exercise of its power under section 42B, including about the circumstances in which it is likely to make an order and the method it will use to determine the capital expenditure limit. Clause 33 entirely replaces sections 42B and 42C with rewritten sections, with some notable changes. The wording is changed from “capital expenditure” to “expenditure”. The power is therefore widened from capital expenditure limits to limits on any expenditure—capital and revenue. The Secretary of State replaces NHS England as the entity with the power to impose limits, which makes sense, and the subsection requiring an order to specify the trust, the financial year and so on has been removed in full.
The change gives the Government financial control to stop overspending by NHS foundation trusts. I note that in financial year 2023-24, NHS trusts overspent by £1.2 billion, so presumably this is the Secretary of State getting a tighter grip on spending. In some respects that is sensible, but overspending is often due to staffing costs and day-to-day pressures, not capital expenditure, so there is an argument that the capital limits themselves are not sufficient to deal with the problem. Under the new governance model, the Secretary of State has oversight and responsibility for the health service, and financial control aligns with those changes. The new power could prevent one organisation’s failures from undermining the health service’s wider financial position or impacting other providers.
However, the purpose of foundation trusts is supposed to be that they have greater independence over spending, and the Government have stated that their aim is to create a more devolved and autonomous health system. How does broadening the Secretary of State’s ability to interfere in expenditure devolve power or make foundation trusts more independent? Imposing expenditure limits may control overspending on paper, but it does not address the reasons why it is happening, so limits could lead to a deterioration in the health services delivered by some trusts. What plans does the Minister have to deal with that?
Because the power moves from an arm’s length body to the Secretary of State, interventions could be politically motivated, rather than in the best interests of the NHS. How does the Minister consider that that will be managed?
The power for the Secretary of State to impose expenditure limits at any time during or before the financial year could create uncertainty among trust leadership and undermine long-term planning. If a trust is given a budget for the year, it knows what it has to work with, but if somebody says halfway through the year, “Actually, you are going to have to work with less money than that,” it is very difficult for the board to plan its expenditure, because it is always looking the other way. Why does the Secretary of State need that power? Can the Minister clarify that, if there is a change in the expenditure limit during the year, it will always be revised upwards, and never downwards?
Gregory Stafford (Farnham and Bordon) (Con)
My hon. Friend is making a prescient point. Has she thought about the word “limits”? To me, it is not clear from the clause as drafted—perhaps it is clearer to her—whether that is an overall limit on capital and revenue expenditure, or whether the clause is saying that the Secretary of State could impose limits on individual line items or departments. The word “limits”—plural—suggests that he or she may be able to do that.
Dr Johnson
I do not think the Bill is very clear on that. It says that the Secretary of State
“may by order impose limits on the expenditure that may be incurred by an NHS foundation trust in respect of a single financial year.”
However, it does not say whether that is an overall limit, whether it is for capital or revenue or whether it is a limit on a specific item, so the degree to which the Secretary of State has control is not clear. I presume it is an overall limit and that it is for dealing with budgets, but perhaps the Minister can provide some clarity for my hon. Friend.
Clause 34 requires foundation trusts that have been newly authorised, or that have recently acquired another trust or another foundation trust, to prepare the final accounts for their predecessor trust or foundation trust. It does that by modifying section 36 of the NHS Act 2006 to add new provisions that require foundation trusts to prepare accounts for the final period for which they were an NHS trust, establish that part of schedule 7 and part of the Local Audit and Accountability Act 2014 apply in relation to those accounts, and define the final accounting period. It does the same for section 56AA of the 2006 Act.
Karin Smyth
I thank the shadow Minister for in general, I think, agreeing that the alignment of many of these processes is quite sensible.
The shadow Minister talked in general terms about financial controls. The Government take financial controls and our responsibility for taxpayers’ money very seriously. As I said last week, from very early on, we were very keen to ensure that there is a grip on NHS finances in order to properly deliver the sort of healthcare that all our constituents deserve. We take that very seriously. There has not been that sort of grip at board level and through the system in recent years. As a result of the measures that we have taken, I think this is the first year in six or more years that the NHS has not gone back to the Department for additional funds to get through the year. The Committee can be assured that financial control is important.
The shadow Minister referred to limits. Of course they are overall limits; the Secretary of State does not go line by line through what a trust spends. I understand the point that people are trying to make to conflate some situations, but of course it is an overall limit.
The safeguards in these provisions are designed to protect foundation trusts’ freedoms and not constrain them, but a foundation trust can enjoy such freedoms only if it is in a well-overseen and stable NHS financial system. By including a backstop for use in exceptional circumstances, clause 33 helps to safeguard public funds and will help the Department to meet its financial obligations, which I think hon. Members understand. It is a usual process for the Department to go through, as anyone who has sat on the Public Accounts Committee will know. Adherence to the departmental expenditure limit creates and maintains the necessary environment for the foundation trust to exist.
Question put and agreed to.
Clause 31 accordingly ordered to stand part of the Bill.
Schedule 4 agreed to.
Clauses 32 to 34 ordered to stand part of the Bill.
Clause 35
Conversion of failing NHS foundation trust into NHS trust
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
Schedule 5.
Clauses 36 to 38 stand part.
Schedule 6.
Karin Smyth
During the process of producing our 10-year plan, we were clear that, as much as we will reward the best performing providers with new freedoms to innovate, we will not hesitate to act on poor performance, and this group of measures deal with just that: action in the event of a failing provider.
Clause 35 and schedule 5 insert new provisions into the NHS Act 2006 to enable the Secretary of State to, by order, convert a failing foundation trust to an NHS trust. This is intended to take place only in the most critical circumstances, and where it is in the public’s best interest for the Secretary of State to be able to direct the trust about how it should exercise its functions, to address safety or other issues at the trust. Foundation trust status should be a mark of good performance, and there must be a mechanism to remove it when performance is seriously deficient. This deauthorisation power will help to maintain the integrity of the reinvigorated foundation trust status and provide an additional incentive for challenged foundation trusts to improve.
The power to make a conversion order can be used where the foundation trust has failed to comply with a condition of its provider licence or with another legislative requirement. In deciding whether to make a conversion order, the Secretary of State must consider various factors, including the seriousness of the failure, the health and safety of patients, the quality of the provision by the trust of goods and services, the financial position of the trust, and the way the trust is being run.
The conversion power is also subject to two additional requirements. First, the Secretary of State must publish guidance about the matters they will consider in deciding whether to exercise the conversion power, including the factors I just outlined. They must consult on any such guidance before its publication. Secondly, where the Secretary of State proposes to use the power, they must first consult the foundation trust in question, any integrated care boards in the areas in which the trust operates, and any other person to whom the trust provides goods and services, and whom the Secretary of State considers it appropriate to consult.
Clause 35, together with schedule 5, also inserts new schedule 9A into the NHS Act 2006, which sets out the immediate consequences of a conversion order. Deauthorising a foundation trust has no impact on the property it holds, the contracts it has with commissioners and other groups, or the terms of employment of employees. These powers set clear organisational consequences for significant underperformance and allow the Secretary of State the freedom to take action to protect patients in extreme circumstances.
Clause 36 contains another critical power to allow action in the case of a failing foundation trust. It allows the Secretary of State to add conditions to an NHS foundation trust’s provider licence where they consider that the trust will breach its licence conditions due to issues with its governance. The clause is a consequence of abolishing NHS England and makes changes to the powers currently held by NHS England under section 111 of the Health and Social Care Act 2012, to confer them on the Secretary of State, with additional consequential changes reflecting the abolition of councils of governors.
The clause sets clear expectations for a foundation trust through the licence conditions and provides the Secretary of State with a transparent mechanism to take more urgent, targeted enforcement action to address failures of governance. Should the foundation trust breach any conditions imposed via section 111, the Secretary of State may require it to make changes to the executive directors of its board as necessary, including removing or suspending executive directors, replacing executive directors with interims, and preventing the trust from appointing specific individuals. If the foundation trust fails to take those actions, the Secretary of State may implement the changes.
To reassure the Committee, there are clear safeguards underpinning the clause, which can be used only where there is evidence that failures of governance in the foundation trust will cause it to breach the conditions of its licence. Further, acting under section 111 does not preclude the Secretary of State from using their other regulatory powers, including to require the foundation trust to take steps to address a breach of any condition of the licence, or to accept undertakings from the trust to address the breach.
Finally, the section 111 power was originally granted to Monitor in 2012 under transitional arrangements, as it was anticipated that the power could be withdrawn once governors had transitioned into their roles and could hold boards to account without outside intervention. Over 13 years on, that has proven not to be the case. With the abolition of the foundation trust councils of governors, it makes sense to repeal the provisions under sections 112 to 114 of the same Act that made it transitional.
Clause 37 makes changes to the special administration framework to ensure that it continues to function coherently after the abolition of NHS England. The clause makes focused, technical amendments to the Health and Social Care Act 2012 to amend the framework for establishing a mechanism for financial assistance in cases where a provider is subject to a health special administration order under chapter 5 of that Act. It also amends the Act to remove the duty to establish a mechanism for financial assistance to foundation trusts to which a trust special administrator has been appointed. The duty no longer needs to apply to foundation trusts, because the Secretary of State already has the power under provisions in the NHS Act 2006 to provide financial assistance to NHS foundation trusts if needed.
With the abolition of NHS England, the duty to establish a mechanism for financial assistance for independent providers will be retained and conferred on the Secretary of State. It is worth noting that the provisions related to financial assistance in special administration cases, and chapter 5 of the Health and Social Care Act 2012, which sets out the powers and processes for the making of health special administration orders, have not yet been commenced. However, the amendments made by the clause ensure that the special administration regime can operate smoothly if it is ever needed.
The clause does not create new financial support mechanisms, but ensures that existing ones can be used appropriately in the reformed system. In short, clause 37 ensures that the legal framework reflects the new institutional landscape while retaining the ability to act swiftly to safeguard continuity of services during special administration.
Clause 38 makes changes to the trust special administration framework to ensure that it continues to function coherently after the abolition of NHS England. This clause, together with schedule 6, make targeted changes to the trust special administration process set out in the NHS Act 2006 for NHS trusts and NHS foundation trusts as a consequence of the abolition of NHS England. It also aligns more closely the processes between NHS trusts and foundation trusts.
Trust special administration is, and will remain, a last resort mechanism used only in cases of serious failure. It is used to protect patients, stabilise services and put the organisation back on a sustainable footing. Where deemed necessary, a trust special administrator would be appointed to manage the trust and work with relevant key stakeholders to develop recommendations regarding the organisation and its services.
The amendments made by schedule 6 remove functions that currently sit with NHS England and confer the key decision-making functions on the Secretary of State, who will provide clearer lines of accountability and faster decision making when rapid intervention is required. The amendments also simplify the steps involved in the TSA process, with the aim of improving the speed of intervention and providing transparency. They align more closely the processes for trusts and foundation trusts, and set out a simpler process in relation to the administrator’s draft report, consultation and final report. They also require, as is the case now, that key documents and decisions are published and laid before Parliament. That will help ensure proper and meaningful scrutiny of the TSA process and outcomes. It also helps ensure that affected patients, staff and local partners have the opportunity to engage during the process, while maintaining the balance with the need to deliver timely intervention and secure continuity of safe services.
In addition, the amendments in schedule 6 make changes to the role of the Care Quality Commission in trust special administration. The CQC will be able to recommend that a trust special administrator should be appointed. The Secretary of State is also required to consult the CQC before making an order, ensuring that independent expertise on quality and safety informs decisions and that intelligence on service performance is co-ordinated.
The provisions in the Bill ensure that the process remains fit for purpose, proportionate, and aligned across NHS trusts and foundation trusts. They support faster, more coherent decision making in the most serious cases, with the aim of protecting patients and securing sustainable, high-quality services for the future. Taken together, the clauses provide the necessary tools for the Secretary of State to take proportionate, swift and decisive action in the event of provider failure. I therefore commend these clauses to the Committee.
Dr Johnson
Clause 35 essentially establishes the right of the Secretary of State to convert a foundation trust into an NHS trust in certain circumstances. Currently, section 25 of the NHS Act 2006 establishes trusts and introduces schedule 4 of the same Act, which makes provision about NHS trusts. Section 56AA sets out how additional requirements concerning acquisitions of a trust or foundation trust are to work. Clause 35 deletes section 25(2), which specifies that an order in this context is referred to as “an NHS trust order”, and amends subsection (3), so that no order under section 25—previously no “NHS trust order”—can be made until any consultation that has been prescribed is complete.
Clause 35 introduces proposed new section 57B into the 2006 Act, “Conversion of failing NHS foundation trust into NHS trust”, which provides the Secretary of State with the power to convert if the foundation trust breaches its licence or other legal duties. The trigger is broad and includes non-compliance with any statutory requirement. The proposed new section requires an order to specify when it takes effect and also requires the Secretary of State, when deciding to issue an order, to consider among other things
“the seriousness of the failure…the health and safety of patients…the quality of the provision by the trust of goods and services…the financial position of the trust, and…the way that the trust is being run.”
Before making an order, the Secretary of State will be required to consult the trust, any ICB where the trust has facilities and
“any other person to whom the trust provides goods or services…whom the Secretary of State considers it appropriate to consult.”
The proposed new section also provides the Secretary of State with the power, when the conversion order is made, to
“terminate the appointment of the chair or any executive or non-executive director”,
and to
“appoint a person to be the chair or an executive or non-executive director”.
It also time-limits the powers to intervene with management to one year after the order is made.
Clause 35 also introduces proposed new section 57C into the 2006 Act, “Guidance about conversion”, which requires the Secretary of State to publish guidance about matters to be considered when deciding to make an order and requires them to consult persons considered appropriate before publishing or revising guidance. The clause removes “NHS trust order” from section 276 of the 2006 Act, “Index of defined expressions”, and updates schedule 4, so that an NHS trust may be established by an ordinary order under section 25 or a conversion order under proposed new section 57B.
Schedule 5 to the Bill inserts proposed new schedule 9A to the 2006 Act, “Conversion of failing NHS foundation trusts”, which provides that, on conversion, the foundation trust’s chair and directors become the initial chair and directors of the new NHS trust, unless they are removed by the Secretary of State under the procedures we have just talked about. The proposed new schedule initially keeps the board the same size, until new arrangements are made. It provides that the foundation trust’s public dividend capital carries over to the NHS trust and that the conversion does not affect continuity of the body —it will remain the same organisation, just with NHS trust status.
The proposed new schedule provides that the trust’s property and liabilities, including criminal liabilities, continue unaffected. It also provides that existing contracts continue and that the trust remains party to them. It clarifies that those contracts do not automatically become NHS contracts under section 9(1) of the 2006 Act, provides that the trust keeps any corporate memberships that it held before the conversion, and clarifies that the continuity provisions do not affect the Secretary of State’s wider powers to make directions.
The Secretary of State will have a direct power to act where the foundation trust has failed—for instance, where there have been patient safety lapses—and there are clear benefits to that. There are also transparency requirements built in: the Secretary of State must publish guidance and consult before issuing guidance or undertaking conversion, and the power to change the management is limited to a year.
However, the last Labour Government said that independence was central to the success of foundation trusts. In 2005, the then Secretary of State, Patricia Hewitt, said:
“We know that independence from central Government control and greater freedoms are giving NHS foundation trusts the opportunity to innovate new approaches to healthcare and healthcare services, for the benefit of NHS patients.”—[Official Report, 7 November 2005; Vol. 439, c. 5WS.]
The challenge with innovations is that, even with the very best intentions and the very best advice, some will work and some will not. If any failure at all is a reason for trusts to be taken over, will that cause them to be shy about innovating, for fear of their independence being undermined as a result? There is a balance to strike, so I wonder whether the Minister will comment on that.
The change also makes it easy for the Secretary of State to convert a foundation trust for political reasons—for instance, because of pressure from local Members of Parliament. That is a positive in some ways and a negative in others. Again, it could have a chilling effect on the very autonomy and innovation that Ministers want to see, so the question is how they think they will balance that.
Edward Argar (Melton and Syston) (Con)
I will endeavour to be relatively brief in my reflections, and I will address, particularly, clauses 35 and 38. I can see a logic to what the Minister proposes in them. On clause 35, we know that foundation trusts face challenges. We saw that writ large with the scandal at Mid Staffs, and in my time as a Minister, several foundation trusts required intervention—maybe not on that scale—or required improvement. I pick on them just because they are in my head—I do not know the situation today. I am looking across at the hon. Member for Ashford, because going back some years to when I was a Minister, East Kent hospitals NHS foundation trust faced some considerable challenges. I am not necessarily saying that that meets the bar for intervention, but foundation trusts have challenges from time to time.
I should also declare an interest: I was born in the forerunner of the William Harvey hospital—the old Willesborough hospital—in the hon. Member’s constituency. I recognise that on occasions foundation trusts get into serious, or less serious but still challenging, circumstances. So I can see where the Minister is coming from, but I have a few questions for her.
First, we recognise that although foundation trusts can get into bother, so too can NHS trusts. NHS trusts can underperform, have safety issues or have financial or other performance issues. I am interested to hear the Minister’s reflections on why she believes that removing foundation status and the organisation becoming an NHS trust will necessarily solve those problems, when many NHS trusts can have equally significant challenges. I would welcome the Minister’s reflections on that.
In terms of whether a conversion was to take place—if the Secretary of State determined that that was expedient and it met the criteria—what would the timescales and process be if, further down the line, a foundation trust wished to reapply for its old status, having previously converted to an NHS trust? Would that be possible, and how would it work? I suspect that there would be a significant number of hurdles to get over to prove that it had achieved that status. I would welcome the Minister’s reflections on that point.
Finally, on clause 38, what the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham, touched on gives me a little cause for concern. Essentially, this appears to be a further centralisation of powers in the Secretary of State’s hands, particularly with the changes to the role of the CQC. It effectively downgrades the CQC’s power as the independent regulator in these matters. Instead of the CQC being able to initiate the appointment of a TSA where, on safety grounds, they consider it to be necessary and the criteria met, that power will sit with the Secretary of State, who will be required to consult the CQC, but it will seemingly lose its ability to take that initiating step irrespective of what they have seen in any inspections. I would be grateful if the Minister addressed and potentially reassured me on those points.
Karin Smyth
As people who have been listening will know, this is a chunky set of clauses on some technical details. Let me broadly pick up some of the key points.
I want to be very clear about deauthorisation and our seeking to establish, essentially, a more dynamic model. As I said, the coalition Government repealed the legislation on deauthorisation in the 2012 Act. Although other regulatory levers exist to manage poor performance, we are using two core arguments. First, converting foundation trusts into NHS trusts will enable the Secretary of State, if needed, to intervene further through their power of direction over NHS trusts. The Secretary of State will therefore be able to focus on the patient and public interest over preservation of providers’ statutory freedoms in cases of serious failure. I hope that that addresses some of the points that have been raised. Secondly, having a more dynamic environment with the potential for deauthorisation in such cases, and the consequent loss of statutory autonomy, may act as an incentive for challenged foundation trusts to improve, and it would show that there are consequences.
As I think the hon. Member for Sleaford and North Hykeham knows, the usual processes exist for managing performance across various aspects of the provider. They will continue. This is for exceptional circumstances. As I said, this is about maintaining a more dynamic model than the one we have. The purpose behind her questions about continuous service—the purpose of having a range of failure powers—is to ensure continuity of care for patients and the public. The analogy with general practice does not hold; this is a very different set of circumstances. But, obviously, she raises an important point about public concern relating to the service’s provision, and I assure her on that. We need to make sure that we diagnose the situation, provide the trust with support and assess which toolbox is most applicable.
The CQC can recommend that a trust special administrator should be appointed where it is satisfied that there is a serious failure to provide services of a sufficient quality, and it must provide a report on the safety and quality of services following the appointment of an administrator. The Secretary of State must also consult the CQC before making an order to appoint a trust special administrator.
Question put and agreed to.
Clause 35 accordingly ordered to stand part of the Bill.
Schedule 5 agreed to.
Clauses 36 to 38 ordered to stand part of the Bill.
Schedule 6 agreed to.
Clause 39
Joint working and delegation arrangements
The Chair
With this it will be convenient to discuss the following:
Government new clause 20.
New clause 26—Arrangements between NHS bodies and local authorities: duty to review—
“(1) The Secretary of State must conduct a review of the effectiveness of arrangements entered into by NHS bodies and local authorities under section 75 of the National Health Service Act 2006 (arrangements between NHS bodies and local authorities).
(2) In conducting the review, the Secretary of State must consult—
(a) NHS bodies,
(b) local authorities, and
(c) any another person that the Secretary of State considers it appropriate to consult.
(3) Having conducted the review, the Secretary of State must consider whether the power to make regulations in section 75(1) or the power to issue guidance in section 75(6) of the National Health Service Act 2006 should be exercised in order to improve the effectiveness of arrangements under that section.
(4) The Secretary of State must lay before Parliament, and publish, a report of the review.
(5) The report of the review must explain whether the Secretary of State decided to exercise the powers in section 75(1) and (6) of the National Health Service Act 2006 and the reasons for that decision.
(6) The Secretary of State must comply with the requirements of this section before the end of the 12-month period beginning with the day on which this Act is passed.”
This new clause requires the Secretary of State to conduct a review into arrangements under section 75 of the National Health Service Act 2006, and to consider whether to require NHS bodies and local authorities to enter into arrangements with each other if this is likely to lead to an improvement in how their functions are exercised.
Karin Smyth
Government new clause 20 and clause 39 both look to strengthen joint working arrangements across the health system. Clause 39 is part of the architecture of the Bill that allows the delegation of functions from the Secretary of State to NHS bodies, local authorities or other relevant organisations. The clause builds on the existing delegation powers in section 65Z5 of the National Health Service Act 2006, which already allow NHS bodies to delegate functions and pool resources with one another and with local authorities or other relevant bodies on a voluntary basis. It is a well-used voluntary power that enables systems to develop joint working and ensure that health functions are carried out by the most appropriate body or groups of bodies. The result is stronger integration, with better joint working between NHS and local government, and services better tailored to meet local needs.
With the abolition of NHS England and the new functions of the Secretary of State, it is right that the Secretary of State should have the flexibility to delegate their health functions appropriately and efficiently under a voluntary arrangement, as and when necessary. We would not want to exclude the Secretary of State from joint working arrangements, if joint working would bring benefits to patients and the public. The power is therefore purposefully broad to allow that, including allowing the Secretary of State to delegate to a range of public bodies, establish joint committees and pool funds. It also allows the Secretary of State to issue guidance to relevant bodies about the use of their powers under sections 65Z5 and 65Z6.
This proposal is not, however, a means to avoid accountability. Accountability for any function delegated through this power remains with the person delegating it whereas liability rests with the person to whom the function is delegated. Accountability, as opposed to liability, means that the body delegating a function must provide oversight for how their functions are carried out and ensure that any issues are dealt with. Ultimately, the Secretary of State will continue to be accountable to Parliament for the health service in England, including any delegated powers. I am sure that Parliament will relish holding all Ministers to account.
Building on our ambition to support greater local partnership working, as set out in our 10-year plan, we have tabled Government new clause 20 to strengthen section 75 of the NHS Act 2006 by providing much greater scope for combined authorities, combined county authorities and the Greater London Authority to use these arrangements. Section 75 currently supports flexible voluntary partnership arrangements, including the pooling of budgets between NHS bodies and local authorities. These arrangements are a critical tool in supporting local collaboration and ensuring more joined-up working within systems.
The new clause looks to strengthen the section 75 guidance-making power. At present, that power only covers consultation and applications for consent on section 75 arrangements. The Government’s new clause will extend the guidance power so that it can cover all aspects of section 75, helping us to support the wider and more effective use of partnership arrangements. For those reasons, I commend new clause 20 and clause 39 to the Committee.
The Chair
I do not think that the Minister addressed new clause 26, so does she wish to do so now? [Interruption.] She need not worry about it, I am told.
Dr Johnson
Clause 39 broadens the Secretary of State’s ability to delegate or jointly exercise health service functions with NHS bodies and local government. Currently, section 7A of the National Health Service Act 2006 enables the Secretary of State to arrange for any of their public health functions to be exercised by relevant bodies, such as NHS England, ICBs and local authorities. Section 65Z5 sets out how relevant bodies may jointly exercise delegated functions, and section 65Z6 sets out how funds may be pooled for such purposes. Section 65Z7 sets out that NHS England may issue guidance for exercising functions under those two sections and that relevant bodies must have regard to any guidance. Section 75 then sets out that the Secretary of State can make regulations to enable NHS bodies and local authorities to enter into arrangements related to the delivery of health functions.
Clause 39 deletes section 7A, removing the separate power for the Secretary of State to delegate public health functions. It amends section 65Z5 to create a wider power that allows the Secretary of State to arrange for any health service-related function in England to be exercised by or jointly with relevant bodies, local authorities, combined authorities, combined county authorities or other prescribed persons. It removes outdated references in section 65Z5 linked to NHS England and updates the wording so that arrangements can be made with a wider range of persons and not just bodies.
Clause 39 also replaces section 65Z6 so that where functions are exercised jointly, the parties can use joint committees and pooled funds. It provides that pooled funds can include payments from relevant bodies and the Secretary of State, and can be used for expenditure connected to jointly exercised functions. It amends section 65Z7 so that guidance on joint working and delegation is issued by the Secretary of State rather than NHS England. It makes consequential amendments to provisions on directors of public health and local authority public health functions, reflecting the removal of section 7A. It also makes consequential amendments to section 75 partnership arrangements and the Local Government Act 1974, again removing references to section 7A.
Once again, it is necessary to move functions to the Secretary of State when NHS England is abolished—somebody else needs to do the work. The changes introduce more flexibility for joined-up working between the Secretary of State and other entities in the health system, which could support integration and the shift to place-based care, with localised approaches to prevention, integration and service planning in line with the Government’s 10-year plan.
However, the power is very broad, relating to any function in the health service. The Secretary of State could arrange for functions to be exercised by or jointly with any person prescribed, which could mean anyone. How will it be possible to determine who is responsible for things that have gone wrong when joint committees are established and funds are pooled? The Minister has spoken a number of times during our sittings about the importance of clear accountability. In the event that the work, funds and activities are pooled, how will it be made clear who is responsible and therefore accountable for the activity that occurs?
Melanie Williams, the then president of the Association of Directors of Adult Social Services, told the Health and Social Care Committee that we spend
“a lot of time debating about who pays, rather than having a conversation about how, in the longer term, we can invest in people’s outcomes to enable better health and wellbeing.”
Is it the Government’s intention to decide the allocation of money for social care and health providers, or that whoever they decide will work together?
The Government have said that this is all about the devolution of power. This morning, we discussed the abolition of integrated care partnerships, on which ICBs and local authorities work together on projects that they choose locally. The Government are now introducing another power that will enable the Secretary of State to direct them to work together on things that he or she chooses. That does not sound terribly like the devolution of power. Could the Minister explain that to me?
I shall leave new clause 26 to the Liberal Democrats. Government new clause 20 ensures that there is a complete list of authorities that may be included. I think some were missing from the first iteration. I just make the point that the more actors there are in the mix, the harder it may be to see who is responsible overall. We also need to discuss how to maintain the balance between clinical need and political priorities in the choice of what healthcare is provided.
Dr Danny Chambers (Winchester) (LD)
New clause 26, tabled by my hon. Friend the Member for Oxford West and Abingdon (Layla Moran) and the hon. Member for Worthing West (Dr Cooper), who both sit on the Health and Social Care Committee, would require the Secretary of State to review the arrangements under section 75 of the National Health Service Act 2006 and consider whether to require NHS bodies and local authorities to enter into new arrangements with one another if that is likely to lead to an improvement in how their functions are exercised.
A recurring theme of Health and Social Care Committee inquiries is the impact of financial flows and how they frustrate attempts to deliver truly integrated care—an issue we discussed in earlier sittings. We all recognise that closer arrangements are needed to properly address discharge delays, which directly lead to corridor care or even unnecessary admissions to hospital. It seems that a consensus has been reached, yet the action to back that up is not there. We feel that, through this Bill, the Government are moving away from closer integration.
Melanie Williams, the then president of the Association of Directors of Adult Social Services, told the Health and Social Care Committee that the NHS and local authorities
“spend a lot of time debating about who pays, rather than having a conversation about how, in the longer term, we can invest in people’s outcomes to enable better health and wellbeing.”
She highlighted concerns about the funding of intermediate care and community health services through aftercare under section 117 of the Mental Health Act 1983 and NHS continuing healthcare.
Section 75 of the 2006 Act provides a legal mechanism for NHS bodies and local authorities to pool budgets and jointly commission health and social care services. The Select Committee has heard evidence of positive examples of such arrangements being used to commission integrated services. It also heard that the use of section 75 arrangements is inconsistent.
In October 2023, the Government launched a call for evidence to explore how section 75 could be better utilised to support integration. A summary of responses published in December 2024 identified several areas for improvement, including the need for stronger inter-organisation relationships, clearer governance and financial structures, and better data sharing. The Health and Social Care Committee recommended that the Government expand the use of section 75, including the range of services that it will be used to support.
This Bill is a missed opportunity for the Government to reform or promote the use of section 75 arrangements, or to provide an alternative mechanism that they believe would be more effective in addressing the challenges that funding flows present to the integration of health and care services. That is why the Select Committee suggested this new clause to prompt a review of section 72 and the introduction of guidance to support pooled budgets and jointly commissioned health and social care services.
Gregory Stafford
I want to touch briefly on clause 39, Government new clause 20, and new clause 26, tabled by the hon. Member for Oxford West and Abingdon in her role as Chair of the Health and Social Care Committee.
I recognise the intention behind clause 39. Greater collaboration between the NHS, local authorities and other public bodies has the potential to improve the co-ordination of services and deliver a more integrated approach to population health, which I think we all welcome. However, it sits slightly uncomfortably with other clauses we have debated that appear to draw local authorities and the NHS further apart. In this case, it looks like they may be brought together.
As the clause expands delegation and joint working powers, I would be interested to understand from the Minister where the oversight and safeguards for accountability for spending the joint budgets would sit. Would it be with the NHS, local authorities or somewhere else? We hope that everything goes well, but if services fail or financial problems emerge, the public deserve to know who precisely is accountable for those budgets. As I have said in debates on numerous other clauses, I continue to be concerned by the broad powers that the Bill gives to the Secretary of State. I have the same concerns about this clause.
On Government new clause 20, bringing health services and wider local government functions together is really important, particularly where combined authorities have responsibilities that affect the wider determinants of health. However, once again, I am concerned about the fact that the new clause further complicates an already crowded accountability landscape. As more functions are delivered through pooled budgets and joint arrangements, it becomes harder to identify who is responsible for outcomes, spending decisions and—hopefully not, but potentially—service failures. I welcome the flexibility, which I think has value, but it must be balanced with transparency and democratic accountability. I am not convinced that the new clause gets that right.
On new clause 26, as I have said before concerning amendments and new clauses that have come from the Health and Social Care Committee, it is often difficult to get entire agreement on these things because of the cross-party nature of the Committee. Therefore, new clauses and amendments that come out of the Committee are in some ways aspirational, rather than ones that hit the nail on the head.
The new clause suggests that the Secretary of State carry out a review of how effective section 75 arrangements are—the hon. Member for Winchester outlined evidence that in some cases, the use of section 75 arrangements has not always been effective—consult NHS bodies, local authorities and anyone else considered appropriate; consider whether existing powers should be used to improve those arrangements; publish a report and lay it before Parliament; explain whether the Government intend to use their powers to change regulations or guidance and why; and complete all that within 12 months of the Bill passing, which I think is a reasonable timeframe.
Section 75 arrangements already play an important role in bringing together health and social care. It is reasonable to ask, as the hon. Member for Winchester did, whether they are delivering the benefits in the most effective way possible. I would potentially say that this proposal does not go far enough. The new clause would require a review, a consultation and a report, but would not require any action to follow that. The Secretary of State need only “consider” whether existing powers should be exercised and explain the reasons for any decision. If the review identified significant weaknesses, there is no obligation in the new clause, as far as I understand it, to implement those changes.
I agree that the new clause is well-meaning. It has some good recommendations, and I hope the Minister takes on board its sentiment, but it probably does not have the teeth and the power to make it an effective part of the Bill.
Karin Smyth
I got a little confused at the end, but I think the Opposition generally accept the power in this clause. The hon. Member for Farnham and Bordon contended that this Bill and previous amendments to it will drive local authorities and the NHS further apart; just to have it on the record, I do not accept that that is true at all. Section 75 of the National Health Service Act 2006 and the work that we are doing on this further highlights the effect of some of the things that we are trying to do.
The hon. Member for Winchester raised new clause 26. I have sympathy for the intention behind the new clause. We all want health and care services to work closer together, as I have said repeatedly, and we agree that the partnership framework under section 75 of the National Health Service Act 2006 is a useful tool for doing so. While I understand the new clause, it is not necessary. The Department can review the section 75 framework without needing legislation, and indeed it has already done so. The Department carried out a review of section 75 in 2023, as has been said. Since then, we have continued to consider how these partnership arrangements can best support health and care integration.
The new clause would risk duplicating ongoing work. Furthermore, that work is not a one-off exercise but an ongoing process of learning and improvement across the country, and we want something that is responsive and flexible enough to respond to changes in health and care services and to the changing needs of people who use them. For that reason, I do not consider requiring a single statutory review to be the most effective approach.
Hon. Members raised important issues about clarity of accountability and responsibility. To reiterate, the legislation is clear: the legal responsibility or liability for a function being carried out properly rests with the receiving party; however, the delegating party is accountable for that function being carried out, and they must know how it is being carried out and make sure that any issues are addressed. The hon. Member for Sleaford and North Hykeham rightly alluded to one of the examples that we are exploring around section 75, which is how it might support key priorities in delivering neighbourhood health, to make absolutely clear and sure that we bring services closer together.
Both spokespeople outlined a quote from Melanie Williams of ADASS. Although I do not know the whole context of the quote, I understand the frustration of colleagues in social services and this whole area as it is one that I worked in myself. I understand the issue, but it is slightly different because it concerns the what, rather than the how, of what is being discussed. Section 75 is part of the how. We want to make this easier for people who are trying to do the right thing, and these provisions, which I commend to the Committee, do just that.
Question put and agreed to.
Clause 39 accordingly ordered to stand part of the Bill.
Clause 40
Consolidated accounts
Question proposed, That the clause stand part of the Bill.
Karin Smyth
We know that robust finances are an essential part of the health service. The financial accounts related to the NHS are of keen interest to His Majesty’s Treasury and indeed to Parliament. The Government are especially mindful of the keen interest of the Public Accounts Committee in this area. Under current arrangements, NHS England prepares a set of financial accounts for all NHS trusts and foundation trusts, and that is audited by the National Audit Office. That is the point at which the National Audit Office conducts its oversight of NHS providers, with that feeding into the National Audit Office’s assurance over the Department of Health and Social Care group.
The financial accounts for integrated care boards are currently included in the NHS England group accounts, which are presented separately and audited by the National Audit Office. With the abolition of NHS England, the Government intend to reduce central administration costs, so financial reporting needs to be proportionate while balancing stakeholders’ keen interest in financial information related specifically to the NHS. Clause 40 therefore replaces the current consolidated accounts of NHS providers with a single set of consolidated accounts for the NHS covering its trusts, foundation trusts and integrated care boards. That consolidated account will continue to be audited by the National Audit Office.
We believe that bringing the accounts together in this way will assist the public, Parliament and the National Audit Office in scrutinising NHS expenditure. Although it is not covered by the clause, it is important for the Committee to be aware that there will be no change to the current requirement for the Department to publish a Department of Health and Social Care group annual report and accounts that will consolidate the NHS accounts with the core Department and other group bodies—for example, its arm’s length bodies.
However, the Government recognise that only reporting figures for the NHS in the overall Department group would reduce transparency compared with the current structure of NHS financial accounts. The clause therefore seeks to prioritise high quality audited financial accounts information being made available while balancing against administrative costs, both of which are important to the Government.
Clause 41 amends the Secretary of State’s existing power to create a scheme allowing NHS bodies to pool funds to cover property losses and legal claims arising from their healthcare activities. They ensure that when liabilities arise, whether from damage to property, negligence or other claims, there is a clear and consistent mechanism through which those liabilities can be managed and resolved. In doing so, they protect the financial stability of the NHS. The clause updates the legislation for the new landscape by removing NHS England from the arrangements and ensuring that responsibility for administrating the schemes rests appropriately with the Secretary of State.
Although the clause is targeted and technical, its effect is essential in that it ensures continuity and legal clarity and continued effective operation of arrangements that underpin confidence and functionality across the health service. Clause 42 is a necessary technical and structural change that supports the new statutory framework following the abolition of NHS England. It removes provisions in the NHS Act 2006 and the Health and Care Act 2022 that relate specifically to NHS England’s funding and financial responsibilities, which will no longer be required once NHS England ceases to exist. The clause avoids duplication and confusion and ensures that financial accountability is clearly defined in the post NHS England system. Under the reformed framework, the Department is responsible for the overall funding of the NHS and for national financial assurance, while integrated care boards and providers continue to operate within defined statutory financial duties and controls.
Clause 42 plays an important housekeeping role, providing legal clarity and underpinning a more transparent and coherent financial framework that is fit for the NHS future operating model. I therefore commend the clause to the Committee.
Dr Johnson
Clause 40 prepares for the preparation of the annual accounts of NHS trusts and integrated care boards. Existing legislation in section 65Z4 of the NHS Act 2006, “Consolidated accounts for NHS trusts and NHS foundation trusts”, requires NHS England to prepare a set of accounts every financial year and consolidate the accounts of all the trusts and NHS foundation trusts. The Secretary of State can give directions about the content for methods and principles, and the accounts must be accompanied by reports or other information as directed by the Secretary of State. A copy may be sent by NHS England to the Secretary of State and the Comptroller and Auditor General. The latter must then examine and certify those accounts before sending a copy to the Secretary of State and NHS England, and NHS England must then lay a copy of the consolidated accounts and the Comptroller and Auditor General’s report before Parliament. That is how it works at the moment.
Clause 40 rewrites section 65Z4 and the duty to prepare the consolidated accounts every financial year moves to the Secretary of State, and the list of what gets consolidated now includes the ICB accounts. The power to give directions to NHS England about accounts is removed, which is fair enough because there would be no need for it, as the Secretary of State is now preparing them and NHS England will cease to exist. The requirement for the accounts to be accompanied by such reports or other information as the Secretary of State may direct has been removed. The accounts go straight to the Comptroller and Auditor General, who reports back only to the Secretary of State. At the end, the Secretary of State lays the accounts before Parliament. The changes are necessary owing to the abolition of NHS England.
I want to ask about the consolidation, including the ICB accounts, which was not there before, and what impact that will have. Will the accounts be sufficiently detailed so that it is possible to disaggregate that information if people are interested in doing so?
Clause 41 changes which NHS companies can be covered by the scheme that meets certain losses, legal claims and liabilities. Currently, section 71, “Schemes for meeting losses and liabilities etc of certain health service bodies”, of the NHS Act 2006 enables the Secretary of State to establish schemes to meet the losses of NHS England, ICBs, trusts, the National Institute for Health and Care Excellence, the CQC and several other bodies. The list of bodies includes
“(ha) a company formed under section 223 and wholly or partly owned by the Secretary of State or NHS England”.
In the new legislation, clause 41 rewrites paragraph (ha) so that it is
“a company formed under section 223 other than by an integrated care board by virtue of section 223A”.
That narrows the scope of the liability scheme by preventing ICB-created companies from automatically gaining protection, presumably to encourage ICBs to manage risk responsibly.
Edward Argar
I will be relatively brief, turning just to clause 40. I hope the Minister may be able to clarify something for me. I take the opportunity to thank the Minister for the letter that I received this morning, which was a very prompt response to her promise to write to me last week.
In respect of clause 40 and subsequent clauses, I can see the logic of updating the legislation to reflect the abolition of NHS England and the changes that come with that. I can also see the logic of a consolidated set of accounts so that one can see the national, or overall, picture. In the interests of transparency, I would be grateful if the Minister could confirm that that will be in addition to, and in no way replace, every individual trust having to produce granular public accounts that anyone can inspect, so that we can see not only the overall operation and financial health of the system but that of each of its individual component parts sitting beneath.
Gregory Stafford
I wish to carry on the point that my right hon. Friend the Member for Melton and Syston has just raised. He rightly says that there is a transparency element to this, so that the public and any other interested party can look at the individual accounts of an ICB or a trust. Going further than that on the technical elements, my understanding is that NHS England’s own guidance notes suggest that consolidation does not just bring accounting under one set of accounts, one umbrella or one document. Within that accounting, however, adjustments and eliminations of transactions between NHS bodies can happen. Therefore, the aggregated figures do not necessarily reflect the financial reality of individual organisations.
I understand why that might be entirely appropriate from an accounting point of view, but it can make it harder for external observers to understand exactly where the pressures are coming from, where they are concentrated and, in a world where we want accountability, who should be held responsible for addressing them. That is all I need to say on that point.
Karin Smyth
I am pleased that, in an outbreak of cross-party agreement at 3.20 pm on a Tuesday, I completely agree with the comments made by the hon. Member for Farnham and Bordon and the right hon. Member for Melton and Syston. It is a point that I made myself: the ability of Members of Parliament and the public to understand the granularity relating to their local providers and ICBs is very important for transparency and accountability. I hope Committee members recognise that I have tried to drive much more transparency in that system. They are absolutely right that that is separate from this clause, and we will continue to expect providers and ICBs to do that; I hope that addresses that point.
To add further clarity on the wider point the clause deals with, the consolidated accounts we prepare include some analysis by different types of body. That will mean separate information about NHS providers being included in the document, such as a summary of income and expenditure. Separately, providers and ICBs will continue to publish accounts so that people can look at those. The Government will listen to any feedback from users to adapt the nature of this content in future years after the initial publication, recognising that this is a new development following the abolition of NHS England. We are also mindful that too many separate publications add to administrative costs and risk losing focus. The intention is to have transparency at the local level, building that up to do something more sensible and cost-effective that is also transparent at national level. I commend the clauses to the Committee.
Question put and agreed to.
Clause 40 accordingly ordered to stand part of the Bill.
Clauses 41 and 42 accordingly ordered to stand part of the Bill.
Ordered, That further consideration be now adjourned. —(Emma Foody.)
Health Bill (Tenth sitting)
Thursday 2nd July 2026
(3 weeks, 4 days ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 1 July 2026 - (2 Jul 2026)
The Committee divided: - Ayes: 1 / Noes: 7 - Question accordingly negatived.
Dr Danny Chambers (Winchester) (LD)
I beg to move amendment 60, in clause 43, page 30, line 35, at end insert—
“(2A) The Secretary of State must give integrated care boards directions to increase spending on Primary Care services.
(2B) The increase in spending set out in subsection 2B must be in line with the change in level of their total programme funding.”
This amendment would introduce the primary care investment standard, requiring integrated care boards to increase spending on primary care services at least in line with the growth in their total programme (healthcare) funding.
The Chair
With this it will be convenient to discuss amendment 61, in clause 43, page 30, line 39, after “subsection (1)” insert “and (2A) and (2B)”.
This amendment is consequential on Amendment 60 and would enable the Secretary of State to implement financial penalties if an integrated care board fails to comply with a direction to increase spending on primary care services in line with the growth in their total programme (healthcare) funding.
Dr Chambers
Amendments 60 and 61 would introduce a primary care investment standard that required integrated care boards to increase spending on primary care services at least in line with the growth of their total programme healthcare funding. We have discussed the importance of primary care in previous sittings, so I will be brief now, because we have a lot to get through.
The primary care investment standard would be similar to the mental health investment standard. It would set a clear benchmark to which to hold the Secretary of State. Primary care is the very frontline of a health service, and it is vital to stop the rest of the health system becoming overburdened, with issues such as corridor care and long ambulance handovers often a direct result of the system’s failure properly to shift resources and focus into primary care and community care, so that we can catch diseases early and prevent people from going into hospital.
If people cannot get GP or dentist appointments, they turn up to A&E. That transfers the load to what is not only not the most efficient part of the NHS for dealing with routine issues, but the most expensive part of the NHS. That is hugely expensive, as well as not ideal for the individual. Although more than 90% of patients’ direct experience with the NHS is through primary care and GP practices, less than 10% of the NHS budget in England is spent on primary care.
Despite years of all Governments promising to shift patient care out of hospitals into the community, the proportion of the NHS budget spent on general practice has fallen to its lowest point in the past 10 years. The Royal College of General Practitioners’ 2025 practice manager survey revealed that although 61% of practice managers said that they need to expand the GP workforce to meet their patients’ needs, 62% said that the lack of funding in general practice is a major barrier preventing them from hiring the number of GPs they need.
It has been revealed that 22 out of 27 of the first round of neighbourhood health centres are already doing some of those functions; they are simply being rebadged and slightly expanded. We know that in the NHS, money is key, and there are constant important and competing demands for the limited amount of funding. Protecting funding streams for primary care would ensure that the Government actually provided the funds to back up their ambition of shifting care into the community. The benchmark that amendments 60 and 61 would set for the Government is modest, but it would have a huge impact if we could successfully transform the NHS by shifting care into the community. We hope that the Government will view this as a spend-to-save initiative as well. One question is always where the money comes from, but having fewer demands on A&E, the most expensive part of the NHS, would save money in the long run.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
The amendments would introduce a primary care investment standard, requiring the ICBs to increase spending on primary care services at least in line with the growth of the total funding that they receive. The Secretary of State would be able to implement financial penalties if ICBs failed to comply.
As the hon. Member for Winchester said, we do not need to talk about the importance of primary care, because we all know it is very important and quite efficient. The Darzi report said that primary care is one of the most financially efficient parts of the NHS. The challenge is that demand is increasing across the whole system, and unless overall funding is increased, then giving primary care a bigger share must mean giving somebody else a smaller one.
My other concern is about how the hon. Gentleman thinks this will be measured. Is measuring inputs rather than outputs really the right way to run the health service? We have tested almost to destruction the idea of just giving more and more money, which I suppose is why the Government have introduced this Bill: to try to reform things and make them more efficient. We can argue about whether they are doing that well or not, but that is the thrust of what they are trying to do.
I think the idea behind the amendments is interesting, but I would be interested to hear more about how the hon. Member thinks the standard would work, and in particular whether he thinks it could be justified if there was huge unmet demand in the secondary care or mental health sector. The balance of need may change over time, and if it does, then legislating for a set proportion to go on this or that type of care, rather than on delivering this or that type of outcome, might not be the right approach.
Edward Argar (Melton and Syston) (Con)
It is a pleasure, as always, to serve under your chairship, Ms Lewell.
I am grateful to the hon. Member for Winchester for his explanation of amendments 60 and 61. Like my hon. Friend the shadow Minister, I entirely understand what he is seeking to achieve, and also how important general practice is. Access to appointments with a general practitioner or at a practice is one of the most significant issues in Melton Mowbray. Despite the fantastic work that doctors are doing to try to manage that, the pressure continues to be intense, which on occasion is causing real anxiety for patients. Equally, I can see what the hon. Gentleman and the hon. Member for Epsom and Ewell (Helen Maguire) are trying to achieve by kick-starting a shift away from acute settings and towards front-loading—for want of a better way of putting it—people’s treatment in the NHS. As he said, Governments of many different complexions have tried to achieve that shift; what he is trying to do is give it a bit of oomph.
I can entirely see where the hon. Gentleman is coming from, but I do have some concerns, one of which was articulated well by my hon. Friend the shadow Minister, which is that the amendments are very much focused on inputs rather than outcomes. With the Health and Care Act 2022, we sought to shift the focus more towards outcomes, and I think the Minister is also seeking to move it towards outcomes rather than purely inputs—she will correct me if I am wrong—so I do worry about that.
Like my hon. Friend, I also have a slight concern about the effect of amendment 60 on the flexibility to address local circumstances and—for want of a better way of putting it—the discretion available to ICBs in determining the local health priorities. The Bill moves us away from the conception of ICBs in the 2022 Act, under which they were essentially mapped on to an upper-tier local authority geography, so that those delivering social care mapped directly on to the same geography and better integrated with it. With the removal of local authority reps and their potential replacement with representatives of a mayoral authority, and with ICBs covering much larger areas, we see a fracturing of the link with social care provision, and also perhaps a lot of local mapping and a local focus from the ICBs. None the less, my concern is that taking a prescriptive approach in primary legislation could further reduce ICBs’ ability to flex in order to address local needs. I can entirely see what the hon. Gentleman is getting at, and we all want to see primary care—general practice and dentistry—getting the funding it needs to address needs, but I am not convinced that the amendment will not have potential unintended consequences.
On amendment 61, I can again see what the hon. Gentleman and the hon. Member for Epsom and Ewell are trying to do: give the shift teeth and make sure that ICBs look at it. The risk is that if they fail to achieve it, they will face financial penalties, which risks compounding the financial challenges they face and potentially reducing the available funds for primary care, mental health and a range of other healthcare services in the vicinity. I get where the hon. Gentleman is coming from and I share the objective, but I have concerns about how it would work in practice and whether it would be overly prescriptive.
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship, Ms Lewell.
My right hon. Friend the Member for Melton and Syston and my hon. Friend the Member for Sleaford and North Hykeham have covered a lot of the points I wanted to make, so I will keep this relatively brief. Like them, I entirely sympathise with what the hon. Member for Winchester is trying to achieve with the two amendments. I think we would all want to see more investment in primary care. As my right hon. Friend—a former Health Minister—knows all too well, we need to see growth in primary care. The fact that there is not a single dentist’s practice in my constituency taking new NHS patients is a real concern, as are the waiting times for GPs in my constituency.
However, I do have some concerns. The first is that the standard, as the hon. Member for Winchester puts it, would be mandatorily enforced with a potential financial penalty. That takes away from what I think the Government are trying to achieve, which is local flexibility. As far as I can tell from the amendment, it makes no distinction between revenue spending and capital spending. I am still hopeful that my ICB is going to build a brand-new GP surgery and health hub in my constituency—it has been promising that for eight years and it is not here yet, so this may be hope over experience—and that would be a significant capital investment. Would the ICB be able to include that as spending on primary care services and get around the potential financial penalty?
I also worry about pitting one part of health spending against another. The hon. Member for Winchester said that the proposed standard would be similar to the mental health investment standard, but I believe that the Government—I am sure the Minister will correct me if I am wrong—have relatively recently changed the mental health standard to be in line with inflation rather than overall total spending. Therefore, if the amendment were to pass, primary care budgets would increase in line with total overall spending, whereas mental health budgets would increase in line with inflation. If those two things were out of sync, there would be a problem.
I totally accept what the hon. Member is trying to achieve. We all want to see more spent on primary care. The Government’s stated intention is to bring healthcare closer to home, and that can only be delivered, in my view, through primary care services. But there are some unintended consequences of the two amendments, which at least need more exploration before I could vote for them.
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairship, Ms Lewell. I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. As has been said, we all know how important investment in primary care is, particularly as this Government shift to neighbourhood health, and that is why we have invested so heavily.
Although we are absolutely interested in the outcomes, the inputs merit some attention too. We have provided an additional £601 million for general practice to reinforce the front door of the NHS, bringing the total spend on the GP contract to £14 billion in this year. That builds on last year’s £1.1 billion of investment, which was the biggest increase to GP contract funding in over a decade. In community pharmacy, we have increased funding by £340 million, bringing the total spend to £3.636 billion. That represents a 10.3% uplift on the back of an uplift of more than 19% across 2024-25 and 2025-26, which again was the largest uplift in funding of any part of the NHS at the time.
In 2024-25, we invested around £3.7 billion in primary care dentistry, and we reduced the underspend from £392 million in 2023-24 to just £36 million in 2024-25, maximising the treatment provided across all our constituencies from taxpayers’ money. We are investing £20 million to support digital integration between primary care optometry and secondary care, supporting more eye care in the community.
Dr Chambers
I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Dr Chambers
I beg to move amendment 9, in clause 43, page 30, line 36, at end insert—
“(2A) The Secretary of State must give integrated care boards directions to increase spending on mental health services at least in line with the change in level of their total programme funding.”
This amendment would place the original mental health investment standard on a statutory footing, requiring integrated care boards to increase spending on mental health services at least in line with the growth in their total programme (healthcare) funding.
The Chair
With this it will be convenient to discuss the following:
Amendment 10, in clause 43, page 30, line 39, after “subsection (1)” insert “and (2A)”.
This amendment is consequential on Amendment 9 and would enable the Secretary of State to implement financial penalties if an integrated care board fails to comply with a direction to increase spending on mental health services in line with the growth in their total programme (healthcare) funding.
New clause 27—Duty of integrated care boards to meet Mental Health Investment Standard—
“In the National Health Service Act 2006, after section 223GC insert—
‘223GC A Duty of integrated care boards to meet Mental Health Investment Standard
(1) An integrated care board must exercise its functions with a view to ensuring that expenditure incurred by the board in a financial year in relation to mental health complies with the Mental Health Investment Standard.
(2) For the purposes of this section, expenditure by an integrated care board complies with the Mental Health Investment Standard where the expenditure is greater than or equal to the amount specified for that board by the Secretary of State in accordance with subsection (3).
(3) The Secretary of State must specify an amount of expenditure for an integrated care board which secures that the proportion of the board’s expenditure in a financial year in relation to mental health is larger than the proportion of the board’s expenditure in relation to mental health for the previous financial year.’”
This new clause puts the Mental Health Investment Standard on a statutory footing by requiring the Secretary of State to specify an increasing amount of expenditure by integrated care boards on mental health and then requiring integrated care boards to incur that expenditure.
New clause 33—Review on mental health treatment delays across rural and urban areas—
“(1) Within six months of the passage of this Act, and every 12 months thereafter, the Secretary of State must conduct and publish a review into the number and length of delays for patients’ receipt of mental health treatment.
(2) A review under subsection (1) must consider any disparities in the number of length of delays between rural and urban areas.”
This new clause would require the Secretary of State to conduct and publish an annual review into the number and length of delays for patients’ receipt of mental health treatment across rural and urban areas.
New clause 34—Duty to promote mental health wellbeing—
“(1) It is a duty of the Secretary of State and any relevant body or authority carrying out functions under this Act or the Mental Health Act 2025 to promote mental health wellbeing among the people of England.
(2) In carrying out the duty under subsection (1), the Secretary of State and/or any relevant body must have regard for—
(a) the prevention of mental illness,
(b) the promotion of positive mental health,
(c) the reduction of stigma and discrimination associated with mental health conditions, and
(d) the provision of accessible and appropriate support services to individuals experiencing mental health challenges.
(3) The Secretary of State must publish an annual report outlining the steps taken to discharge their duty under subsection (1), including an assessment of—
(a) progress in improving mental health wellbeing amongst the people of England, and
(b) any barriers to promoting mental health wellbeing for such persons and proposed actions to address them.
(4) The Secretary of State may issue guidance on the discharge of the duty under subsection (1) for which any relevant body or authority to which subsection (1) applies must have regard.”
This new clause creates a duty for the Secretary of State and any relevant body or authority carrying out functions under this Act or the Mental Health Act 2025 to promote mental health wellbeing among the people of England.
Dr Chambers
Amendment 9 would place the mental health investment standard on a statutory footing, requiring ICBs to increase mental health spending at least in line with the growth in their total programme funding. Amendment 10 would enable the Secretary of State to implement financial penalties if ICBs failed to comply. New clause 27, tabled by the Chair of the Health and Social Care Committee, my hon. Friend the Member for Oxford West and Abingdon (Layla Moran), is similar. It is quite reassuring to see that the policies of the Liberal Democrats and of the Health and Social Care Committee are fairly well aligned.
The Darzi report highlighted that 20% of the NHS caseload is mental health, yet at the time it was receiving just under 10% of the NHS budget in funding, and now it is receiving 8.4%. To put that in the context of real lives, when I was first elected in 2024, there were just over half a million children and young people on mental health waiting lists; as of last week, there were 1 million. While the Government have done commendable work in reducing waiting lists for physical conditions, mental health cases are increasing—and fast.
Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I am very interested in the increase in the number of people waiting for mental health care, particularly mental health assessments. Does the hon. Member think that that is because the funding is inadequate, or is there some other reason why the waiting list numbers have been shooting up?
Dr Chambers
I would happily speak for several hours on the multifaceted reasons why young people in particular are struggling with mental health. One of my passions is ensuring that people get intervention and support before they require clinical care, but at the moment that is not happening. For a whole variety of societal reasons, including young people applying for 300 or 400 jobs and not even getting a response, more and more people are ending up on mental health waiting lists.
The mental health investment standard has been widely hailed for bringing about positive change in the health service. It protects funds and provides certainty for services that are seeing dramatically rising demand and, importantly, it provides certainty about future finances. Placing it on a statutory footing in primary legislation would make it more transparent and prevent it from becoming a political football. It would also help to stop the watering down of targets that seems to have happened over the last few years. Claire Murdoch, NHS England’s national mental health director, essentially resigned over those changes.
To pick up on the point made by the hon. Member for Bury St Edmunds and Stowmarket, the Milburn report and the report by the Children’s Commissioner this week showed that the number of children referred to mental health services in England has risen by over 10% in just one year—it is now at more than a million. The pressures on NHS services and funding are clear. If funding is not protected, there is a real risk that it will be cut due to competing demands.
One thing I found when speaking to staff at Winchester’s A&E department is that when mental health patients turn up, having been unable to get support and often having already been on a waiting list, sometimes for more than 18 months, the average time they spend in A&E is more than 18 hours, during which some of them require constant supervision. So, we are badly supporting people with mental health issues in the most expensive part of the NHS. We cannot afford to let the mental health crisis in this country continue slipping out of control, and funding for NHS mental health services is an essential part of stopping that.
New clause 33 would require the Secretary of State to
“conduct and publish an annual review into the number and length of delays for patients’ receipt of mental health treatment across rural and urban areas.”
Something I found interesting growing up on a farm and working as a vet is the almost unrecognised mental health issues in rural areas. That is partly because many people who work in rural vocations have minimal contact with people outside their workplace. Sometimes the vet and the postman might be the only people that a farmer sees in one, two or three weeks. There are a lot of questions about why disparities in accessing treatment in rural versus urban areas exist. Alternative approaches are needed, and some of the ideas floated have included mental health support officers for rural GP surgeries, or training vets up as mental health first aiders, because they might be a point of contact for a farmer and recognise when they are struggling.
Different communities require help in different ways, and farming communities often feel overlooked. They are vital for keeping the nation fed and fit and healthy, but they have a job that involves working from before 5 or 6 in the morning until late at night. If services are provided that do not fit with that person’s lifestyle and job restrictions, they can often struggle to access them, which, when coupled with having virtually no mobile signal and poor broadband, means that people in rural areas are sometimes cut off in more ways than one.
The Mental Health Act 2025 had a fairly limited focus on providing care to those with the most acute mental health problems. We need to look at preventive measures to ensure that people are supported through difficult times in their lives. These new clauses will require a report from local authorities so that we can ensure that they are providing tailored support to those in need. The Liberal Democrats strongly believe that early intervention and preventive services are key to tackling to mental health issues. These new clauses would urge mental health service providers to look beyond putting out the fire. This is about moving from crisis management to ensuring that people are supported in their local communities so that they do not reach the point of crisis. We need to treat mental health as seriously as we treat physical health. I know the Minister agrees with that; we think these new clauses will enable the Government to deliver on that ambition.
Dr Johnson
Amendments 9 and 10 have some similar issues to the last two Liberal Democrat amendments. They referred to the primary care investment, while these amendments refer to the mental health investment standard, which seeks to define the proportion of NHS money spent on mental health and maintaining it at a static position. Essentially, similar arguments apply.
In 2016, the mental health investment standard was brought in, albeit not on a statutory footing, to ensure that mental health got the attention it deserved and that the resources provided to it were higher, because the number of people with mental health problems was increasing. There was good sense to that.
However, the challenges to the NHS evolve over time. If the standard were to be fixed in statute, what effect would that have? Would that create an upper limit on spending on mental health at a time when mental health was increasing in prevalence as a problem? Would it increase the lower threshold when the reverse was the case? The Government need flexibility. I would hope that the Government make the right decisions, but that is the democratic process, and they need the flexibility to make the decisions that are appropriate for the time, rather than having this fixed in place.
If we look at current waiting list figures on the Government’s referral to treatment dashboard, in general, the number of people waiting has risen in the last month for which figures are available. If we look in particular at people who require an admission to hospital for a procedure or operation, the numbers are higher over the last month, and also over the last year, for all types of admissions. Not all mental health figures are covered in the dashboard, but those that are have improved slightly in the last month. The point I am making is that things fluctuate over time, and the Government need flexibility to deal with that.
Let me turn to new clauses 33 and 34. As a rural MP, I have some sympathy with the point that the hon. Member for Winchester made about rural healthcare. It is more difficult to get to the major, tertiary centres that provide the most up-to-date treatments. People might have to travel quite long distances to get to the doctors they need to see or to visit in-patients. Of course, those individuals also face transport costs, as we discussed in a previous sitting.
I note for the record that I am a member of the Royal College of Paediatrics and Child Health and the British Medical Association, and an NHS consultant paediatrician. Last week, the Children’s Commissioner published a report that found that 60,000 children were waiting for more than two years for support; the Royal College of Paediatrics and Child Health has also sounded the alarm about the number of children attending A&E because of mental health service issues. In that sort of the situation, the Government might want to move money from A&E services to mental health support to prevent A&E admissions. They may also need to do the reverse, in order to treat those A&E admissions in the first place. Flexibility is required.
New clause 34 would create a duty for the Secretary of State and any relevant body or authority carrying out functions under this Act or the Mental Health Act 2025 to
“promote mental health wellbeing among the people of England.”
That is a statement of his job, and a statement of the obvious; if the Minister is responsible for the mental health services of the country, of course he has a duty to make sure that they do their jobs properly.
It is a nice amendment—it is one of those things that it is politically difficult to vote against—but I would ask the hon. Member for Winchester what practical effect he thinks it would have on mental health. Does he think the Secretary of State is not thinking about mental health? I do not sit on the same side of the House as the Secretary of State, but I think he is interested in mental health and wants to do his best job. Does the hon. Member for Winchester think that is not the case? What does he think the new clause would achieve in practice?
Gregory Stafford
I will start by addressing Liberal Democrat amendments 9 and 10; once again, I see the impetus and reason behind tabling them. As the hon. Member for Winchester said, new clause 27, tabled by the Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon, has a similar but subtly different—in my view, usefully different—impetus and emphasis.
I am a member of the Health and Social Care Committee, and we published a report into community mental health in December last year, which laid bare the shocking state of mental health services in this country, especially community mental health services. Mental health accounts for over 20% of the demand for health services in this country, but in the period 2025-26, it is forecast to receive only 8.7% of NHS expenditure.
The spend in that period is expected to be higher than in the previous year, 2024-25, but it will actually be a smaller proportion of total NHS spending, decreasing from 8.78% to 8.71%. That reduction also means that 2025-26 will be the first year since 2016-17 in which mental health spending will not rise as a proportion of total health spending, which is in contravention of the mental health investment standard that has been introduced. In fact, on 17 November last year, NHS England confirmed that the proportional increases will not take place over the next two years to 2028-29, and that there will instead be “flat real funding growth”.
Overall, although I accept that the Government have increased spending on mental health, the fact that it is going down as a proportion of the total bill is one of the many reasons why we on the Health and Social Care Committee were very concerned about the future of mental health funding. It is also why we supported our Chair, the hon. Member for Oxford West and Abingdon, in tabling new clause 27.
The differences between new clause 27 and amendments 9 and 10, tabled by the hon. Member for Winchester, relate to the financial penalty. If we want people to spend more on mental health, it would seem perverse to punish them by taking money away from them, because there might be reasons why they could not meet this requirement. I totally accept what the hon. Member is trying to achieve, because as he said, Claire Murdoch, the national director for mental health, resigned in September over the fact that she did not feel that the Government were spending the right amount on mental health.
New clause 27 would put the mental health investment standard on a statutory footing by requiring the Secretary of State to specify an increasing amount of expenditure by integrated care boards on mental health, and then requiring integrated care boards to incur that expenditure. It also differs from amendments 9 and 10, in that rather than increasing the amounts as a total of expenditure—an approach for which I have sympathy—it has the more realistic requirement that it must only go up every year. Over some years, I would like the amount to increase as a total proportion from the current figure of 8% or 9% to 20%, which is the real cost or burden of mental health care in this country. I think new clause 27 is a much more fair and appropriate way of achieving that.
I accept the arguments of my hon. Friend the Member for Sleaford and North Hykeham about a potential loss of local flexibility, but I think the new clause is written in a way that gives ICBs at least some flexibility to decide how they spend that money. Also, unlike amendments 9 and 10, there is not a financial penalty if for some reason they do not manage to do so it.
In principle, I see merit in new clause 33. Like my hon. Friend the Member for Sleaford and North Hykeham, I represent a semi-rural seat, so I know that understanding delays in accessing mental health treatment is essential if we are to have services that meet patient needs and ensure greater transparency on waiting times. All this can help identify inequalities and inform better policymaking. The requirement to examine the disparities between rural and urban areas is particularly welcome given the challenges that rural communities can face in accessing specialist mental health services. However, it should be noted that the new clause would primarily deliver a reporting mechanism rather than a solution to the problem. Although annual reviews might improve our understanding of treatment delays, they do not in themselves guarantee improvements in access, workforce capacity or service provision. There is also a question as to whether the health service already collects much of this information in other ways, and whether a new statutory review would add significant value beyond the existing reporting arrangements.
Better evidence about the scale and geographic distribution of mental health treatment delays could support more targeted interventions and help to ensure that patients are not disadvantaged simply because of where they live. The challenge will be ensuring that the findings of any review actually lead to meaningful action, rather than just becoming another reporting exercise or inquiry.
Joe Robertson (Isle of Wight East) (Con)
Does my hon. Friend agree that reporting between urban and rural, which runs through these amendments, is particularly useful? Many of the solutions put forward throughout this Bill involve mayoral areas or authorities, which of course do not currently exist in many rural areas, and in some may never exist.
Gregory Stafford
My hon. Friend is absolutely right. We have talked about this issue while debating numerous clauses of the Bill. If someone were being ungenerous, they might say that there is an urban bias to this Bill. I think that it is less that than the fact that the Government have decided to use, as my hon. Friend rightly says, these mayoral structures to base health services on, when in fact, in so many areas, they either do not exist yet or, as far as we can tell, will never exist. Maybe Manchesterism will change that; we do not know. The Minister is smiling, so maybe she knows.
Regarding new clause 34 and the promotion of positive mental health, the prevention of mental illness and the reduction of stigma are obviously vital and important goals. I welcome the intention of the new clause to ensure that mental wellbeing is taken seriously across the health service. However, I have a few concerns about placing such a broad duty on a statutory footing, not least because, as my hon. Friend the Member for Sleaford and North Hykeham asked: is that not the job of the Secretary of State anyway?
As far as I can tell, new clause 34 essentially duplicates many of the responsibilities that already exist. The Secretary of State and NHS England—as currently exists—along with integrated care boards and other public bodies, are already subject to duties relating to improving health, reducing inequalities, promoting public health and improving the quality of services. Many of the objectives listed in the new clause are already capable of being pursued under those existing powers and obligations. The question therefore arises as to what additional legal effect the new duty would have.
Secondly, the concept of “mental health wellbeing”, while perhaps being a term we kind of understand, is inherently broad and rather difficult to define when we are talking about writing it into law. Unlike things such as waiting times, staffing levels, or access standards, “wellbeing” is not really a measurable outcome. I have some sympathy with my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), who said in evidence that he wanted to see fewer targets, because they often have unintended consequences and skew the system towards the targets rather than what is actually required.
Mental health wellbeing could encompass life satisfaction, emotional resilience, social connections, employment, housing security and many other factors. As a result, I do not think it is clear what compliance with the duty in this new clause would look like in practice, how the success would be measured or how public bodies could demonstrate that they had fulfilled the obligations.
Finally, although the requirement for an annual report may improve visibility, as with the provision in new clause 33, there is a risk that new clause 34 could create an additional reporting obligation without necessarily improving services or outcomes. Before Parliament imposes a new statutory duty, it should be satisfied that there is a clear objective, a measurable standard against which performance can be assessed and a distinct purpose that is not already served by existing legislation or rules. I am afraid that, unless the hon. Member for Winchester comes back with a devastating argument in his wind up, I am not yet convinced that new clause 34 amendment meets that test.
Karin Smyth
I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. I will turn to amendments 9 and 10 along with new clause 27, which address similar points. These amendments would require integrated care boards to increase their spending on mental health services at least in line with their growth in their total programme funding. Amendment 10 would enable the Secretary of State to implement financial penalties for non-compliance, and new clause 27 would also place the mental health investment standard, or MHIS, on a statutory footing by requiring the Secretary of State to specify an annual increase in the proportion of mental health expenditure for each integrated care board and require integrated care boards to meet that level of expenditure.
I want to be really clear with the Committee: mental health remains a priority for this Government, and the Government are already making record investments in mental health services. Spending on mental health continues to increase in real terms and is forecast to reach a record £16.1 billion in 2026-27. That represents a real-terms increase of around £140 million, compared with 2025-26 and around £900 million of real-terms growth since 2023-24.
Liz Twist (Blaydon and Consett) (Lab)
The Minister has pointed to some improvements. She will know there is real concern about parity of esteem between mental and physical health, including the ways that we measure them. The Government have already done a great deal, but would the Minister say how we can ensure that parity of esteem between mental and physical health is achieved using the powers in clause 43?
Karin Smyth
I thank my hon. Friend for that and for her work on this issue. She is absolutely right: parity of esteem is critical, and we are committed to a spending increase to deliver it. I will come on to some of the points that she quite rightly made.
Although I do not think he was speaking on behalf of the Select Committee, the hon. Member for Farnham and Bordon took us through some of the concerns of his Select Committee. The Government have put a formal standard and a financial safeguard in place through the mental health investment standard, and as set out in NHS England’s medium-term planning framework, we expect all integrated care boards to meet the standard over the next three years, and all are currently forecast to do so. For this period—2026-27 to 2028-29—the standard has been set on real funding growth, meaning that funding is expected at least to keep pace with inflation.
Meeting the mental health investment standard remains essential to delivering the Government’s ambitions on mental health, including achieving full national coverage of mental health support teams in schools and colleges by 2029, and expanding access to NHS talking therapies. The Government’s approach is to maintain strong protections for mental health investment, while giving local systems the flexibility to focus on outcomes and deliver services that meet the needs of their communities, which, as we have heard this morning, are very different. However, workforce increases and funding alone will not deliver the improvements the public and patients rightly expect in mental health care and support.
Demand for mental health support has risen rapidly, as we all know from our constituencies, with long waits and too many people unable to access the right support when they need it. We need a new approach that reduces waiting times, improves care quality and promotes early intervention and prevention in mental health. That is why we are developing a new cross-Government mental health strategy for England that will transform mental health care into a system that responds and intervenes earlier, reduces waiting times for support and ultimately supports people to participate fully in education, work and community life.
Liz Twist
I wonder whether, as part of that strategy, the Government will look at waiting times for mental health services, as we have heard of the considerable delays. That issue is important to everyone, but especially young people. Will the Government look at that issue and get waiting lists down?
Karin Smyth
Again, my hon. Friend makes an important point. Of course, the rising demand and the ways that waiting lists are managed and supported locally will have to be a critical part of any strategy. Also, as we have said in our elective reform plan, giving people information so that they can understand what is happening in their local systems is part of the wider patient experience work that we are going to do.
The Government are committed to prioritising the delivery of mental health services. That is why we have a standard already ensuring that mental health spending keeps pace in real terms, while allowing systems discretion to make additional investment in the way that best meets local needs. The amendments would place an inflexible financial requirement in statute. A more effective and overarching approach will be delivered through our cross-Government strategy. For those reasons, a further statutory duty is unnecessary and I ask the hon. Member for Winchester to withdraw the amendment.
Dr Prinsley
We are talking about investing in mental health services, and we should consider more widely the causes of the mental health disorders that we are having to approach. If we are spending public money, we may be better off spending it on dealing with the causes of mental health problems rather than the consequences.
Karin Smyth
My hon. Friend touches on what I will come to as I conclude my remarks on the next new clause. He is absolutely right. The wider determinants of mental health need to be part of developing these services, as with physical health.
On new clause 34, I reassure the Committee that the Government are taking significant steps to improve mental health services in this area. We have recruited over 8,500 extra mental health workers since July 2024, we are accelerating the roll-out of mental health support in schools and colleges, and we are investing a record £16 billion in NHS mental health services this year. Furthermore, there will remain a requirement, as introduced in the Health and Care Act 2022, for mental health expertise on local integrated care boards.
However, as my hon. Friend just said, we know that good mental health and wellbeing requires more than improving NHS services. It requires concerted action to promote positive mental health and tackle the causes of mental ill health. That is why we are developing a new cross-Government mental health strategy for England, to be published later this year. It will take a whole-system approach, recognising the role of schools, employers, the voluntary sector and local government, and representing all parts of the country in promoting positive mental health and preventing mental health ill. The strategy will also go further on reducing the stigma and discrimination associated with mental health conditions, with a focus on improving mental health literacy across the population.
Finally, the new clause risks imposing unnecessary burdens on local systems. For those reasons, I ask the hon. Member for Winchester not to press it. I hope he feels assured that the Government will take forward many of the Committee’s concerns in the mental health strategy.
Dr Chambers
I thank hon. Members for their insightful input to the discussion on mental health in general and for their thoughts on our amendments. It is reassuring to see the cross-party concern for mental health and the recognition that it seems to be an increasing problem.
The hon. Member for Bury St Edmunds and Stowmarket made a good point about the causes of mental health problems. We know that people in debt are three times more likely to have mental health issues than people on an average income, and that people who have served in the armed forces are at a higher risk. A whole combination of non-clinical things, such as insecure housing, zero-hours contracts and even social media for adults and children, are potentially adding to the mental health challenges that we are facing.
I appreciate the Minister talking about the new cross-Department mental health strategy. It sounds valuable and it seems to address a huge number of the multifactorial issues that have led us to this point. I will happily not press any of the amendments apart from amendment 9. The mental health investment standard is one of our absolute core priorities, and I would like to press that to a vote. I thank everybody for their contributions and insight into this.
Question put, That the amendment be made.
Karin Smyth
These clauses will make a series of vital changes to the NHS financial framework following the abolition of NHS England, strengthening funding arrangements and financial accountability. First, clause 43 will enable funding to flow to integrated care boards following the abolition of NHS England while simplifying the powers to direct how resources are used. The first change in new section 223G will transfer the responsibility to fund integrated care boards from NHS England to the Secretary of State, maintaining continuity of allocations and allowing in-year adjustments where needed.
We will also simplify the existing power in new section 223GA to direct integrated care boards in how resources are used, making it clearer and easier to use. That will ensure that safeguards can be applied consistently, such as the ability to recover funding where there is a failure to comply with a direction. Transparency will be maintained through the requirement to publish directions.
The clause will also introduce new section 223GB, setting how the direction powers in new section 223GA can be used in relation to expenditure on service integration across health and social care. At present, service integration funding must be placed in a pooled budget with local authorities, even if that is not the most effective approach. The current legislation allows for only one model, even where that may introduce unnecessary bureaucracy or delay. The clause will remove that mandatory requirement, giving the Secretary of State discretion each year on whether integration funding should be pooled.
That will not remove pooled budgets; they will remain the default where they deliver better outcomes, and local areas will still be able to enter section 75 agreements voluntarily. This clause will introduce proportionate flexibility and enable the Secretary of State to decide, transparently and through published directions, whether funding should be pooled in particular circumstances. That will ensure that we can act quickly when needed, for example in responding to urgent pressures, so that the Secretary of State is not constrained by a blanket legal requirement that does not always add value.
Clause 43 will also make necessary consequential changes following the transfer of functions from NHS England to the Secretary of State. That will include replacing “NHS England” with “The Secretary of State” in section 223GC, which concerns the power to give directions about integrated care board expenditure limits, and repealing section 223K on quality payments, as the Secretary of State can use other powers to deliver payments for quality improvement purposes.
Having set out a clearer and more streamlined framework for allocating and directing NHS resources, we now turn to how integrated care boards and providers will be held accountable for managing those resources. Clause 44 will omit sections 223M and 223N from the National Health Service Act 2006, which require each integrated care board and its partner NHS trust and foundation trust to balance their finances collectively. By removing sections 223M and 223N, we will ensure that one organisation’s deficit can no longer be obscured by another’s surplus, while preserving the Secretary of State’s ability to set joint financial objectives for integrated care boards and their partner trusts where system-wide alignment is needed.
If we are to achieve the ambitious aim set out in the 10-year health plan, of getting most providers to achieve a surplus by 2029-30, we must place the onus back on individual organisations. Each NHS organisation should be unambiguously accountable for managing its own finances, rather than relying on collective system balances to absorb overspends.
Importantly, that does not mean abandoning collaboration. Clause 44 amends section 223L of the National Health Service Act 2006 to enable the Secretary of State to set joint financial objectives for integrated care boards and their partner NHS trusts and foundation trusts, where local system-wide alignment is genuinely required.
This approach supports the wider policy direction for ICBs to operate as strategic commissioners. With clearer organisation and financial accountability, ICBs can focus on population health outcomes, prioritising prevention, reducing health inequalities, shaping services around need, and driving better value for money through more effective commissioning.
These clauses make a clearer, more disciplined framework, where individual accountability is strengthened, ambiguity is reduced and national oversight is more coherent, while retaining targeted tools to support collaboration where it adds value. I therefore commend clauses 43 and 44 to the Committee.
Dr Johnson
Clause 43 is particularly long: it runs to almost two pages of text. Essentially, clause 43 transfers the responsibility for funding ICBs, and deciding how they use the resources, from NHS England to the Secretary of State. In many cases, that is consistent with the Government’s plan to abolish NHS England, take decisions and responsibility in-house, and get some more control.
One thing that does not make sense to me is that the Government are talking about devolving control and decision making, yet this clause gives the Secretary of State powers to control spending, direct how ICBs spend money in different areas, and penalise them if they do not do what they are told. The Minister has also talked in this Committee about a vision for the future in which ICBs are consistent with mayoral authority areas, and mayors sitting on ICBs to provide some sort of democratic accountability. But how can mayors be held democratically accountable if they are, or might be, overruled by the Secretary of State? How does the Minister see that working?
Also, greater financial intervention powers for the Secretary of State, if used, could expose ICB budgets to short-term political pressure, such as funding for a specific health area that has received celebrity or media attention. How would the Minister guard against that?
If the Secretary of State is able to contest financial decisions taken by ICBs, will that slow down decision making and make things more “sticky”? Essentially, the changes seem to go against the Government’s stated aim of a more devolved and autonomous operating model for the health service. I would be grateful for the Minister’s comments on that.
Clause 44 is a little shorter. It essentially makes changes to the joint duties of ICBs and providers. Some of those changes are again necessitated by the abolition of NHS England; keeping some of the sections would result in overlapping systems, so those make more sense. But the duties requiring ICBs and their partner trusts to achieve overall system balance are repealed. That goes against the collaborative principle behind the creation of integrated care systems, and makes it more difficult to manage financial pressures across a geographical footprint. If, in a particular year, there is financial pressure in one area of an ICB but less so in another, it is not able to transfer things so easily between those areas. How does the Minister expect that to work?
Clause 44 also allows the Secretary of State to set objectives for “one or more” partners. Is that discretionary or are there criteria for it? If it is discretionary, what would prevent the Secretary of State from selectively choosing which trusts are bound by joint objectives and which are not? How will that decision be made? How will trusts know whether it is likely to be made, or in what circumstances it could be made? This could undermine consistency of treatment across different ICBs and trusts. I will be interested in the Minister’s comments on those points.
Dr Chambers
The hon. Member for Sleaford and North Hykeham covered most of the points I was going to make, so I will be very brief. The changes that are proposed to the better care fund seem like another example of decision making being taken away from local authorities and other organisations, which are often the ones that are best placed to understand the health and care needs of their local populations. This measure centralises power rather than devolving it.
Ultimately, the Bill leaves the impression that social care is being pushed more and more on to local authorities. That seems like an ill-judged move, given the ongoing stand-offs we have on the funding of social care and continuing healthcare up and down the country, and it is hardly encouraging the integrated working that everyone accepts is needed to address the joint issues in social care and the NHS. We are worried that there are multiple measures in the Bill that are separating social care and the NHS at a time when greater integration and closer working are so clearly needed. If we want to grasp the nettle on corridor care, overcrowded hospitals, ambulance delays and delayed discharge, we need to get the NHS and social care working together. All those issues seem to have their roots in social care—or the lack of it.
Taking these changes alongside others, such as the removal of local authorities and GPs from ICBs, it looks as though ICBs will not be capable of living up to the ambition of acting as joint committees that co-ordinate care with local trusts, GPs and social care. In summary, this all boils down to the fact that we cannot keep treating NHS services and social care as separate entities.
Gregory Stafford
While I agree with the points made by the hon. Member for Winchester, I note the irony that he is talking about how he wants more independence in this clause, whereas the amendments he tabled previously would have taken independence away from the ICBs—but hey, ‘twas ever thus with the Liberal Democrats.
On the new powers in clause 43, we have previously discussed the power of the Secretary of State to direct how ICBs use and manage both financial and other resources, impose expenditure limits, require approval of local decisions and compel repayment of funds where directions are not followed. These provisions substantially weaken the operational independence of ICBs, transforming them from organisations that are intended to exercise local strategic leadership, as my hon. Friend the Member for Sleaford and North Hykeham said, into bodies primarily responsible for implementing centrally determined priorities. Such centralisation risks diminishing the flexibility required to respond to local, demographic, clinical and population health challenges.
The timing of these legislative changes also raises significant concerns, because they coincide with the abolition of NHS England, the redistribution of its functions and the requirement for ICBs to reduce their operating costs by at least 50%--and, in some cases, even more than that. Collectively, those reforms represent one of the most significant reorganisations of NHS governance. However, there remains little clarity regarding which responsibilities will remain with the ICBs.
The clause makes it even less certain which responsibilities will transfer to regional teams or providers, and how accountability will operate across the system. Introducing substantially enhanced ministerial powers before the future operating model is fully defined, as we have discussed with regional mayors and other bodies, will essentially risk creating uncertainty, duplication and potentially gaps in oversight.
Dr Johnson
My hon. Friend is talking about uncertainty. Essentially, those powers could not be used at all to direct or they could be used to micromanage. It is not clear what the intent is.
Gregory Stafford
My hon. Friend is right, and I have mentioned that in relation to other clauses. I am perhaps a cynic in my belief that if stuff is being written into legislation, that probably means that the Department has some idea of what it wants to use those powers for. It would be useful to hear from the Minister what her and the Department’s intentions are for these powers. How directing or otherwise will they be of ICBs?
Specifically, proposed new section 223GB to the NHS Act 2006, relating to service integration, also exposes that inherent contradiction. It enables the Secretary of State to require ICBs to allocate designated funding into pooled budgets with local authorities, and at the same time to impose centrally approved spending plans and performance objectives. It is not possible to take the clause forward without having some clarity on exactly how those powers are going to be used in future.
As my hon. Friend the Member for Sleaford and North Hykeham said, clause 44 is shorter. She covered most of the points that I was going to make, but I think the Government should explain how effective oversight of the system-wide financial discipline that we have talked about will be maintained in the absence of the provisions omitted from the 2006 Act and the Health and Care Act 2022 by the clause.
Dr Johnson
I note that proposed new section 223GA to the 2006 Act, inserted by clause 43, includes the duty to “publish any directions” but there is no timing for that. Does my hon. Friend agree that it is important to understand how soon after the direction is made we should expect the Minister to publish it?
Gregory Stafford
My hon. Friend is right again: there is a lack of clarity in these two clauses, as I have highlighted. I am sure the Minister, having heard my hon. Friend’s question, will respond when she gets her moment.
Karin Smyth
In my comments on the amendments, I think that I addressed many of the points raised. On the final point made by the hon. Member for Farnham and Bordon, he will be aware that the Government have already improved financial oversight of the NHS system this year without any changes. We are getting a grip on the finances that were allowed to go so badly out of control across the entire piece under the Conservative party’s stewardship.
The hon. Member for Sleaford and North Hykeham, the Opposition spokesperson, started her comments by saying that the changes made by the two clauses are entirely consistent with the wider Bill, and I agree. We are abolishing NHS England—which, as I have oft repeated in these deliberations, has not been opposed by the Opposition parties—and of course there are some consequences of that, including giving the Secretary of State powers.
I will address a couple of other points directly. To be very clear, the better care fund remains a core mechanism to support the NHS and local government to join up health and social care services to a greater degree. The changes made by the clauses address the inflexibility of the current arrangements. The Committee had a good debate earlier this week about the Government’s commitment to enhancing that collaboration and joint working at a very local level. The clauses introduce flexibility, allowing the Secretary of State to determine when pooling is the best way to achieve better outcomes, while local areas are of course still able to pool budgets voluntarily through section 75 of the NHS Act 2006.
The allegation that there is weakening of joint working is not true. The clauses do not remove the ability to pool budgets; they just allow flexibility. As I said, the focus remains on delivering outcomes for patients and communities, not on financial structures.
A final question asked for reassurance that decisions made by the Secretary of State will not be arbitrary. Parliament will be reassured through clear safeguards and transparency. Any directions issued under the new powers must be published, ensuring visibility and accountability. Decisions will be guided by consistent criteria, including joint spending plans and performance objectives. Pooled budgets will continue to be required where they support better outcomes. In exercising these functions, the Secretary of State must also have regard to the need to reduce inequalities in access to health services and the outcomes achieved. Together, that ensures that decisions are—quite rightly—transparent, justified and applied fairly across the entire system.
Question put and agreed to.
Clause 43 accordingly ordered to stand part of the Bill.
Clause 44 ordered to stand part of the Bill.
Clause 45
Licence conditions
Question proposed, That the clause stand part of the Bill.
Karin Smyth
Clause 45 adds an additional purpose to those already listed in the Health and Social Care Act 2012 under which the Secretary of State can set or modify conditions in the provider licence. It will allow the Secretary of State, who will be responsible for licensing following the abolition of NHS England, to set licence conditions that promote or secure compliance with statutory obligations.
The NHS provider licence was first introduced in 2013 for NHS foundation trusts and in 2014 for eligible independent providers of NHS-funded care. It set clear rules and expectations around a range of matters, such as pricing and governance, for providers of NHS services. It also provided a mechanism for regulatory action when failures occurred at those organisations.
Licence conditions can be set only for specific purposes set out in legislation; the additional purpose does not change the existing licence conditions. The Secretary of State will be able to add or modify licence conditions only following a statutory consultation.
This additional purpose will allow the Secretary of State to hold providers to account when they are not meeting their legal obligations; for example, when they are not following procurement rules. As with other conditions in the licence, it means that we can use guidance to influence provider behaviour in these areas. The change is necessary and forms an important part of the Secretary of State’s powers to intervene where providers are not meeting expectations.
Clause 46 clarifies the methods by which the Secretary of State can serve certain notices relating to changes in the regulation of healthcare services. It brings existing requirements up to date with modern methods of communication, reducing administrative burden.
As the Committee already discussed when considering the abolition of NHS England, the Bill will transfer functions relating to the provider licence and the payment scheme from NHS England to the Secretary of State. When changes are proposed to these documents, NHS England must consult those affected and must notify all relevant organisations of the consultation. Currently, that notice cannot be delivered by email without the agreement of the organisation receiving it—without that agreement, it must be posted.
That process is out of step with the modern, digital-first approach set out in the 10-year health plan. Technology has evolved since those requirements were set, and we no longer communicate predominately through the postal system. The changes in the clause allow for rapid communication to ensure that the notice reaches the appropriate person promptly.
The clause brings the method by which the Secretary of State can deliver notices up to date with modern methods of communication to ensure that everyone affected has the chance to participate in the consultation in a timely way. I am sure all hon. Members agree that that is necessary, so I commend clauses 45 and 46 to the Committee.
Dr Johnson
Clause 45 makes technical changes to the licence conditions, allowing the Secretary of State to use those conditions as a tool to ensure compliance with legal requirements beyond those in the Health and Social Care Act 2012. That power is somewhat open-ended, which reduces certainty for providers, particularly independent ones, as they will not be able to easily anticipate what additional legal duties might be folded into the licence. The Minister said that there would be a consultation, but does she have any more details on how long the consultation process will be, or on how much notice of changes providers can expect? Like other clauses in the Bill, despite the Government’s discussion of devolution, the clause introduces another centralising power.
Clause 46 is about the specifics of to whom legal documents can be served and through what mechanism. I understand the Minister’s argument on the need for modernisation, but everyone will have had emails that were bounced by spam filters or the like. How will she ensure that the emails are not just sent but received, so that there is a fair playing field for everyone?
Gregory Stafford
I understand the purpose of clauses 45 and 46, as there is clear public interest in ensuring that providers that hold licences in our health and care system comply with the law. Patients, taxpayers and staff are entitled to expect high standards, proper governance and accountability. Where a provider delivers vital public services, it is reasonable for the licensing scheme to help to uphold those obligations. In that sense, the intention of the clauses is good.
My hon. Friend the Member for Sleaford and North Hykeham outlined a number of questions for the Minister. Could the Minister explain in more detail how clause 46, which essentially provides for the enforcement of the provisions in clause 45, will operate in practice?
Karin Smyth
I do not have any more details on how the clauses will operate in practice and follow through into guidance; that will obviously be in the usual guidance on the operation of the system. It is usual practice for people doing the work to make contact with the receiver of the email to check that they have received it and are acting on it appropriately.
Question put and agreed to.
Clause 45 accordingly ordered to stand part of the Bill.
Clause 46 ordered to stand part of the Bill.
Clause 47
Single patient record
Dr Chambers
I beg to move amendment 8, in clause 47, page 34, line 19, after “behalf” insert “, including nominated carers”.
This amendment makes it explicit that nominated carers can access the single patient record on behalf of those they care for.
The Chair
With this, it will be convenient to discuss amendment 65, in clause 47, page 35, line 6, after “treatment” insert
“, or to any specific support needs or reasonable accommodations required for the effective provision of such care or treatment”.
This amendment aims to clarify that “patient information” held on the Single Patient Record would also include any specific support needs or reasonable accommodations, such as those arising from health conditions or disabilities, that a patient requires for the effective provision of their care or treatment.
Dr Chambers
All the stakeholders have said that the single patient record is part of the Bill that could be genuinely transformative. I would also like to note the Bill’s many references to carers, including the Secretary of State’s duty to promote the involvement of carers alongside patients in decision making around care and commissioning. However, the Bill is currently quite vague as to whether carers will be able to access the single patient record, and we want that to be made explicit. We want to reiterate the lack of focus on social care, which is the biggest issue facing the NHS, and emphasise our call for carers in general.
The benefits that the single patient record could bring to patients have been well-established, and it is well-supported, but we believe that the single patient record could also be of huge benefit to carers. It could allow them to care more effectively for their loved ones, and it could allow it to be flagged on their own records that they are carers, so they receive the support that they need.
Gregory Stafford
I have a lot of sympathy with this amendment and what the hon. Gentleman is trying to achieve through it. Does he have any idea of how a patient would nominate a carer in such a circumstance? Indeed, would it be done by the patient themselves? If not—for example, the patient might have mental health issues or capacity issues—could the carer be nominated by a health professional or a statutory body?
Although I absolutely agree with the intentions of the amendment, could he give some examples? For instance, would a carer be able to access all of the patient’s record, or just the part for the period in which they have been providing care? It is entirely right that a carer should see the patient record relating to whatever it is they are providing care for, but—I am not trying to be flip—should carers know that at 17, the person who they are caring for was treated for a sexually transmitted disease or something similar, which the patient might not want them to know?
Dr Chambers
The hon. Gentleman makes some very good points. Obviously, the whole point of this amendment is to equip people who are providing what is often the daily care for someone else with the information they need to provide that care. My family cared for my father at home for many years when he had dementia; he was on medication for other physical health issues as well, and he was not capable of administering his own medicine, or even of understanding what he was on half the time.
Sojan Joseph (Ashford) (Lab)
I am very sympathetic to this amendment, and to the argument that patients and carers should have enough information about what they are providing care for. In the current system, carers get a copy of the care plan, which states what the patient’s care needs are, as assessed by health professionals. Does the hon. Member agree that carers need to see only the care plan for the patient, rather than the patient’s whole record?
Dr Chambers
I agree that there is no need for carers to see irrelevant or extremely historical information in the single patient record. Currently, however, there are a lot of carers who, for various reasons, such as not having legal power of attorney, cannot access the information that they need.
We also sometimes find that the people who are carers, who are potentially the spouse of the patient and are themselves elderly—because a lot of people receiving care are elderly—do not understand the information that they are being given. There can be a situation where the person providing care does not fully understand why the patient is getting some medication, or the best way to treat them. We hear that quite a lot.
We understand that the Bill is not designed to set out all the specifics of what the single patient record will look like—that key point was made in the interventions by the hon. Members for Farnham and Bordon and for Ashford. However, although we do not know exactly what it will look like, as it is being created, drafted and thought through, we would love the Minister to confirm to us that carers will be able to see the appropriate parts of the single patient records of those they care for, so that they can oversee their medical care and flag any issues.
There are some specific advantages to having a single patient record when travelling between hospital trusts. For example, being able to quickly see what historical medication the patient has had, especially when it comes to antimicrobials, and the results of tests that were performed in other hospitals and healthcare settings, is absolutely vital to ensure that we do not allow antimicrobial resistance to increase at an unnecessary pace. Often, patients do not understand the type of antibiotic they are on, or remember the name of it, and that is a specific but big issue, because it can generate antimicrobial resistance. There are a few more issues that I could speak to, but I will sit down.
Dr Johnson
I rise to talk about amendment 8. I essentially understand what the hon. Member for Winchester is trying to do—to make sure that carers are provided with the information that they need to provide the best possible care—and I think we would all agree with that ambition. However, I have a couple of questions for him. The Bill, as drafted, discusses “making” information
“available to people other than a patient on the patient’s behalf”.
I am not quite clear why would that not encompass a nominated carer.
My hon. Friend the Member for Farnham and Bordon made an important point about privacy. The single patient record will encompass a patient’s entire medical history, medical notes and medical information, but every person who provides that patient with medical or social care does not need to see all of that, and in some cases, the patient may not want them to. My hon. Friend gave a good example of that; another example would be an elderly lady who does not want her carer to see that she had a termination at 23. There are lots of things that are private to people that they do not want others to see. I am interested in the Minister’s comments on this issue. Access to the record is seen as a binary choice, but in some respects, it needs to be a much more nuanced affair than that, while still allowing someone access to the areas of the record that are required for them to complete their duties.
Dr Chambers
The hon. Lady is making very good points. The whole thrust of the argument is that there is little detail around how the single patient record will be created and implemented. This is a perfect opportunity to work out how we can empower carers while preserving patient confidentiality where necessary. If we do not focus on that in the early stages of the SPR’s implementation, before it has even been designed, we will miss the opportunity to ensure that carers have an easy way to get the right information. We should not miss that opportunity.
Dr Johnson
I understand the hon. Member’s point, but we need to start with the patient at the centre and ask what is best for patient care. It is about what the patient wants to share with their carers. The patient may make an informed decision not to share information that is potentially useful, but if they have capacity, they are free to do that. It is about starting with the patient.
I have huge sympathy with the principle of what the hon. Gentleman is trying to achieve, but I am not sure that that is not already included in proposed new section 250E(2)(c)(i) of the NHS Act 2006, which mentions “making” information
“available to people other than a patient on the patient’s behalf”.
The important thing is that patients make the decision if they have the capacity to do so, or that someone acting with power of attorney has done so on their behalf.
Amendment 65, which is also in this group, talks about support needs. I have some sympathy with that as well. When I see a patient in clinic—I am a paediatrician, so they are all children—I look at the notes, which say they have a particular issue, and I go out into the waiting room and call the child’s name. There is nothing on the record, necessarily, to tell me that the patient and the mum are deaf, or that the other parent is deaf and may not be able to hear me calling them in the waiting room. So I have sympathy with the idea that the record would flag up reasonable adjustment needs; I think there is a place for that.
There is something called the reasonable adjustment flag on the NHS Spine, and perhaps the answer is to use that rather better than is happening at the moment. With carers, as the hon. Member for Winchester said, or with parents or legal guardians looking after children, we should consider whether reasonable adjustments also need to be made for the parent, guardian or carer who is likely to bring the patient to be seen.
Gregory Stafford
As I expressed in my intervention on the hon. Member for Winchester, I have a lot of sympathy for what he is trying to achieve with amendment 8. Whether by accident or design, he has allowed us to have a real think about—
Gregory Stafford
I will be charitable and take him at his word. We have opened a vital conversation about who will have access to this record, how it will be shared, which bits of it will be shared, and how we ensure that the laudable aim of a single patient record—to ensure that a clinician treating a patient has all the vital facts in front of them—is balanced with that patient’s privacy. As the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham said, we must make sure that the patient is put at the centre of this.
We need to look at the amendment under that microscope of scrutiny. We must use our role as legislators to ensure that gaps in legislation are closed so that loopholes cannot be exploited. I am fully in favour of the Government’s intention on that. However, I have some concerns about privacy and access, and amendment 8 potentially highlights those.
The amendment provides for a nominated carer to access a patient’s record, but who nominates the carer? Is it always the patient, and how will that consent be verified and continually checked so that if the patient wishes to remove consent for the carer to see their record for whatever reason, there is a way of doing so? What protections exist for vulnerable patients who may feel pressured or even coerced into granting access? If circumstances change, how easily can that access be withdrawn, by whom and through what process?
Although I am not being critical specifically of the amendment, the Government will need to think about those questions when they introduce the single patient record. It is not as simple as saying, “Here is a wonderful record and everyone can access it,” because it will contain some of the most sensitive information an individual holds, including details of their physical and mental health.
I entirely accept that carers often play a vital role in supporting patients, but unrestricted or poorly governed access could undermine patient confidentiality and therefore trust in the system. I am sympathetic to the concerns of the hon. Member for Winchester and think that, not just in relation to this amendment but as the record is pulled together, we really need to consider these vital issues.
On amendment 65, like the shadow Minister, I have a lot of sympathy with the point about reasonable adjustments. We need to be careful when deciding as legislators the purpose of the single patient record. Is it simply a repository of treatments, illnesses, conditions and so on, or does it give a wider commentary on those conditions and treatments? In the example given by the shadow Minister, knowing that someone has hearing difficulties would be useful, but is the single patient record the appropriate place for that? I do not know the answer, but we need to discuss and decide that, because there is a danger of scope creep. If we try to make it all things to all men and women, it could lose the stated purpose, which is to ensure that a clinician has the full facts when dealing with a patient.
Dr Johnson
I understand what my hon. Friend is saying; he is making a very good speech. I wonder whether he agrees that one of the challenges for us as legislators, in looking at all the amendments on the single patient record, and indeed at the single patient record itself, is that while the principle of a single patient record might be a good, it is all about the devil in the detail and the delivery. We do not have a delivery plan or a vision of more of the detail relating to how it will look, so it is difficult to make judgments on many of the clauses.
Gregory Stafford
As ever, my hon. Friend is entirely right. It would be helpful to have more clarity on what the single patient record will look like. I will not repeat my earlier questions, but I think they are prescient. I hope that the Minister—even if she cannot answer now, which I accept—has those in mind when she and her colleagues start to look at this.
Even if the Minister cannot provide detail, all I ask is that she provides reassurance that access to the single patient record will be based on explicit consent, limited to what is necessary for either the caring role—as in the amendment of the hon. Member for Winchester—or the clinical role overall, subject to some kind of regular review and supported by some robust audit mechanism. If we are to create a system on this scale, we must ensure that the safeguards are just as strong as the benefits.
Karin Smyth
I agree with the hon. Member for Farnham and Bordon that, through this amendment, the hon. Member for Winchester has given us an opportunity to think. I am grateful to him for this chance to talk about carers and this important issue. I am a carer of an older person, and for those of us who are carers, it is helpful to have some discussion about this area. Carers play a vital role and we are committed to ensuring that they have the support they need. We are of course very grateful for all the work that they do.
The Bill already includes a power that permits regulations to make patient information available to people other than patients on the patient’s behalf. As the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham, said, that can include carers, and it is our intention to do so. We want to ensure that carers who act on behalf of the people they care for get the full benefit from the single patient record.
NHS proxy access already allows for people other than patients—which includes carers, parents or care home staff—to manage the health and care of someone they care for. Setting up proxy access requires the consent and involvement of the individual and the person they care for. We will set out in regulations how proxy access will work for the single patient record, as in the existing NHS position.
The single patient record will be developed on two priority care pathways in maternity and frailty, which will initially be delivered through local arrangements. Some clinicians and patients will be able to view and manage additional elements of care, such as proxy access for carers, earlier than others. For those reasons, I ask the hon. Member for Winchester to withdraw his amendment.
We have had some helpful comments about some other concerns.
Dr Johnson
Will the Minister confirm whether the intention of the Government is to separate parts of the record out so that people can give consent for part of the record to be shared, but not the complete record, where they have reasons to want extra privacy?
Karin Smyth
The hon. Lady knows that we are talking about an enabling power in the Bill. All the details will be brought forward in regulations, through discussions and consultation. We will discuss that more broadly as we talk about the wider clause.
One of the key issues I have been asked about is protecting vulnerable people. Patients will access a single patient record through the NHS app, and NHS England has published guidance on clinical safety, safeguarding and the NHS app, which provides advice on minimising the risk to those where there may be challenges or potential risks. We will adopt a similar approach to the single patient record. Clinicians will be able to redact information that is too sensitive to share, and we will agree a protocol with professional bodies on how that will be applied. I am sure that we will discuss that in more detail, because it is an important area to get right.
Dr Chambers
I thank everyone for that very useful discussion. I was pleased to see everyone broadly in agreement that we need to work out how we can provide the necessary information to provide better care, and to balance that with privacy. Everyone made really insightful points on that.
I just emphasise that, as we all know, there is a difference between treatment/prescription and compliance, and compliance is where many medical treatments fall down. It is once the medical staff are not involved on a day-to-day basis, when the patient is not under their direct care or in the facility of the medical treatment, that most of the care takes place, and that is when successful or unsuccessful treatment for the medical condition occurs. If the people providing the daily care are not empowered properly, it is—well, not a complete waste of time, but the efforts of the medical staff are in vain if the compliance day to day is not accurate.
I thank everyone for the discussion. I will not press the amendment to a vote, and I beg to ask leave to withdraw it.
Amendment, by leave, withdrawn.
Ordered, That further consideration be now adjourned.—(Emma Foody.)
Health Bill (Eleventh sitting)
Thursday 2nd July 2026
(3 weeks, 4 days ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 1 July 2026 - (2 Jul 2026)
The Committee divided: - Ayes: 6 / Noes: 7 - Question accordingly negatived.
The Committee divided: - Ayes: 6 / Noes: 7 - Question accordingly negatived.
The Committee divided: - Ayes: 6 / Noes: 7 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 8 - Question accordingly negatived.
Dr Danny Chambers (Winchester) (LD)
I beg to move amendment 71, in clause 47, page 34, line 29, at end insert—
“(3A) The regulations must make provision for medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record.
(3B) The regulations must include a requirement for the Secretary of State to prepare and publish a report on the potential merits of introducing a statutory requirement for mandatory medical markers for firearms licence holders to be used by those relevant in providing patient care.”
This amendment would require medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record.
The Chair
With this it will be convenient to discuss amendment 72, in clause 47, page 34, line 29, at end insert—
“(3A) The regulations must make provision for prior membership in the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record.
(3B) The regulations must include a requirement for the Secretary of State to prepare and publish a report on the potential merits of making prior membership in the armed forces visible on the single patient record.
(3C) A report under subsection (3B) must consider—
(a) the ability of veterans to access the necessary NHS support, and
(b) the ability of medical staff to provide former members of the armed forces with appropriate care.”
This amendment would require prior membership in the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record and require the Secretary of State to publish a report on making prior membership in the armed forces visible on the single patient record.
Dr Chambers
The amendment was tabled in the name of my hon. Friend the Member for Epsom and Ewell (Helen Maguire), and would require medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record.
I will not read through all my speaking notes but, in a nutshell, a person rightly undergoes mental health checks before they acquire a firearms licence, but that will not be reviewed until they are due to renew their firearms licence a few years later. If their mental health status changed during that time, the amendment would enable them to be flagged to healthcare workers and GPs as a person who has a firearms licence, so that any necessary proactive measures could be taken to ensure that they are still safe to have that licence, or should have it removed, rather than waiting for them to apply for a new licence in a few years’ time.
The British Medical Association supports the amendment and the Royal College of General Practitioners thinks it would be valuable. A survey carried out by the Association of Police and Crime Commissioners found that 87% of existing certificate holders believe that GPs should inform the police if they become aware of health issues that could have an impact on the certificate holder’s ability to own a gun safely. Quite often, however, the GP is not aware that the person is in possession of a firearms licence.
Gregory Stafford (Farnham and Bordon) (Con)
In essence, we debated the amendment in a Westminster Hall debate some months ago, when I had the dubious honour of being the shadow spokesman for the Conservative party despite not being a Home Office shadow Minister. It became clear in that debate that mandatory medical markers do not exist. It is still a voluntary system. How does the hon. Gentleman propose to make the system equitable?
The hon. Gentleman and I support mandatory medical markers, and there seemed to be cross-party support for them in the Westminster Hall debate. If they are not mandatory, some people will potentially be put under a different system, because their sufficiency or ability to hold a shotgun licence could be taken away from them, while those who are not on the system, because it is not mandatory, would not lose theirs. How does the hon. Gentleman deal with the equity issue and the potential for some people to be missed?
Dr Chambers
The hon. Gentleman makes an interesting point. I suppose this is another chance to use the developing single patient record to ensure that we close the gap. The record could be formed in such a way, and the process put in place, to ensure equity in the system, with mandatory markers.
Amendment 72, also tabled by my hon. Friend the Member for Epsom and Ewell, would require prior membership of the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record. It would also require the Secretary of State to publish a report on making prior armed forces membership visible on the single patient record.
There are just over 1.85 million armed forces veterans in the UK, 13.6% of them women and 86.4% men. The transition from serving in the armed forces to civilian life can mean that many of those individuals struggle with mental health issues, such as post-traumatic stress disorder. The issues are often specific to the service the individuals have given. Some stats show that more than half of England’s Army veterans have some sort of health problem. I should point out that veterans do not only have mental health problems. Specific back and knee problems are much more common among infantry soldiers because of the type of training they have done over many years.
The amendment seeks to make prior armed forces membership visible to all relevant healthcare workers, and to make the Secretary of State consult on the merits of doing so, so that when a GP is treating a patient, they are aware of that person’s service history without having to ask about it specifically.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I have a couple of questions about amendment 71 for the hon. Member for Winchester. First, can he comment on why the amendment refers to firearms, which have stricter licensing conditions than shotguns? Also, the GP should be aware, because all relevant medical information should filter back to them, that the person has a firearms licence, which, as I say, has stricter criteria. It is essentially harder to get a firearms licence than a shotgun licence. I am interested to hear the hon. Gentleman’s thoughts on that.
On amendment 72, I have a large veteran population in my constituency, and I am very grateful to all those who have put their lives on the line to keep us safe, both today and in the past. I can see that there may be benefits to the amendment in respect of the delivery of the armed forces covenant and aspects of veterans’ care, but I am curious about how it is written. Proposed new subsection (3A) of proposed new section 250E of the National Health Service Act 2006 says that
“regulations must make provision for prior membership…to be visible to all relevant healthcare workers under the establishment of a single patient record”,
but proposed new subsection (3B) requires a report on the potential merits of doing that. It seems slightly counterintuitive to do it and then decide whether it is a good idea, rather than decide whether it is a good idea, consider the pros and cons, and then do it afterwards. I am interested to understand why the hon. Gentleman thinks the amendment is drafted in that way.
Gregory Stafford
It is a pleasure to serve under your chairmanship again, Ms Lewell. On amendment 71, I ought to declare that I am a supporter of the Countryside Alliance. Although I do not own a shotgun myself, I represent a large shooting community and I have been on a shoot relatively recently, but without a gun, so I did not shoot anything.
As I alluded to in my intervention on the hon. Member for Winchester, I spoke on this issue in Westminster Hall some months ago, when it was clear to me that there was a significant level of cross-party support for the idea of mandatory markers for GPs. As mandatory markers for firearms licensing are technically a Home Office issue rather than a Department of Health and Social Care one, the Under-Secretary of State for the Home Department, the hon. Member for Dover and Deal (Mike Tapp), responded to that debate, but he was unable to reassure us that provision would be made. I did not understand the arguments he made, because I think mandatory markers are probably the way forward. Given that they are supported by organisations such as the British Association for Shooting and Conservation and the Countryside Alliance—organisations that one might not have expected to be in favour of them—the Government should look into the idea.
There would clearly be a benefit to the proposal in amendment 71. If a patient who holds a firearms licence presents a serious medical risk because of a mental health crisis, suicidal ideation or behaviour that raises concerns about risks to themselves or others, an immediately visible marker would help clinicians to make informed decisions and take the appropriate safeguarding action. But a firearms licence is obviously not a medical condition, nor is it health information in any traditional sense. This goes back to the point I made in the debate on a previous amendment, about how broad the information that we keep on the single patient record will be. The inclusion of such a marker across the single patient record could lead to issues relating, as we talked about in previous debates, to who would want to see that information.
For example, there may be people out there who are not in favour of recreational shooting, and someone may hold a firearms license for recreational shooting. Of course, section 2 firearms licences, especially for shotguns, are often held by farmers and people involved in conservation, and for all sorts of other reasons, including the control of pest populations. But if someone has a licence for recreational use, there may be people who, for whatever reason, find that to be against their own beliefs and opinions. That might lead to a patient being subjected to a level of intrusion or bias, or perhaps not receiving the care they deserve, because someone has made an assumption about what they are like based on that information. We need to be careful about that.
Dr Johnson
Before my hon. Friend moves on, may I ask him about security? It might also be possible for someone who looked at the records to identify where guns are kept. That information is currently is more protected than that.
Gregory Stafford
I thank my hon. Friend for that helpful intervention; I had not appreciated that. If that is true, the security and safety of the individual who holds the firearms licence, and indeed of anybody else in the vicinity, is paramount, and we generally would not want people to know precisely where guns are held, because that could be a security risk. I think the hon. Member for Winchester has the best of intentions, but the consequences have not been fully thought through.
Gregory Stafford
I will, but first I want to be kind to the hon. Gentleman and say that, as with his previous amendment, he has opened up a conversation about the single patient record that we really need to have, to ensure that what is on it needs to be there for the treatment of patients. As legislators, we need to have a wide conversation to decide what it includes and how it is going to be used.
Dr Chambers
The hon. Gentleman makes some good points, especially given his experience as the Conservative spokesperson in the Westminster Hall debate on this subject, for which he did a lot of research. I do not think we need to worry about medical professionals seeing that someone has a firearms licence and potentially treating them differently because of assumptions they make about them. Medical professionals are trained to be dispassionate, and they try to show little bias. I would be very surprised if a doctor, seeing it flagged on a single patient record that someone was in possession of a firearms licence, changed their attitude towards or approach to the treatment of that individual. I think that particular point is probably not relevant.
Gregory Stafford
I admire the hon. Gentleman’s optimism. I am not belittling his point—I, too, hope that no one would be treated, both in the traditional sense and in the medical sense, based on their background or anything else, including their recreational hobbies. Unfortunately, we have seen cases in the NHS in which someone’s religious background has led to antisemitism and other unfortunate issues. Unfortunately, sometimes the system itself has a problem. The Health and Social Care Committee published a report relatively recently on black maternal health. We could see the difference and the fact that, unfortunately, black women experience a worse level of care, often because of assumptions made about their backgrounds. I agree with the hon. Gentleman that I hope everyone is treated dispassionately, but I am afraid it does not always happen. We need to make sure that we root out that kind of behaviour, but we also need to protect people from it.
Amendment 72 is another that was tabled with the best of intentions. The improved identification of veterans is an interesting idea, because I do not think many veterans actively identify themselves when they access healthcare. A visible marker could help to ensure that healthcare professionals are aware of a patient’s service history without relying on self-disclosure. There may be direct benefits to a veteran, because they may be eligible for dedicated NHS services—including mental health, rehabilitation and other veterans’ healthcare pathways—through the armed forces covenant. A marker could, then, assist clinicians in directing patients to appropriate support more quickly.
The Minister for Secondary Care (Karin Smyth)
Wherever possible, the single patient record will build on source records such as GP records. As such, it will include relevant patient information and, where appropriate, digital markers such as those suggested in the amendments. We have had some useful discussion as a result of the amendments, but such considerations are generally operational, and legislation is neither necessary nor practical.
On amendment 71, Members will know that the Government have been doing significant work in support of a digital medical marker for firearms. Medical information for firearms licensing provided by the applicant has been a mandatory requirement for every firearm and shotgun licence application since November 2021, as we have heard, when the new statutory guidance for chief officers of police on firearms licensing was introduced. When any individual applies for a firearms licence, the applicant’s doctor must provide details of any relevant medical conditions, such as depression, dementia, mental health conditions or drug or alcohol abuse.
A digital maker is placed on the GP patient record when a certificate is granted, and a GP can alert the police if a licence holder has a relevant medical condition. The digital marker automatically flags to the GP if a patient is suffering from a relevant medical condition and is a firearms certificate holder. It is true that the marker is not legally mandated, but it is supported by the British Medical Association and the Royal College of General Practitioners, and the former issues guidance to GPs about the firearms marker.
GPs already have professional duties to consider patient and public safety, and existing firearms licensing arrangements support GPs to share relevant concerns with the police where appropriate, while the responsibility for licensing decisions rests with the police. Data shows that, since its introduction in 2023, the marker is being used and that GPs are notifying police of medical issues that have arisen. There is nothing to suggest that the system is not effective.
Dr Johnson
Is it not also the case that anyone who is aware that an employee or relative has a licence and is concerned about their mental health can make such a report?
Karin Smyth
I am afraid I do not know the answer to the hon. Lady’s question, but if it is relevant, I will try to get back to her on it.
People applying for a licence must now indicate whether they have seen a medical practitioner other than their GP. The Government also intend to make a statutory instrument to require licence holders to inform the police if they consult a third-party medical practitioner who is not their GP.
The single patient record will build on and connect with information from GP source records where appropriate; no new provision is needed for that to happen. That process should be agreed as part of operational arrangements with the profession, in line with the current approach to markers in the GP record. If it is agreed that it would be beneficial for health and care professionals to have wider access to the firearms marker, the single patient record could facilitate that, but we do not intend to fill the Bill with detailed operational requirements such as that.
We do not believe that the SPR is the appropriate vehicle for having a debate about regulations requiring a report on the merits of a mandatory marker. As the hon. Member for Farnham and Bordon said, we should not expand the clearly defined scope of the single patient record—the scope is limited to direct care—to include a debate about what is stored more generally in NHS records. For those reasons, I ask the hon. Member for Winchester to withdraw amendment 71.
On amendment 72, as I have already outlined, the single patient record will build on and connect with existing source records, such as GP or hospital records, wherever possible. Where a person’s status as a military veteran is recorded, it will be possible to make that information available in the single patient record. Therefore, the provisions already ensure that the information is made available, where veterans opt to have that status recorded—that addresses some of the other issues raised by the hon. Member for Farnham and Bordon. There is no need to make any statutory requirement to ensure that staff have that information and consider any necessary adjustments or potential treatment options that may be relevant to ensure safe and effective care.
In addition, the clause contains powers to make regulations to allow people involved in the provision of an individual’s direct care, including that of any veteran after they have left the military, to access their single patient record. We want the single patient record to improve the accessibility and effectiveness of care for everyone. That includes making sure that military veterans can access necessary support and that staff can provide them with appropriate care. Furthermore, duties in the Armed Forces Act 2006 require the NHS and local authorities to have due regard to the armed forces covenant, which, of course, I fully support. For those reasons, I ask the hon. Member for Winchester not to press amendment 72.
Dr Chambers
I thank all hon. Members for their input, and the Minister for her insights. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Helen Morgan (North Shropshire) (LD)
I beg to move amendment 70, in clause 47, page 34, line 38, at end insert—
“(6A) Before making regulations under this section, the Secretary of State must prepare and publish a risk assessment on the potential for digital exclusion under the establishment of a single patient record.
(6B) In preparing a risk assessment under subsection (6A) the Secretary of State must consult all stakeholders the Secretary of State considers relevant, including patient representation groups.
(6C) In preparing a risk assessment under subsection (6A) the Secretary of State must have particular regard for—
(a) those without access to a suitable electronic device,
(b) those without access to suitable broadband connectivity,
(c) those with physical and/or mental disabilities,
(d) those belonging to groups considered socially excluded, and
(e) those considered lacking digital skills.
(6D) The Secretary of State must lay a copy of the risk assessment under subsection (6A) before both Houses of Parliament.”
This amendment would require the Secretary of State to prepare and publish a risk assessment on the potential for digital exclusion under the establishment of a single patient record.
The Chair
With this it will be convenient to discuss amendment 49, in clause 47, page 36, line 1, at end insert—
“(4A) Regulations may not be laid under this section unless the Secretary of State has published a plan for a public awareness campaign to be conducted before the system established under section 250E(1) is made available to patients (a ‘public awareness plan’).
(4B) The public awareness plan must include—
(a) a description of the information to be communicated to members of the public through the campaign, which must include information about—
(i) what the single patient record is and what patient information it will contain;
(ii) who will be able to access patient information through the system and for what purposes;
(iii) the rights of patients in relation to their patient information, including any right to object to or restrict access;
(iv) how patients will be able to view a record of access to their patient information; and
(v) how patients can raise concerns or make complaints;
(b) the steps to be taken to ensure that the campaign reaches groups who may face barriers to accessing information, including people with disabilities, and people with limited digital access or literacy;
(c) the proposed timetable for the campaign, including the date on which the campaign is to commence and the minimum period during which it will run before the system is made available to patients; and
(d) a description of how the effectiveness of the campaign will be evaluated.
(4C) The minimum period referred to in subsection (4B)(c) must be not less than three months before the date on which the system is first made available to patients under subsection (1)(a).
(4D) The Secretary of State must lay the public awareness plan before both Houses of Parliament.”
This amendment prevents the Secretary of State from making regulations to establish the single patient record unless a public awareness plan has first been published, laid before Parliament, and a minimum three-month public information campaign has been conducted before the system goes live.
Helen Morgan
Amendment 70, tabled by my hon. Friend the Member for Epsom and Ewell, would require the Secretary of State to prepare and publish a risk assessment on the potential for digital exclusion under the establishment of a single patient record. I declare an interest as the current chair of the all-party parliamentary group on digital communities.
I hope that we Liberal Democrats have been clear that overall, we are supportive of the single patient record; it is important that every patient can access their own health records. Under the SPR, however there is a risk that people belonging to already vulnerable groups will be digitally excluded from accessing their health information. Research commissioned by Ofcom suggests that 2.8 million people—5% of the UK population—do not have access to the internet at all. Although age is a predictor for a person not having access to the internet at home, especially if they are over 85, more than half of such people are younger than 75.
Amendment 70 would ensure that the Secretary of State assesses the potential for digital exclusion with relevant stakeholders, including patient groups, and that the assessment is laid before Parliament. It would also ensure that the Secretary of State takes into consideration the risk of exclusion for those lacking access to a suitable electronic device or suitable broadband connectivity, including people who have disabilities, who belong to socially excluded groups or who lack digital skills.
Dr Johnson
Amendment 70, as the hon. Member for North Shropshire said, would require the Secretary of State to publish a risk assessment on the potential for digital exclusion in the single patient record. That is important because, as our lives become more electronic and online, there are people who are getting left behind. That could be because they have a disability that prevents or makes it more difficult for them to access online facilities, because they do not have the resources, because they live an area of the country that is less well served by digital or broadband provision, or because they are elderly and have decided that they will not get involved in the digital world.
In fact, according to the Good Things Foundation, 7.9 million people in the UK lack basic digital skills and 1.6 million adults do not have a smartphone, tablet or laptop. Of those with no basic digital skills, 77% are over 65. People need more healthcare as they get older, yet those individuals have fewer digital skills, so this issue needs to be addressed. The NHS Alliance published a report on digital inclusion in March 2026, which found that rural and coastal areas typically have higher levels of digital exclusion than urban areas.
Lincolnshire ICB, which covers the area that I represent, estimates that 21.3% of Lincolnshire’s population live in the most digitally deprived areas. The ICB has a digital inclusion strategy for 2025 to 2028, which includes efforts to try to reduce digital exclusion; I am interested in the Minister’s thoughts on how she might expand that sort of initiative across the country.
The Government’s equality impact assessment for the single patient record recognises that digital exclusion is a significant challenge in several groups with particular protected characteristics and other characteristics. I am interested in learning more from the Minister about how she intends to mitigate that challenge. In many ways, digital availability is a good thing, and it makes things much easier for many people—I am not knocking it in any way—but we need to ensure that people do not get left behind.
I understand that NHS England is supporting public libraries to signpost users to the NHS website and help them navigate it. What will happen to that support as NHS England gets abolished? Does the Minister intend the Department of Health and Social Care to provide something similar?
Amendment 49, tabled in my name, is basically about public awareness. Although we get immersed in what we are doing here, the public are not necessarily following every word that is said in Committee or in this House—or even necessarily every word that appears in the press—so when the single patient record is launched, it is important that they are aware of it, and in particular, aware of their rights.
We have talked about whether a person might want to let a carer see the single patient record or whether they might want to let someone see part but not all of the record. If the record goes live before people are aware of their rights and abilities in relation to it, they might find that things are available to people, or can be viewed by people, who they would not have wished to see them, which could lead to a number of problems. The amendment would allow people to be more aware of the single patient record for a period of time before it is brought in to try to make sure that that sort of problem is mitigated, and I am interested to understand the Minister’s view on it.
Joe Robertson (Isle of Wight East) (Con)
It is a pleasure to serve with you in the Chair, Ms Lewell. I wish to speak on this aspect of the single patient record. Although I support the general intention and aim of the single patient record, I have some wider concerns about how it will be implemented. I will restrict my remarks to the issues related to this group of amendments, and particularly amendment 49 in the name of the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham.
Plainly, most people—I would probably include myself in this—are not immediately familiar with all the ins and outs of how their medical records are kept and used, and why should they be? However, they have some pretty clear views on what they expect, whether that is confidentiality or their records being used and stored in such a way that does not inadvertently act as a barrier to accessing healthcare in an efficient and timely way. That is why the Government have introduced these proposals, which I mainly support.
Gregory Stafford
As we move towards a single patient record, we have to ensure that technological progress does not come at the expense of those who are least digitally connected. As others have said, I am particularly concerned about older patients and many disabled people, who often rely most on NHS services but can face the greatest barriers when healthcare systems—and all systems—become increasingly digital. For some elderly patients in my Farnham and Bordon constituency, navigating online platforms is challenging, and others may not have regular access to the internet at all. Unfortunately, my constituency has one of the worst full-fibre broadband roll-outs in the country, and it has extraordinarily poor mobile phone reception in the central rural parts of the constituency, despite my best efforts with BT Openreach and others.
Disabled people may also face accessibility barriers that these systems do not always anticipate in their design. Modernisation should never mean creating a two-tier NHS—one for those who are digitally confident and another for those who are not. The people at risk of being left behind are often those with the most complex healthcare needs and the greatest reliance on the continuity of care. A proper assessment of digital exclusion is therefore not just a bureaucratic exercise, as some may describe it; it is an essential safeguard. We need to understand how the single patient record will affect elderly patients, disabled people, carers, those with learning disabilities and those who may struggle to engage with digital services.
Sojan Joseph (Ashford) (Lab)
My understanding is that the single patient record is just a single place where all of a patient’s medical records will be kept. It will not necessarily change the ways in which they access healthcare services, such as A&E, the GP or a dentist. Those ways of accessing healthcare will stay the same, whether we have a single patient record or not.
Gregory Stafford
For me, the key thing is that we must have equity of access to the single patient record. If somebody wishes to see their own medical record, they should be able to do so, whether they are digitally savvy or not. As far as I can tell, that is the intention behind the Liberal Democrat amendment.
However, the hon. Gentleman raises an interesting point. We are seeing this already, but the more we go down the digital route—because it is more efficient and straightforward, and takes out the unnecessary bureaucracy of having a human interaction to book an appointment or whatever—the more likely it is that this will become the portal for all interactions. I am not saying that that is the Government’s intention, but he raises a point, perhaps inadvertently, that we need to think about.
To conclude on amendment 70, before we proceed any further, the Government should be able to demonstrate that no patient will receive a worse service, face greater barriers to care or lose access to information simply because they are older, disabled or less digitally connected than others—that goes to the heart of fairness and equity of access in our NHS. I am absolutely certain that the Minister does not wish that to happen, but it would be interesting to hear how she will ensure that it does not happen.
Amendment 49, in the name of my hon. Friend the Member for Sleaford and North Hykeham, would prevent the Secretary of State from making regulations to establish the single patient record unless a public awareness plan had first been published and laid before Parliament, and a minimum three-month public information campaign had been conducted before the system went live. That seems eminently sensible, and I hope it is something that would be not just welcomed by Ministers, but on their agenda already.
Patients clearly have a right to know what information is being held, who will have access to it, how it will be used, what safeguards are in place and what rights they have in relation to their own data before the system goes live. A three-month campaign to give them that opportunity would be appropriate, because the things that I have outlined are not technical details that need to be buried in some Government website or hidden in the small print of a privacy notice; they are fundamental questions that deserve proper public engagement.
I am especially supportive of amendment 49 because of the impact on older people, disabled people and those who are less digitally engaged. I do not think that most of my constituents spend their time reading NHS policy documents online—my notes say “most”, but I think none of them do, unless they are involved in the health world themselves—and they should not wake up one morning to discover that a major change to the management of their health information has already been implemented without their knowledge.
A public information campaign is not a bureaucratic hurdle; it is a democratic necessity. If Ministers are confident that the single patient record will improve care, strengthen efficiency and protect privacy, they should be eager to make that case to the public and should therefore welcome the scrutiny, transparency and informed debate that a three-month public information would bring.
Edward Argar (Melton and Syston) (Con)
I want to speak primarily to amendment 49, in the name of my hon. Friend the Member for Sleaford and North Hykeham, the shadow Minister, and to agree with what my hon. Friend the Member for Farnham and Bordon has just said. Sadly, there will be a large number of people who do not follow the debates in this House or this Committee in great detail, however fascinating they may be. That is perfectly understandable.
The single patient record has genuine potential. It has the potential to put all the different bits of data in one place, so that when, for example, someone is blue-lighted to hospital, their consultant or the doctors treating them in A&E can access the information they need about their medical history and any medications they are on, which could improve clinical outcomes for patients.
I can entirely see the potential of the single patient record, but I am also conscious of the genuine concern among those of our constituents who are aware of this about what it might mean in practical terms for them and their data—it is important to remember that it is their data. They will have concerns, as my hon. Friend the Member for Farnham and Bordon set out, about who can access it, what safeguards are in place, whether they can opt out, and a range of other legitimate questions about how it will work.
I have to say that amendment 49, tabled by my hon. Friend the Member for Sleaford and North Hykeham, is not unreasonable. It would give the Government an opportunity to reassure our constituents and bring them along on this journey, rather than leaving questions unanswered or just addressing them in a Q&A on a Government webpage. People have genuine questions, and in many cases I am confident that the Minister will be able to allay those concerns or put them to rest, but some campaign of that sort is needed.
Such campaigns happen regularly on a range of subjects. The Department of Health and Social Care spends a significant amount of money on public health and awareness campaigns, and His Majesty’s Revenue and Customs spends a large amount of money on reminding everyone to get their tax returns in on time, in the lead up to that, or to remind them of the penalties if they do not. Government do that day in, day out across a range of services and where major changes are being made.
The Government have a genuine opportunity to accept amendment 49, which will help them to bring the people we serve on this journey, and potentially help to realise the benefits and allay people’s concerns. I genuinely hope that the Minister will be able to accept the amendment or will commit to take it away, look at it, engage with my hon. Friend the shadow Minister and possibly bring back a Government amendment that does exactly this on Report.
Dr Johnson
I am advised to declare that, although I am not a licence holder of a shotgun or a rifle, my husband has both a shotgun and a firearms licence.
Karin Smyth
I am grateful to hon. Members for this debate. Meaningful public engagement will be key to the success of the single patient record—we absolutely understand that—in building awareness and in designing the system. It has to have digital inclusion at its heart, but adding statutory requirements for public awareness campaigns and risk assessments is not the way forward. Amendment 49 seeks to put such a requirement on a statutory footing. I want to reassure the Committee and all Members: as the right hon. Member for Melton and Syston said, public awareness is absolutely key and will be integral to success. Work is already under way to ensure that we do that; we do not need to wait, nor should we be constrained by the proposed amendment.
In 2024, we began extensive public engagement on the use of data across health and social care, which showed strong support for the single patient record. We have heard that most people felt it was
“long overdue and a necessary step towards better care”.
The public engagement findings indicated support to progress at pace on the concept of a single patient record, to resolve the frustrations that patients and the public have when they have to repeat their story at multiple health and care settings.
As we move towards our ambition to give all patients in England access to a core set of their data through the single patient record from 2028, we will maintain a sustained drumbeat—as they say in the jargon—of public communications to raise awareness of the single patient record. We have heard some examples of where the Government do that well. Of course we want to learn from such examples across the country and from previous Government campaigns that have worked well, to explain the benefits and safeguards in plain English, and to signpost accessible information and feedback routes for patients and the public. I heard the comments made about people who may be excluded or have particular disabilities, including some older people—from conversations with my own constituents, it is often older people or those with multiple disabilities who can have their experience enhanced. We should make no assumptions about who does or does not feel excluded in this space; we need to learn from them all.
Furthermore, we have already published public-facing single patient record information and a dedicated feedback route. We will continue to co-create plain English, easy-read and translated materials, frequently asked questions and “voices heard/action taken” updates with public panels and patient groups ahead of roll-out. We will build on what we learn from that ongoing work as we develop the regulations. For those reasons, I respectfully ask the hon. Member for Sleaford and North Hykeham not to move amendment 49.
On the lead amendment, moved by the hon. Member for North Shropshire, we recognise, as I hope I have assured the Committee, that digital inclusion is an important issue. To quote another Member, we are eager to get it right, and we are taking it very seriously. Digital inclusion is a key driver in addressing health inequalities, supporting individuals and empowering people to better manage their health, which is at the heart of our 10-year plan. It is a system-wide issue, and one that the health and care system is taking action to address. We have considered this as part of the equality impact assessment of the single patient record provisions in the Bill, and will continue to keep those issues and potential mitigations under consideration throughout the development and implementation of the SPR. Therefore, although we agree with the aim of the amendment, we do not consider it necessary. Indeed, it would duplicate work that has already been done.
Helen Morgan
We have not seen a full design of the single patient record yet, but it is difficult to envisage what it would looks like for somebody who does not have access to the internet. It is not just older people; it is obviously a significant problem in deprived areas as well. Can the Minister elaborate on what that might look like for somebody who does not have a device or does not have broadband or mobile access? How will they be able to access their medical record? We might need to understand that before we move forward.
Karin Smyth
The hon. Lady makes an excellent point. Part the difficulty is that the powers in the Bill that enable the Government to bring forward a single patient record are separate from the secondary routes whereby we describe and work through the detail of regulation. All those considerations have to be very clear. The hon. Lady and I have spoken regularly about the lack of broadband access in her community, which remains a huge problem. All those considerations need to be worked through with the team. They are varied and multiple, and we need to bring parliamentarians and the public with us in doing that, as we bring forward secondary regulations.
NHS England’s digital inclusion framework, as currently, supports the delivery of the 10-year plan by addressing those particular connectivity and skills issues, as well as confidence and accessibility. That work is already partly in train through NHS England. We need to build on that and bring it forward as we come forward with the regulations. I visited the team up in Leeds around some of the digital inclusion they have already been doing from the app. It is very impressive how much they are doing with people to develop the app. I think people would agree that we can take some of that learning forward, because it is about making sure that digital transformation is inclusive and aligned with the ambition in the 10-year plan to personalise care, reduce inequalities and create a health system that works for everyone.
In addition, as set out in the “Managing health services for others” guidance, since February 2026 the NHS has had a process to allow proxy access to the app, which should also support people who, for example, do not have the skills to do it for themselves. Alongside those improvements, it is policy to undertake an inequality and health inequalities assessment prior to hosting anything new on the app. Again, that helps to identify, mitigate and monitor unintended negative impacts on vulnerable and marginalised populations before implementing new policy, services and procedures, as raised by the hon. Member for North Shropshire. That process should identify and consider the mitigations for the groups identified in the amendment.
I hope that Members can see how seriously the Government have taken the development of digital access so far. We absolutely recognise that we have to get it right to enable this record, which the public and population so desperately want to see. That work has already been undertaken and it will continue. For those reasons, I ask that the amendment be withdrawn.
Helen Morgan
The importance of the amendment is that it requires this problem to be monitored in an ongoing way. Monitoring something usually makes the situation improve, so I will not withdraw the amendment.
Question put, That the amendment be made.
Gregory Stafford
On a point of order, Ms Lewell. Are we not voting on amendment 49?
The Chair
We will vote on amendment 49 later if the hon. Member for Sleaford and North Hykeham wishes to.
Dr Johnson
I beg to move amendment 48, in clause 47, page 36, line 1, at end insert—
“(4A) Regulations may not be laid under this section unless the Secretary of State has published a plan setting out the measures to be taken to prevent clinicians and other persons involved in the provision of health care or social care from accessing patient information made available through the system otherwise than for the purposes of the care of the patient concerned (an ‘inappropriate access prevention plan’).
(4B) The inappropriate access prevention plan must include—
(a) a description of the technical controls to be applied to restrict access to patient information to those with a legitimate care relationship with the patient;
(b) the system of audit logging to be applied to record each instance of access to patient information, including the identity of the person accessing the information and the time and circumstances of access;
(c) the sanctions applicable to persons who access patient information without lawful authority or without a legitimate care relationship with the patient;
(d) the arrangements for detecting and investigating suspected cases of inappropriate access; and
(e) the role of the Care Quality Commission, the Information Commissioner and any other regulatory body in enforcing compliance with access controls.
(4C) The Secretary of State must lay the inappropriate access prevention plan before both Houses of Parliament.”
This amendment prevents the Secretary of State from making regulations to establish the single patient record unless a plan to prevent inappropriate access by clinicians and other care workers has first been published and laid before Parliament.
Amendment 48 would prevent the Secretary of State from
“making regulations to establish the single patient record unless a plan to prevent inappropriate access by clinicians and other care workers has first been published and laid before Parliament.”
This is about trust. It is about people being able to trust that the records that will now be more widely available will remain confidential and be looked at only by those who need to look at them.
We have seen that people can be uniquely nosey when it comes to accessing medical records. For example, 48 staff members at the University Hospitals of Liverpool Group were found to have looked at the records of those involved in the Southport attack without any medical basis to do so. Almost a dozen staff members were sacked from the Nottingham University Hospitals trust because they had looked at the records of the victims in Nottingham. It is important that we address this, because it is happening already and needs to be tackled.
Paul Arnold, the chief executive of the Information Commissioner’s Office, said that trust is being “jeopardised”. The amendment seeks to ensure that proper thought goes into making sure that people cannot access records they should not be able to look at—for example, those of the Prime Minister or members of the Royal family—before the single patient record is live and can be used. We have Public Department 1 for HMRC; is there an intention to have something similar to close off records to reduce their accessibility where the public may be particularly nosey, either because of the person’s job or because of an event such as a terrorist attack, where we have seen people look at records when they should not have? There were reports that staff at The London Clinic, a private clinic, had been trying to sell records of the Princess of Wales online, so there are examples where this has happened before.
In addition, it is important that people know what the penalties are for deliberately misusing these records. My final question for the Minister is this. If a record has been viewed and there is a data log of it having been viewed, how long will that data log last for? Will it last for six months or a year, or will I be able to look back in 10 years’ time and see who accessed my records today? It is a case of understanding the Minister’s intentions and pushing the Government to ensure that these records are truly private to those who need to see them, not accessible to anyone who just happens to be curious.
Sojan Joseph
I declare that I am a registered nurse. I have worked in the NHS for many years, and I have used patient records throughout my career. The Nursing and Midwifery Council code requires nurses, midwives and nursing associates to respect patient confidentiality, share information appropriately and ensure that patients are informed about how their information is used. That is the existing system, and every nurse, midwife and nursing associate has to follow the code of practice. A similar code is there for the General Medical Council for doctors, and all other registered professionals follow those codes.
On top of that, information governance in the NHS ensures that patient data is handled legally, securely and ethically, providing a framework for data protection and confidentiality. We have numerous different digital systems in the health system currently. Before anyone gets access to those digital systems and patient records, they all have to go through information governance and data protection training. They are then given access to patient records. That is the existing system.
The shadow Minister, the hon. Member for Sleaford and North Hykeham, has just mentioned the Nottingham incident, which is a good example. It is a clear example of where those who accessed the records were able to be identified. There is a clear audit trail, and I have my own experience of taking people through disciplinary proceedings for accessing patients’ notes when it was not relevant to those staff. The existing patient data systems do have provisions to safeguard and monitor who is accessing patient records.
Dr Johnson
I understand what the hon. Gentleman is saying, which is that there are processes in place already and that the fact that someone got sacked for looking at the records is a sign that the systems work to an extent. However, does the fact that they could look at them at all suggest that the systems are not working well enough? Because it is a computerised system, there are methods for identifying whether someone is likely to need to look at that record. By knowing the profession of the person looking at it, and the department they are in, the computer can help to limit the number of people who look at those records when they should not.
Sojan Joseph
I agree that we are never going to have 100% proof. There will always be people accessing records. What I am talking about is the existing system, which does have provisions. What we need to strengthen is the training and the audit trail. All staff who do the training are aware that they are not supposed to check patients’ records unless it is relevant to them. Those who access records inappropriately should be identified and action should be taken.
Just because we are moving to a single patient record system, it does not mean that everybody is going to access everything they want. People working in the healthcare system are given access based on their role. Not everybody is able to access everything. Systems are in place, and we need to strengthen those systems and the training. We should not be scaremongering by saying that, because we are moving to a single patient record, everybody will be able to see their records.
Edward Argar
The hon. Member for Ashford made his point very clearly about what happens when something goes wrong and someone behaves inappropriately—the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham, has highlighted some very concerning recent incidents—and was right to highlight the ability to follow an audit trail and take action. He is also right to highlight the importance of training.
However, taking action once inappropriate access is known, and then following the audit trail, deals essentially with the consequences rather than preventing it from happening in the first place. That is why amendment 48, and particularly proposed new section 250E(4B)(a) of the National Health Service Act 2006, is important. It describes the technical controls. That goes beyond the audit process and what happens after something has gone wrong. It is about what can be done to build safeguards into the system to make it much harder for anyone to circumvent their obligations, and to build those technical safeguards into the overall design of the single patient record. That is a reasonable ask, because such incidents, while hopefully rare, as the hon. Member for Ashford alluded to, do happen and understandably cause concern.
The challenge is that there is potentially a lot more information in one place, rather than being held in different pots, trusts or GP surgeries. For those inclined to break their legal obligations and behave outside the rules, the potential opportunity to access a wider range of information is more significant. The design of the record needs to have those technical safeguards strengthened and built in.
Dr Johnson
If we use the example of Southport, the people who could access those records worked in the Liverpool trust, because that is where the records were stored. With the single patient record, as planned, people would be able to access those records from across the country, if they had a clinical reason to do so. However, someone behaving badly could also potentially do so, even if they did not have a reason.
Edward Argar
That is the challenge. The Minister knows her brief very well—if I may say, I hope that whatever happens in a few weeks’ time, she retains it. She is that rare thing among Ministers in Government: someone who comes to their position with a hinterland of knowledge, experience and interest, which she has demonstrated through her period in office thus far. I hope that she retains her role, because continuity of Ministers in Government is a good thing.
Can the Minister reassure us on the shadow Minister’s point, which is one that I have been seeking to make? Can she reassure us that the system will include barriers to prevent whoever builds and operates it—whether a third party or someone internal—from having inappropriate access to the records? The data must be ringfenced and protected, so that it does not go out of the country and cannot be accessed by those who are technically running or providing the platform. Even within the social care system, there must be very clear and technical restrictions on who can access the records for legitimate purposes, as the hon. Member for Ashford has highlighted. I think that would just reassure people.
As I said in response to previous amendments, I think the potential of the single patient record to improve clinical outcomes in care is very significant, but we need to bring people with us. I suspect that if anyone can reassure us on those points, it is the Minister.
Gregory Stafford
As my right hon. Friend has just said, this is a unique system that will have unique benefits, but it will also have unique risks. Almost in answer to the point made by the hon. Member for Ashford, I do not think there is anything—[Interruption.]
The Chair
Order. As Members can hear, there is a fire alarm. Can everyone return to this room as soon as possible, when it is safe to do so?
Gregory Stafford
Before I was rudely interrupted by the fire alarm—I am not taking it as a hint, much to the Minister’s disappointment—I was saying that this is a unique system and that with the unique benefits come unique risks. I was trying to answer the points made by the hon. Member for Ashford.
As my hon. Friend the Member for Sleaford and North Hykeham and my right hon. Friend the Member for Melton and Syston have mentioned, we already know that despite the regulations, whether they are from professional regulators or the ICO, people will get round the system. One of the biggest concerns that patients will raise is not simply whether patient records will be accessed by nefarious people from outside, such as cyber-hackers, hostile states and so on, but whether they are secure from inappropriate access by people who have access to the system. As my hon. Friend the Member for Sleaford and North Hykeham pointed out, those people could be situated anywhere across the country. Patient records should be accessed only where there is a clear clinical, professional need. The public rightly expect robust safeguards, strong audit trails and meaningful consequences where the rules are breached. Amendment 48 raises that important issue. The Minister should explain how inappropriate access will be prevented, how misuse will be detected and what sanctions will apply when the standards are not met.
My hon. Friends have already mentioned a number of cases and I pick another one: the unfortunate case of the three-year-old boy who was hospitalised after being attacked by a crocodile at a zoo. Cambridge University Hospitals trust is currently investigating 40 members of staff who appear to have accessed that boy’s medical records inappropriately.
While we would always hope that that would not happen, unfortunately it clearly does. This single patient record means that someone will potentially be able to look at patients’ records regarding anything and from anywhere in the country. My hon. Friend the Member for Sleaford and North Hykeham slightly generously described some people as “nosey”. Along with those who have an actual ulterior motive, that presents a real challenge. I say to the hon. Member for Ashford that just because the current system is in place to protect patient records as they currently exist, that should not be a bar to making sure that we make the system even more robust given its potential risks.
It goes directly to proposed new section 250F(4B)(b) of the National Health Service Act 2006, which is the system of audit logging to be applied to each record, so that every time someone accesses a patient record or part of that patient record, the identity of the person obtaining that information should be recorded. I believe that the patient should be able to easily see, hopefully in real time, who has been accessing their record and at what time.
We on this side have mentioned a number of big events: that poor boy with the crocodile, terrorist attacks in Southport and so on. I suspect that those data breaches have been identified because they were big events. People have gone out to check that nobody has been inappropriately accessing those records. I worry that every patient record will potentially be available to every single person, and I doubt that there will be an ability to check every single person proactively rather than reactively. That means patients need access themselves to look at their record and see who has been accessing it. If the name of the person who has accessed the record, or the organisation they belong to is available, patients can say, “Well, there is Mr Smith, my child’s paediatrician, and that is fine. However, who is this guy from elsewhere in the country who has looked at the record?” They can then raise that. That is absolutely vital.
Dr Johnson
My hon. Friend is making a very important point. Does he also think that it is possible for the system to have some designs built into it that identify that someone from another area of the country, or from another department or different profession is unexpectedly looking at results? Perhaps AI could help with this.
Gregory Stafford
My hon. Friend is right. I will not sit here and propose a solution to this problem, but what her amendment does is ensure that the Government look at this and present a plan before both Houses of Parliament, before we get to a single patient record.
I have now touched on the nefarious and the nosey. I think there is also a case of inadvertent access. With this new system, despite what the professional regulators might think, and despite the best training from the Information Commissioner’s Office, there will be occasions in a new system where people do not understand the limits of what they are allowed to look at or the appropriateness of access. There could well be inadvertent access to these systems. Again, the Government need to have a plan and system in place to ensure that there is not inadvertent, non-nefarious access to patient records as well. That is why I am very supportive of amendment 48.
To make sure that this system is trusted by patients, we need to have the highest level of safeguarding possible, both from external attacks and from internal misuse. My hon. Friend’s amendment goes a long way to putting some of that trust in place.
Joe Robertson
Plainly, there is already scope for this to happen and sadly patient records are wrongly accessed, either inadvertently through mistake or deliberately in bad faith. However, from a technological and design point of view, the single patient record inevitably makes that easier and more likely, whether through mistakes or deliberate acts. That is just one of the many considerations and downsides of a single patient record that is otherwise beneficial.
It is incumbent on the Government to do what they can to mitigate against those inevitable structural problems that the record will produce, and amendment 48 is an entirely sensible way of achieving that. I am always slightly reluctant to use analogies from other sectors, because plainly there are differences, but in my former life as a family law solicitor, even within a small private law firm, there were structures in place to ensure that only people who needed to access data could do so, and much of it was arguably less sensitive than patient records.
That was the case in a small firm, and because we have a national system of healthcare in this country, which is a good one, the scale of fallout and harm that could arise from such mistakes or deliberate acts is so much greater. I urge the Government not to see the amendment as seeking to undermine their overall plans, but as a means of strengthening them.
Karin Smyth
This is another important discussion to have on the record to give patients and the public confidence as we introduce the vital single patient record. I start by stating that the security and privacy of people’s health data is paramount, and we will build the strongest safeguards possible into the record. Members from across the House have asked how those safeguards will be built into how the system is designed and operated, which is what we are doing.
It will operate on a roles-based access control model, similar to other NHS patient record systems where access to patient information is restricted to the authorised user only. The single patient record will go a step further by applying advanced cloud-based audit and oversight capabilities, enabling near real-time monitoring of system access and detection of unusual or inappropriate patterns. That will allow NHS security teams to track and detect access patterns, and to quickly intervene if specific records are accessed by staff who have no clinical relationship with the patient in question.
The single patient record will ensure that just because a clinician has permission to view a specific patient record, that does not mean they are authorised to do so without a clinical need. The security and access arrangements will be set out in the regulations themselves, which will be debated, rightly, in Parliament. Therefore, it is not necessary to set them out in a plan beforehand.
Furthermore, there are already existing enforcement arrangements that provide sanctions for inappropriate access to patient data, which will also include accessing the single patient record. I commend my hon. Friend the Member for Ashford for his extremely helpful intervention, in which he highlighted his own experience in this field. Some of the examples that we heard again today, including Southport, Nottingham, the recent case in Cambridge and others, are truly shocking to people. Clearly, that should never happen, but sadly it has. As my hon. Friend rightly outlined, there are provisions in place for training people on information governance and tracking when that happens.
Additionally, I want to be clear that the Computer Misuse Act 1990 makes it an offence to use a computer to access information in an unauthorised manner, such as a person accessing information without a legitimate reason. Inappropriate or unauthorised access to health records—often referred to as snooping—is a serious offence that can lead to severe penalties, including dismissal, criminal prosecution and financial penalties. Regulated healthcare professionals, such as doctors, nurses and pharmacies, can be reported to their respective professional bodies, which can result in them being struck off in serious cases.
The information commissioner also has powers to investigate and take action against infringements of data protection legislation, which can include monetary penalties, enforcement notices, undertakings, prosecutions and reprimands. Furthermore, patients have a right to access data that is held about them under the data protection legislation, and those rights will continue to apply to the single patient record. For those reasons, I ask the hon. Member for Sleaford and North Hykeham to withdraw her amendment.
Dr Johnson
We think this is an important issue, so we would like to divide the Committee.
Question put, That the amendment be made.
The Chair
With this it will be convenient to discuss the following:
New clause 7—Privacy by design in NHS Single Patient Record and Federated Data Platform architecture—
“(1) The Secretary of State must ensure that there is privacy by design as part of the delivery of the NHS Federated Data Platform architecture.
(2) For the purposes of subsection (1), privacy by design includes—
(a) patient data anonymisation outside its usage by clinicians and within the National Data Integration Tenant; and
(b) patient consent for the processing of personal information by NHS.”
New clause 8—NHS ownership of connection software—
“(1) The Secretary of State must ensure that there is NHS ownership of any data connector software architecture used as part of the delivery of the NHS Single Patient Record or Federated Data Platform.
(2) In this section, a data connector means an interface or connection between the NHS Federated Data Platform and any other health system.”
Karin Smyth
The single patient record is fundamental to the Government’s mission to create a modern, joined-up NHS that puts patients at the centre of their care. The way we currently manage health records is letting patients down. That must change. Patient information is fragmented, so care is fragmented.
Local shared care records have demonstrated what can be achieved. The OneLondon shared care record is used by more than 100,000 frontline staff, with estimated monthly savings of £4.6 million, and around 45,000 patients are reported to have benefited from the Greater Manchester care record in March 2026, with 15 minutes of treatment time saved per patient.
Successful as some local shared care records are, however, they do not provide a uniform, comprehensive single record across England. The single patient record will allow people to have access to a summary of their full health record and provide relevant health and care providers with access to the health and care information they need to provide effective joined-up care.
This is not a new problem and patients have not been silent about it. For more than a decade, patient groups and organisations across the country have been calling for exactly the kind of change that the single patient record will deliver. As far back as 2013, National Voices captured it simply and powerfully:
“I would like to tell my story once.”
The call has only got stronger. Our independently delivered public deliberations found strong support for the single patient record. It was described as a long-overdue fix to fragmented care, while the survey of 2,000 people found more than three quarters in favour of a single patient record. The Committee has heard directly from a range of stakeholders about the benefits a single patient record could have for patients and their care.
Clause 47 enables the Secretary of State to make regulations for the purpose of creating and operating the single patient record. The purpose of regulations made under this clause is to bring together patient information and make it available to patients and their relevant health and care providers such as GPs, hospital doctors, social care providers or others involved in their direct care. Only information concerned with direct care will form part of the system.
We have also included strong safeguards. The security and privacy of people’s health and social care data are paramount, and we will build the strongest of safeguards into the single patient record. It will be designed to protect personal data by default, with the highest standards of cyber-security and information governance ensuring that only the right people can access the right information, at the right time—and only for the right reasons. Permissions to access patient information will be restricted to authorised users only, with an audit trail of who has accessed a patient’s data. The Secretary of State must also consult appropriate persons before making regulations and must have regard to ensuring that adequate safeguards are in place to prevent misuses of data.
Dr Johnson
Clause 47 amends the existing legislation to facilitate the single patient record. We have heard about the many benefits that it may bring, for example for patients who find themselves telling the same story again and again and having to repeat themselves because caregivers cannot see the records that they need to see. That can be frustrating and sometimes very distressing for patients.
I caution the Minister against saying that the single patient record will completely fix that issue, because from a clinical perspective, particularly in certain presentations, hearing the story again from the individual can be helpful for a diagnosis, but the principle is a good one, and it will make things easier for clinicians, particularly if the patient is in an area away from home. Records may be kept in a particular geographical location or hospital, and if someone is away on holiday and they come in, we may not have access to their records. In paediatrics, we often give the parents of children with complex problems letters to carry that have the necessary information in them. That would not be necessary if the record were more accessible, so there are benefits to the single patient record.
There are, however, a lot of questions about it. One problem is that the single patient record has not really been designed yet, so we are being asked to approve something that is a hazy vision in the distance. On 1 June, the Minister said that
“although the Bill establishes the legal framework for the SPR, much of the detail will be in secondary legislation.”—[Official Report, 1 June 2026; Vol. 786, c. 957.]
I appreciate that it will be subject to the affirmative procedure, but we are being asked to make a decision now on something that is unfortunately very woolly.
Will the Minister reassure us that she will address the following questions in the secondary legislation? Who will have permission to edit the information in the single patient record? When will they have access to it? Will it tell us who has edited it—will there be a record of who, when and where? If the record is not accurate when it is edited, how will that be addressed? How will people know that it is inaccurate, and how will it be improved? In 2025, Healthwatch reported that 23% of adults who had seen their medical records reported inaccuracies or missing details, 12% said they had been refused treatment because of inaccurate information, and 10% said they had received inappropriate medication as a result. This is important. In recent years, there have been several incidents of patients dying after doctors used incorrect medical histories and prescribed medication that they should not have. This information needs to be available, but also accurate. I am interested in what the Minister has to say about that.
The other question is: what is going to happen to the records people have now? I am 48. I am sure the Minister is much younger than that, but we have records: our vaccination records, our childhood records, and records of any admissions or treatment we have had. Will those be added to the single patient record, or will the SPR start from day zero and go forwards? If it does, how will people access their historical records? If it goes backwards, what provision has been made to ensure that the data that is input is accurate, and for the cost and personnel required to do it?
Is the intention that the SPR will be one-size-fits-all? The Secretary of State talked about people not being asked to have a one-size-fits-all but being able to access the various systems around the country, but there are so many different systems. In my own practice, if I want to look at the notes of somebody I am caring for, I go to Evolve, where the notes are scanned in and I can look at the pages one at a time. If I want to look at blood results, I go to ICE, which is a different system where I can see the test results. If I want to look at the films of an X-ray, they are on a different computer system again. If I want to follow the patient’s pathway through the hospital, see when their next appointment is with me or see who is next in my clinic, I go on to e-Track. There is a different system for maternity, and there is Symphony in A&E.
Each hospital trust has a lot of different computer systems and information, and they do not all use the same systems, as I know having rotated through a number of hospitals during my training. How will the single patient record work with that? Will people be able to access all those different systems, and will they need to be trained to use them, or will there be a homogeneous system—and if so, what does the Minister envisage that looking like?
The Government say the single patient record will be more efficient, reduce the number of A&E attendances and hospital admissions, and make £20 million in annual savings to the NHS. Those are quite small margins compared with the scale of the project. Is the Minister satisfied that the savings will not be obliterated by the cost of the project running away?
The other thing is the public view of this. Polling published in January 2025 by the Tony Blair Institute found that 69% of people are willing for their anonymised data to be used to help plan NHS delivery, 71% are willing for it to be used for research into drugs and new treatments, and 75% are willing for it to be used for speeding up and making better diagnoses. There is an amendment—amendment 11—that make data available only for patient care, but patient audit and research can be quite important. Does the Minister have any comments on how audits and patient research might be used in a clinical context to improve care using anonymised or non-anonymised data?
Proposed new section 250E(3) of the National Health Service Act 2006 says:
“The regulations may provide that the processing of information in accordance with the regulations does not breach any obligation of confidence owed by the person processing the information.”
As one of my hon. Friends said earlier this afternoon, if the Government put a clause into a Bill, they normally have a reason for wanting to use it. Can the Minister expand on the circumstances in which they might want, in essence, to bypass patient confidentiality in pursuit of that provision?
In addition, the regulations may make information
“available to people involved in the provision to patients of health care or social care anywhere in the British Islands,”
which means it will not all be provided in England, and it will not necessarily all be provided within the United Kingdom. Will there be reciprocal arrangements with the self-governing territories? If not, how will the Government ensure that the data is properly protected once it has been shared?
I also want to mention cyber-security. On 30 June—just earlier this week—it was reported that the UK healthcare sector experienced a tenfold increase in attacks during January to May 2026 compared with the whole of 2025, recording 264,000 individual events compared with just 27,000 in 2025. In June 2026, Bedfordshire hospitals NHS foundation trust revealed that data relating to 33,000 hospital patients was stolen and shared online two years ago. Mid and South Essex NHS foundation trust reported the theft of 2,380 records in the same attack. The Secretary of State said earlier in June that
“the situation with the single patient record is…different from that of the federated data platform, because it is likely that we will let a series of contracts to de-risk the delivery of the single patient record.”—[Official Report, 1 June 2026; Vol. 786, c. 891.]
That suggests that the Government are aware of the problem but have not yet nailed down the detail of how to contract the delivery of the single patient record or worked out how they are going to keep data safe once they have. How can patients have confidence when their health data—their most personal data—is on the line and the Government have not yet made the key decisions for protecting it? Does the Minister have any comments on that?
What will happen to private providers? The Government are increasingly using private healthcare providers to try to improve the waiting lists, but will they have access to the single patient record? If they will, will they have to contribute to it financially or get it for free? How will the data be protected if it is not in NHS hands and not necessarily under the same regulation? What plans do the Government have to monetise the data? In December 2025, the then Under-Secretary of State for Health, Innovation and Safety, the hon. Member for Glasgow South West (Dr Ahmed), was reported in the Financial Times as having said that the UK should make money from patient data for the
“benefit of the Treasury coffers”.
Can the Minister expand on her Department’s plans to monetise patient data? Can she guarantee that personal data will not be exposed or leaked?
Can the Minister give assurances that the tendering process for contracts to set up and run the single patient record will be fair and transparent? It has been said that companies that donated to Labour before the general election were awarded contracts worth almost £138 million during this Government’s first year. It has also been reported that Peter Mandelson had links to Palantir, which secured a £240 million deal with the Ministry of Defence. It is important that people have confidence in the contracts. Does the first person to get a contract get locked in? Once the system is set up with one provider, will it be prohibitively difficult to change provider? Will the contracts become more and more expensive as time goes on because of the difficulties in redesigning a system? Who will own the intellectual property of the system that is designed? Will it be the Government or the private company? If it is the private company, how will that work going forwards?
The other question is: can we trust this Labour Government to deliver this? In 2005, the previous Labour Government launched a digitisation project called the NHS national programme for IT. In 2007, the Public Accounts Committee found that the Government had not sought to keep a detailed record of expenditure and there was no evidence that officials had carried out an examination to see whether the benefits exceeded the cost. The Father of the House, my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), described the project as
“one of the biggest IT disasters of all time”.
Costs ballooned to more than £9 billion, leading a member of the PAC to say in 2013 that it was one of the
“worst and most expensive contracting fiascos”
in the history of the public sector. How will the Minister convince the House and the public that the contract is being provided fairly, that it will be useful, that it will deliver what it said it would at the prices it said it would, that the data will be held securely once it is delivered, and that provisions will be in place to record access, decide who gets access and limit access?
Who gets access to sexual health records is particularly important. At the moment, sexual health records are kept separate. If someone attends a sexual health clinic specifically for sexual health screening, those records do not appear in their general medical record, in order not to disincentivise people from attending those sorts of appointments. If everything will be in one single patient care record, will sexual health records appear within that record? That is an important issue; indeed, it was raised during the Committee’s evidence sessions, when it seemed that the Government had not yet made a decision.
Dr Chambers
I will speak to clause 47 and to new clauses 7 and 8, which were tabled by my hon. Friend the Member for Newton Abbot (Martin Wrigley). The sector has been calling for a single patient record for decades, and it is the single most impactful part of the Bill. It could be transformational for patient experience, care, outcomes, consistency of treatment and reducing errors.
Members have talked about the hassle of people having to tell their story repeatedly or recollect the history, which many people cannot do accurately, so the clause could be hugely impactful. Polling shows that nine out of 10 Britons want better access to medical records. Many assume that a single patient record already exists and are often quite surprised when they go to another hospital and find that it has no record of what has been done in the county next door.
Although the public are rightly concerned about the use of their data, especially outside of direct care and for planning and research purposes, we wholly support the idea of a single patient record. The plan is for people to be able to see their primary, secondary and social care records all in one place, all in the NHS app. It will be transformational, but patients should be in control of their data. They should be able to see who is accessing their records and should be able to opt out of sharing data. It is essential that there is sufficient control and guarantees around the sharing of data, whether for research or other reasons. The Bill does not go far enough to provide reassurances that patients will ultimately be in charge of their own data and how it is used.
Trust among medical staff, patients and the public is essential for this much-needed system to succeed, and we have only to look at the pushback on the federated data platform to see that. Sufficient guardrails are necessary to make sure that secondary uses of health data are allowed only when they deliver a clear public benefit. Rules need to be future-proofed so that they are not vulnerable to change depending on the political or economic situation. There should be meaningful checks, balances and transparency.
We want to make sure this technology is focused on enabling and delivering healthcare. We know that, in the US, Palantir is providing health data to US Immigration and Customs Enforcement, which is then used to support deportations. We would be really concerned if people were too worried to come forward for medical treatment because they thought that their immigration status might be passed on to another Department.
There was a Westminster Hall debate recently on the concerns about Palantir and about the single patient record being abused. From an economic point of view, it seems a lost opportunity to have such a huge infrastructure project farmed out to foreign companies based abroad. First, this is a huge opportunity for companies in the UK to boost our economy, provide employment and drive innovation. Secondly, if we are reliant on foreign companies to deliver this service, we could lose our health sovereignty and their motivations might change depending on the political and economic situation of the country in which they are based.
There have been recent examples of NHS staff inappropriately accessing the private health records of the victims of the Southport and Nottingham terror attacks. The decision by the University Hospitals of Liverpool Group not to inform patients of the breaches understandably raised privacy concerns. The Government must therefore ensure that there are sufficient safeguards and guardrails, and that they are communicated clearly to the public to build trust.
The single patient record needs to happen, but in the right way. The issues with the FDP’s uptake have shown that patient and staff mistrust can significantly undermine a system’s effectiveness. The most important safeguards should not be left entirely to later implementation. They should be laid out in primary legislation at the beginning of the process. The Bill should be more explicit on who is responsible for decisions about access, sharing, liability and redress. That is why we have tabled various amendments, which we will get to later, most notably on our health data charter, setting out the key principles of how health data should be handled and a duty to prioritise domestic suppliers in technology procurement.
We welcome Opposition amendment 49, which we debated earlier—I believe it was echoed by the NHS Alliance—suggesting that a plan should be laid before Parliament for a minimum three-month public information campaign before the system goes live. The discussion on this needs to be constructive, not alarmist, to make sure that the SPR is rolled out in a safe fashion and so that we all get to feel the benefits.
Public involvement should be ongoing, visible and tied to real implementation decisions. Past NHS data reforms show that support depends on people feeling informed, heard and able to challenge decisions. Any red lines should also be clear. For example, there should be consented use for marketing or insurance purposes.
We also need to discuss the role of GP practices in this debate, given that they work within the NHS but are also private businesses. GP records are among the NHS’s richest data assets, and GP practices are to remain independent data controllers. I have spoken to three different practices in Winchester, and the practice managers are quite concerned that GPs will be required to share data much more routinely than they do now, but they will still carry the legal and professional risk and will likely act as the channel to explain to patients how their data will be used. GPs will need to be brought on side for the SPR to work, and that will depend on who decides, what safeguards apply and how burdens on practices are managed. Recent experiences show the sensitivity of the issue. The British Medical Association has stated that it may consider collective action on GP data sharing. The 2022 roll-out of automated prospective GP record access through the NHS app was paused after concerns about safeguarding and the burden on practices.
Will the Minister expand a little on the detail and on how all this will be implemented? What precautions will be taken to ensure that patient data is protected? Will she consider the Lib Dem proposal for a health data charter that sets out principles and responsibilities for handling NHS data?
Dave Robertson (Lichfield) (Lab)
As ever, it is a pleasure to see you in the Chair, Ms Lewell. I have listened very carefully to people’s speeches, and it is important to say that we are debating that clause 47 stand part of the Bill. The clause creates the single patient record and, while many Opposition Members have justifiably and understandably asked how we will do this right and what safeguards we will have, it is important that what we are debating is that the clause stand part of the Bill.
The clause creates the single patient record, and it creates the overarching ability for the NHS to use data better than it currently does. I am not a data scientist. I am a physicist by training, and I taught physics and worked in trade unions for a long time. Because of my training and my use of data, every group of people I have ever worked with invariably came up with nicknames for me, which usually boil down to “Data Dave”. There is something so valuable about being able to use aggregated values to tell us something that we do not already know.
One of the most valuable things we may get from this is that, when a clinician talks to a patient and they say or present something that does not match what is on the single patient record, it will raise a red flag that leads the clinician to realise something they would not have realised if they did not have access to notes previously taken elsewhere. I genuinely think that is one of the most valuable things that will come from this.
On a wider stage, the ability to aggregate data and properly track what is going on within the health service, and for people to be able to track what is going on with their care, with a wider view of what is going on, will be so valuable to clinicians and wider afield.
Dr Johnson
I am interested in what the hon. Gentleman is saying. Does he agree that, in many ways, the NHS dataset will be one of the most valuable datasets in the world, not only to patients themselves—in terms of the value to them and their privacy—but in the ability to analyse it and perhaps understand parts of medicine that we do not understand at the moment and so improve patient care?
Dave Robertson
I am not entirely certain that I want to agree with “one of” the most valuable datasets in the world; I think it could potentially be the most valuable dataset in the world.
We know that the NHS is the largest healthcare provider in the world. We know that the data is potentially very valuable. Creating this will allow our NHS to be at the forefront of managing how it works, in a way that no other health system will be able to, and certainly to a scale that no other health system anywhere in the world will be able to. That obviously comes with risks.
I have been listening carefully, and it is important that we tease out those risks and make sure that we stay as red hot as we can on all the issues that hon. Members have raised. I go back to the salient point of whether this clause should stand part. I fully support that this measure should be part of the Bill and that we should be moving in this direction.
I have spoken about the more global ideas and the reasons why, intellectually, I think this is a good idea, but let me take an example from my home county of Staffordshire up in the west midlands. There are reports that one hospital in Staffordshire uses 450 different electronic systems, which is absolutely bananas.
For so long, we have not had a single patient record. We have not had one unifying system. Over a cup of tea with the Minister a couple of days ago, I got very excited and started talking about primary keys because, although I am not a data scientist, I like the use of data. I do not think we need to get into a situation where there is a single primary key that is instantly recognisable to everybody and where we are necessarily using some machine learning to assess that. That could potentially come later down the line. That is not what the clause is doing, and it would need a much wider discussion than we are currently having.
If we take the example of Staffordshire and its 450 different data systems in one hospital—I do not know that number for certain, although it has been reported to me by two or three colleagues—I cannot imagine the difficulties that the IT team has in trying to get that number of systems to talk to each other. It will be nigh on impossible. All it leads to is delays. All it leads to is people having to reproduce data from one system to another manually. By creating an overarching single patient record, we will force it to happen.
Joe Robertson
The hon. Member has hit the nail on the head. A single patient record is not the same thing as mandating that 450 record-keeping systems become one. In fact, the single patient record will work as a theory on paper only if there is interoperability between different databases. That is a massive challenge that is not dealt with here. It cannot be dealt with here, in the real world, and the single patient record will not be realised until it is dealt with, which could take years. Does the hon. Member have a reflection on that point?
Dave Robertson
I appreciate the intervention, and it is nice for the hon. Member to get me back after I got him the other week. He is absolutely right. I do not think anybody in this room expects that after we have this discussion and the clause forms part of the Bill, and after the Bill goes through the parliamentary process and hopefully becomes an Act very soon, the next day there will instantly be this magical, ethereal thing called a single patient record and everything will drop into place immediately. I have a bridge to sell to anybody who thinks that.
What the clause does is put the NHS on a path to being able to deal with data appropriately, in a 21st-century way, by adding the ability and requirement for the NHS to use data appropriately. In terms of how that is done technically, I am very far from a computer programmer—I have done a tiny bit in parts of my life, and it always drives me absolutely wild—but there would be a number of architectures that could be used to make this work. I am not an expert and would not profess to be or to give anybody advice on that.
An advantage of the way the Bill is written is that things can be picked up by secondary legislation, which can go into a lot more technical detail. That is a real strength of how this is drafted. If we tried to mandate in primary legislation, in an Act of Parliament, far too granular a level of data science and information technology architecture, we would run a real risk of falling behind. Everybody is very aware of AI, and it is rare that I go a day without hearing people talk about it. Quantum is just behind it, and it is potentially much more disruptive and much more beneficial to huge parts of the economy, especially healthcare.
Trying to do everything through primary legislation is absolute folly. However, making sure we have primary legislation that allows us to drive the NHS into this space and to require and enable the NHS to stay on top of the proper use of data and to modernise its structures and practices can only be a good thing.
I close by saying that I absolutely support clause 47 standing part of the Bill. It has the potential to drive huge improvements in the NHS, both on a local scale and on a more global scale.
Joe Robertson
I will pick up where the hon. Member for Lichfield left off.
I make it clear that a single patient record is not a single electronic record-keeping system. Also, the single patient record is a theory, and it will remain a theory long after this legislation has been passed, as I am sure it will be, unless and until the electronic record-keeping databases and software in this country are able to speak to each other.
I have experience of working for a national nursing charity, and my role specifically dealt with the legal and governance issues of trying to embed community nurses in different settings. However, that work was beset by the problem of different databases—different electronic record-keeping systems—that did not speak to each other. Even those systems that were supposed to speak to each other did not do so. As the hon. Member for Lichfield said, sometimes there can be dozens, even hundreds, within even one NHS trust.
That should not be a problem today, but it is, and the Bill will get us no further on the technicalities and the technology problems we have. These systems are already meant to speak to each other, and we do not need legislation to realise that should be happening. Indeed, there are still paper record-keeping systems in many places up and down the country. The theory of a single patient record is a good one, but it will mean nothing in practice until those paper record-keeping systems have become electronic and then all the electronic systems speak to each other.
That makes me wonder whether a single patient record will ever be realised, regardless of legislation on the model that is supposed to exist. Indeed, the Bill does not mandate a single preferred electronic record-keeping system, and nor should it; there is a competitive market out there in which NHS trusts are free to engage and contract with different providers of electronic record-keeping.
I wrote to the local health bosses in my area after being made aware that the provider of one of their main electronic record-keeping systems had offered to extend the system further throughout the trust in order to save money. However, the trust has not yet responded. I am not in a position to say whether that offer is a better one, but on the face of it, it certainly looked like it would save money because it was a record-keeping system that the trust was already using; it just was not being used across all parts of the trust. That letter has gone unanswered for a year. It is not just a technological issue; there is also a cultural issue of the lack of nimble, joined-up decision making.
Some health bosses, not necessarily those in my area, are unable to take advantage of the financial benefits of changing or adapting to using new systems. Until that is resolved, a single patient record will remain ever wanted but never actually delivered.
To use an analogy, different companies provide the services on people’s mobile phones—the internet access, social media; software and even hardware. Most of us end up with a smartphone that does pretty similar things to every other smartphone and, broadly speaking, all the different apps co-operate with each other. Of course, the major global technology companies have faced legal action in the US, Europe, this country and elsewhere to ensure that their systems talk to each other, and primary legislation has been required to make them do that.
Dave Robertson
The phone analogy is really valuable. I am not an expert on the various architectures that make up phone operating systems, but I know a little about drivers and a little about computer programming languages. The hon. Gentleman is right that all the different bits of hardware in every single phone speak to themselves in a different language. Lots of them use different computer programming languages, and they all require drivers to translate that into whatever the operating system uses.
There are two or three major providers when it comes to mobile phones in the UK: Google and Android, and iOS. There is effectively a requirement on the phone companies that says, “If you want your app to be on our phones, it’s going to have to be able to use this language.” Depending on the operating system, the language will be slightly different, but the commercial requirement that apps must be able to use a certain language obliges the individual app producers and the individual pieces of hardware to have the driver to translate whatever language they use to talk to themselves into the one that works with the operating system.
Does the hon. Gentleman think there is a parallel in the Bill? Having a piece of legislation that requires a single patient record, whatever that looks like and whatever language it uses, potentially shortcuts some of the problems he is talking about with using a plethora of systems. Rather than having 450 systems, which could potentially use 450 languages, and trying to teach all of them all 450 languages, we create the requirement to use a specific language. We then teach all 450 one additional language and they will all be able to feed in—
The Chair
Order. This is a very long intervention. Will the hon. Gentleman please wrap it up?
Joe Robertson
That was a long intervention, but it was helpful. I disagree with the hon. Gentleman, because the legislation is not seeking to require technology companies or the providers of electronic record-keeping systems to be able to talk to each other. It is trying to create the concept of a single patient record, which is good, but it does not mandate a way to achieve that. I do not particularly want to name companies, but a big provider that is already in the health space and that provides electronic record-keeping systems might say, “We can already provide a single patient record. It is for other providers to adapt and feed into our record-keeping system,” and there is nothing in the Bill that says one technology company must adapt to another.
The technological issue is completely unaddressed. I am not even saying that it should be addressed in the Bill, because there are all sorts of issues around competition law and state support for particular companies. It is not a criticism per se of the way in which the Bill drafted, but this is an opportune moment to make the point that absolutely none of the clause will be delivered until a major issue that the Government have not yet addressed is dealt with. That issue is the interoperability of different electronic record-keeping systems provided by the private sector. They are all in competition with each other to get a bigger share of the market; unless and until that is addressed, the Government are not going to realise any of this. I do not want that to be the case. I want the single patient record to be realised, broadly speaking.
Sojan Joseph
I wish to speak in support of clause 47. I spoke on Second Reading about my strong support for the introduction of a single patient record. I am not a tech expert like my hon. Friend the Member for Lichfield—
Sojan Joseph
It really surprised me to hear my hon. Friend talk about his experience of 450 systems in the computer system in his local hospital. I was shocked, because as a clinician who previously worked in the NHS, I wanted a system that made patient records readily available so that we could care for patients.
My understanding is that the clause amends the National Health Service Act 2006 to enable the Secretary of State to make regulations to establish a system to make patient information readily available to patients and to those involved in providing health or social care in England. Under the current system, care and treatment across different parts of the NHS are not as co-ordinated as they could and should be. All too often, that means that patients have to repeat their medical history every time they see a different medical professional. The shadow Minister, the hon. Member for Sleaford and North Hykeham, talked about how that can sometimes be useful for getting the diagnosis right, but it can be very traumatising for someone to have to explain the same story again in such a short period of time.
Speaking in the Chamber, I previously gave the example of a mental health patient going to A&E on a Friday. They tell their story to the professionals there and they tell the same story later when a mental health professional comes to see them. When they are admitted into a mental health hospital, they have to explain the same story when going into the ward, and then again to the nurses. Having to repeat their story again and again is traumatising for most patients.
Dr Johnson
My point was that this can sometimes be beneficial. If a clinician sees a young lady who has collapsed at school, she might have fainted or had a fit. There are a lot of different potential causes, such as cardiac syncope, and lots of different potential diagnoses. A lot of the detail in making the diagnosis is in the history. The patient will probably already have been asked their story when they arrived at A&E, but it is still important for a senior clinician to ask for it again.
My caution was against presuming that we can, in all cases, prevent repeated asking of questions. There would clearly be a benefit when there are particularly sensitive pieces of information, about which we need not ask two, three or four times, but we cannot stop all cases in which a patient is asked for the same story.
Sojan Joseph
Absolutely; a single patient record will not stop professionals from asking the necessary questions of patients at any time. Each ward round, the doctors ask the patients how they are feeling. They will have that conversation; that will not stop. We are talking about repeatedly having to tell the story.
The point was highlighted when the Committee heard from Jacob Lant, the chief executive officer of National Voices, a coalition of health and social care charities. In his 15 years of patient and public engagement, the most consistent theme is patients’ frustration at constantly having to retell their story, and the fact that medical notes are not available across different healthcare settings. Not only is that frustrating for patients, but it can also be deeply distressing. Kath Abrahams, the chief executive of Tommy’s, told the Committee that
“Women report constantly having to retell their story—highly sensitive or traumatic experiences of loss—and that repetition can happen across the early pregnancy unit and maternity services.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 66, Q108.]
As medical professionals, we are taught the importance of empathy and understanding, but if the absence of a unified patient record system is aggravating traumatic experiences for patients, we need to address that. The absence of a national unified report can also compromise patient safety and lead to clinicians making decisions based on partial or incomplete information, significantly increasing the risk of error.
We heard evidence of that from the chair of Healthwatch England, who highlighted the risk posed to patients with multiple comorbidities. He said:
“Without a single patient record, we can find that a consultant or a GP has access to only one part of that multiple comorbidity…That can lead to all sorts of unforeseen errors.”
That can result in poor health outcomes, increased hospital admissions and reduced patient trust, which is why he went on to speak about
“the great advantage that we can get from a single patient record.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 49, Q79.]
Experienced mental health patients often move between A&E, GPs and mental health services and have to repeatedly go through that traumatic experience.
I have spoken in the House previously about my deep frustration that the digital records available to me in mental health services in Kent and Medway were incompatible with those used in other parts of the NHS, both locally and across the rest of England. I know that that frustration is shared, so in advance of the Committee’s consideration of clause 47 I spoke to some of my former colleagues, as well as other healthcare professionals in my constituency, to find out what systems are used to record patient information.
Joe Robertson
The hon. Gentleman is making the point that I have been trying to. He referred to a number of companies that each provide an electronic record-keeping system. The Bill does not mandate those companies to speak to each other and create a single patient record; there is no requirement on those private companies to do anything. As they are in competition with each other, their answer could be, “We can provide the single patient record—we are already doing it—if you just use more of our system and pay us more money.”
I am not suggesting that this is the hon. Gentleman’s responsibility, but does he have anything to say about the practicalities of a single patient record as a theory and the interoperability of electronic record keeping—a practical thing not dealt with in the Bill?
Sojan Joseph
My patient record is currently kept by different organisations or providers, which cannot see each other. If I speak to the GP about my blood sugar and then end up in A&E, they cannot see that record. If I go to the mental health service, they cannot see what medication I was taking. When I get discharged back to the GP, he will not get the information on my medication. That is the clinical aspect I am talking about, although I fully understand the hon. Gentleman’s concern. I hope the Minister will address some of those issues.
The responses I collected demonstrate how disparate and fragmented digital record systems are within just one local area. I do not think any of our constituents are aware that their data is kept in different places and that the services do not talk to each other. That is what the Bill is trying to address. All that information will be available for doctors, nurses and any other healthcare providers so that they can see patients’ history and medication and those patients will be more safe. Things will be more transparent. It will be easier for admission to discharge processes.
Dr Johnson
There is no detail in the Bill. As my hon. Friend the Member for Isle of Wight East said, there is nothing in the legislation requiring the computers in his local area to talk to the computers in my local area.
Sojan Joseph
I hope that would be the outcome of this legislation. I will give an example. My constituency is very close to Dover. Lots of travellers go through Ashford, my constituency. We often get patients from Scotland, Manchester or Liverpool, for whom doctors cannot start a treatment because they have to wait 24 hours to 48 hours to get the information from the hospital where the person comes from. I am not saying that the story is the same across the country, but that is what we are experiencing.
Dr Johnson
In the event that someone from Scotland comes into the hon. Gentleman’s hospital near Dover and a doctor wants to look at their healthcare record, does the hon. Gentleman envisage that the doctor will log on to their local system and see the records from Scotland, or that they will have access to the Scottish system to look at the records directly there?
Sojan Joseph
I do not know whether there will be the same system in Scotland, but my understanding is that in the north of England doctors will be able to see the same system. Again, we can hear more detail from the Minister.
A single patient report has the potential to transform patient experience and safety by ensuring continuity of care, by reducing unnecessary repetition, by enabling better informed clinical decisions and the smoother discharge of patients, and by creating a more efficient and joined up healthcare system.
Gregory Stafford
I thank all those who have spoken so far in this debate. I have never seen the hon. Member for Lichfield so animated—Data Dave is clearly alive and well.
As we have discussed, the clause creates the legal power for a single patient record in the UK. It is important to say, as others have, that the Bill does not create the system but gives the Secretary of State the power to create it later through regulation. That does not mean, however, that we should not have a debate about some of the issues that we have raised.
I should state at the start that I support better information sharing when that helps patients receive safer and better care, and I think that the single patient record could well do that. Anyone who has worked in healthcare, as I have, knows the frustration that results from the records not following patients between services. Clinicians can lose valuable time in searching for information, if they can get it at all. As others have said, patients are often asked to repeat the same details over and again—not, as my hon. Friend the Member for Isle of Wight East rightly said, because it gives a richer experience but simply because people do not have the information. Better joined up records have the potential to improve care.
We have, however, been here before. I was a lot younger—we all were—but back in 2002, the national programme for IT, under the last Labour Government, was a £10 billion unmitigated disaster, which the Public Accounts Committee described as
“one of the worst and most expensive contracting fiascos in the history of the public sector.”
I want to make sure that there are safeguards, from both a contracting and a data safety point of view, so that we do not go down that route again. As my hon. Friend the Member for Isle of Wight East clearly outlined, creating such a record is fiendishly complicated from both a technology and patient information point of view and from a data sharing and data protection point of view.
The record could contain some of the most sensitive information about people, so Parliament has the responsibility to make sure that the legal framework is right. We also know that the record will work only if the data in the single patient record is worth the electronic paper that it is electronically printed on. As I am sure the Minister knows from her time in the NHS, the information is getting better but continues to be patchy across the country. Different trusts and organisations record things in different ways. I take my hat off to those who work in clinical coding, as they do one of the most difficult jobs in a trust. Again, we need to make sure that the data is accurate. Someone mentioned AI earlier; I think AI could help with that, but we are still some way off.
I want to canter through my concerns about the breadth of the powers being given under the clause. The Bill allows the Secretary of State to make regulations establishing the system and to decide how it operates. Those regulations may require or authorise the sharing and processing of patient information, decide who can access the information and create enforcement powers and financial penalties. Some of those important questions are not answered in the Bill. Parliament is being asked to approve a broad framework before seeing some of the detail.
My second concern is that the Bill says little about patient choice. There is no clear statement about whether patients will have the right to opt in or out and no explanation of whether patients can restrict access to all or part of their records. There is no mention of whether someone could choose to limit access to particularly sensitive information, such as mental health records, sexual health information or information about substance dependence. There are major questions for public trust but those are left, I would say, entirely to future regulations. We need clarity about them now.
My third concern is the scope of the information that may be included. The definition of “patient information” is extraordinarily broad. It covers information about physical health, mental health, diagnosis, treatment and care, including social care. The definition of “patient” includes people receiving social care or having their care needs assessed. What we do not know from the Bill is exactly how that data will be presented. Will it use language that a patient can understand? Will it talk about having a heart attack, or will it use medical information that a medical professional will need to assess? Or will it include both, so that the patient knows that they have had a heart attack, for example, but the medic can see the precise detail on what sort of transient ischaemic attack it was. We need to understand what the data is recording and at what level of detail.
Dr Johnson
If it is to include both, who will translate it into the simplest form and how much will that cost?
Gregory Stafford
Precisely. These questions need to be thought about when the Government are creating this system.
As hon. Members have described in their speeches and in their amendments, the system could contain much wider information, including highly sensitive information about disability, safeguarding, care assessments, addiction, pregnancy, military service, caring responsibilities and many other personal matters. This is not simply about a hospital record; it is about bringing together health and social care information. That makes it even more important—indeed, essential—that safeguards be clear and robust.
That leads me on to my fourth issue, which is confidentiality. The Bill says that where information is processed under the regulations, doing so will not breach any duty of confidence. I think that that is a significant legal challenge and change. Confidentiality has been one of the foundations of healthcare. Of course there are already situations in which information can and should be shared, but where Parliament is creating a new legal basis for disclosure, it is reasonable to expect strong safeguards alongside it.
That brings me to my next concern. The Bill says that the Secretary of State must have regard to the need for “adequate safeguards”. That is welcome, of course, but the Bill does not say what those safeguards are. There is nothing in it about role-based access controls, audit logs or whether patients would be able to see who had looked at their records. There is nothing about minimum cyber-security standards, about how inappropriate access will be detected or about independent oversight. Those matters may appear later in regulations or in guidance, but they are not guaranteed in the Bill.
Liz Twist (Blaydon and Consett) (Lab)
I thank the hon. Member for his clear summary, at the start of his speech, about what we are discussing, which is the regulations. He and other Members have rightly pointed out many issues that need to be resolved, but does he agree that the proper way to work through this very detailed and very real concern is through the regulations, which will come with expert advice and ensure that we cover all these points properly?
Gregory Stafford
On the hon. Lady’s specific question, I agree: the regulations will answer these questions. But I think it is entirely appropriate to have them asked here and to have a statement of the principles, at least, on a number of these things from Ministers, so that within a broad scope we can ensure that the Bill is appropriate. The amendments tabled by my hon. Friend the Member for Sleaford and North Hykeham, for example, seek to do so. They were clearly within the scope of the Bill; otherwise, they would not have been accepted.
The next issue is geographical scope, which I do not think anyone has touched on yet. The Bill allows information to be made available to people involved in
“health care or social care anywhere in the British Islands”.
That naturally raises questions about governance across different health systems. How will information be shared between England and the devolved nations? I think my hon. Friend mentioned some of the self-governing territories. I assume that she meant the Isle of Man, the Channel Islands and places like that—Crown dependencies. What rules will apply? How will accountability work where different organisations operate under different arrangements? Again, the Bill does not answer those questions.
Helen Morgan
The cross-border point is really important. A number of people will come into England from Wales to have their secondary care delivered, because that care is not available in Wales. The single patient record will presumably not be available to the clinicians in the hospitals in England who are dealing with the patients. I wonder whether we should consider how that will work when we get to the regulation stage, because other systems will clearly be needed to deal with the people who are coming from outside England to be treated in English hospitals and other settings.
Gregory Stafford
I read the clause differently. I am sure that the Minister can provide an answer, but my reading is that the single patient record could be—but not necessarily that it must be—used in Wales and Scotland as well. I do not know whether it has to be used, but the clause, as I read it, suggests that it would be. If a patient is travelling from Oswestry to somewhere in Shropshire or vice versa—
Gregory Stafford
My geography A-level has clearly departed me. If a patient is travelling from somewhere in Wales to Shropshire, the single patient record would be used. That also presents challenges the other way, if Wales and Scotland are using different technological solutions and systems and operating under different legal frameworks. That is especially the case for Scotland: it has quite a different legal system from England and Wales, so there could be issues.
Dr Johnson
The clause says that information could be made available
“to people involved in the provision to patients of health care or social care anywhere in the British Islands”.
That implies that the English system will be used to share information with people outside England—in the Isle of Man, the Channel Islands, Scotland, Wales or Northern Ireland—but it does not imply that those areas will necessarily have the same systems to share information with us.
Gregory Stafford
That is an interesting question. I do not know the answer, but perhaps the Minister can pick that up.
The Bill also creates powers for financial penalties. It sets out a process for notices and opportunities to make representations and a right of appeal. Those procedural protections are sensible, but the Bill does not tell us who might be fined or what conduct would trigger a penalty, and it does not set out a maximum penalty level. Those decisions, again, are left to regulations.
It is also important to remember that the Bill does not replace existing data protection law, as I think the Minister outlined in her opening remarks. Organisations will still have to comply with the Data Protection Act and other UK data protection rules. However, the Bill would provide a new statutory basis for processing information through the single patient record. That makes the wording of the Bill especially important. Ultimately, public confidence will determine whether the system succeeds. People are generally willing for information to be shared when it improves their care, but they also expect transparency, security and accountability and expect to know who can see their information and why. Those expectations are entirely reasonable.
There are several questions that I believe the Committee should ask before these powers are granted. Will patients have a genuine choice about participation? Will they be able to restrict access to particularly sensitive parts of their records? Who exactly will be able to access the system? Will patients be able to see a record of who has viewed their information? What minimum standards will apply? How will misuse be identified and punished? What independent oversight will exist? Those are not technical details; they are central to public confidence.
In conclusion, the clause will create a legal framework rather than a system itself. It will give broad powers to establish the single patient record while leaving many of the most important questions to future regulations. Clearly most people support the goal of improving patient care, but because the system will involve some of the most personal information that people have, Parliament should ensure that patient rights, safeguards, transparency and accountability are clearly built into the framework from the beginning. It should ensure that questions are asked now rather than decided on later.
Karin Smyth
I turn first to new clause 7. Patient data is at the heart of the NHS, and it is important to help plan and run health and social care services; we have discussed that before, and a lot of these points have already been recorded in our earlier conversations. The security and privacy of people’s health and care data are paramount. To be clear, the Bill does not rewrite our data protection laws; it works alongside them, allowing the NHS to use existing, lawful frameworks to share information safely and legally for the direct care of patients. Article 25 of the UK general data protection regulation already applies to the federated data platform, and will apply to the single patient record. The new clause is therefore not necessary.
In the NHS, there are different ways in which patient information is used, and not all of them involve asking for explicit consent each time. For example, if a GP refers someone to a hospital, that person would not expect the clinician reviewing the case to ask their permission before looking at their medical record; their agreement is understood as part of seeking care. That is called implied consent. Although a national data opt-out exists, it applies only to data used for secondary purposes such as research and planning.
The single patient record is expected to operate roles-based access control, whereby permission to access patient information is restricted to authorised users only, with an audit trail of who has accessed the patient’s data. Inappropriate or unauthorised access to health records, often referred to as snooping, is a serious offence. There are mechanisms to manage that, including prosecution and fines.
In 2025-26, we invested £75 million across health and social care, building on the £375 million invested since 2017. Through our ambitious cyber improvement programme, we are tackling the changing cyber risk head on, expanding protection and services to better protect the health and care system. The single patient record system is expected to be assessed as critical national infrastructure, with the highest standards of cyber-security and information governance to meet our existing duties to keep personal data safe under the data protection legislative framework.
I turn to new clause 8. No decision has been made about who will be the IT suppliers of the single patient record. It is expected and intended that it will be delivered through contracts with multiple suppliers, which will reduce dependency on a single supplier. Furthermore, no decision has been made as to how, if at all, the single patient record will link to existing infrastructure such as the federated data platform. As hon. Members will expect, I would not support using the Bill to try to rewrite the contract for the federated data platform.
Hon. Members have discussed a wide range of issues relating to this area. They probably know that negotiating the intellectual property in relation to software in digital services is complex and often contentious. The new clause would make it a condition of any single patient record IT supplier contract that the NHS owns the intellectual property in data connector software, regardless of the circumstances. In practical terms, that would be likely to disincentivise suppliers from offering their services if they were required to sacrifice the IP of a product. It is unnecessary to impose such a condition, as there are other ways in which the NHS can ensure that software is reusable, such as broad general licences to use the data connector software in whatever manner, requirements to use industry standard code and interfaces, and information standards.
The recent changes to the NHS information standards in the Data (Use and Access) Act 2025 make relevant IT suppliers accountable for meeting information standards and enable the Government to monitor and enforce compliance with information standards by IT suppliers. We wish to see a vibrant UK market in digital and technology, while ensuring that patients get the best technology to improve care outcomes and to keep the NHS financially sustainable. That will give the NHS more choice and help to improve standards while supporting economic growth.
We have had what they call a wide-ranging discussion on some things that are not actually in the clause. I agree with the hon. Member for Farnham and Bordon that it is absolutely right, and we have heard some excellent examples from Members with clinical experience. My hon. Friend the Member for Lichfield will now be forever known as Data Dave—sorry about that. The hon. Member for Sleaford and North Hykeham has clinical experience and my hon. Friend the Member for Ashford has NHS experience, as do I. That experience is really valuable. The Liberal Democrats tabled amendments and had a long list of questions, most of which are addressed in various pieces of information that we have put forward. However, I take the point about the intellectual difficulties of what the clause does. We all agree with it, as does the country, and patients think it already happens.
We are an outlier in this sphere. The Government are going to change that situation. However, these questions and concerns are the reason why we take through secondary legislation, which is something that we all understand but the outside world does not. We need to bring people with us. Our officials have come to talk to Members of Parliament about the Bill. I am open to suggestions from Members about the best way to address the issues, and particularly about the best way to inform Members on behalf of constituents. These discussions are important to building public trust and security.
I will finish on a broader point. I commend clause 47, which gives an enabling power, but let us be very clear that patient information will still be held in the system in which it was originally created. These bodies, whether GPs or hospitals, will continue to be responsible for ensuring that the data is handled securely and lawfully and is accessed for valid reasons only. As I mentioned earlier, we have shared systems operating already. Some parts of the country and some of our constituents are already experiencing some of the benefits of a shared system. We will use that experience and learn the lessons of the past, under whichever Government, to build for the rest of the country the shared systems that some people have already. We will come on later to provisions on devolution arrangements, on working for the future and on operating more efficiently across devolved areas.
Joe Robertson
I thank the Minister for clarifying that the data will continue to be stored and held in the databases in the electronic record-keeping system where it is currently kept. I am not looking for her to give me a detailed solution on the spot, but does she accept that unless there is seamless interoperability across all those systems the single patient record will not be realised, and that we are still an awfully long way from seamless interoperability across England, let alone the UK?
Karin Smyth
The hon. Gentleman tempts me to spend the next hour talking about the shocking state of the capital and infrastructure systems that we inherited from the previous Government, but I will not. Of course they do not work: that is one of the biggest issues around staff morale. We saw through the 10-year health plan, particularly with clinicians having to log on to nearly 10 different systems, how that impedes progress and efficiency at a local level. Where it is rolled out, the federated data platform helps to make systems more efficient, particularly in local hospitals. We heard in our evidence sessions about maternity and frailty, which are the areas in which we will be testing and rolling out this approach to make the best use of it on the ground. Alongside that, the work to make systems more interoperable and efficient at a local level continues. I commend clause 47 to the Committee.
Question put and agreed to.
Clause 47 accordingly ordered to stand part of the Bill.
Clause 48
Information about health service products
Question proposed, That the clause stand part of the Bill.
Karin Smyth
Clause 48 will make amendments to the health service products legislative information gateway to allow the Government to continue to disclose certain information concerning the pricing and supply of health service products, which are items that include medicines that are used in the NHS. We recognise the importance of the effective flow of information between central Government about the pricing and supply of health service products to the NHS. Data sharing is governed by a clear legal framework defining who can access it and under what conditions. That supports the controls that the Government are able to exercise in relation to the pricing and supply of health service products.
Clause 48 will maintain the current safeguards for confidential and commercially sensitive data, ensuring continuity as NHS England’s functions are redistributed to the Secretary of State and integrated care boards. It will achieve that by enabling the Secretary of State to share pricing and supply information with people who provide services to them, such as primary care providers. That is essential to preserve the sharing of information and operation of the service that they provide for patients where that process is currently managed by NHS England.
As a consequence of the changes being made, the Secretary of State will be able to share relevant information with third-party service providers, such as providers of the software that primary care service providers use. They will be able to receive relevant data to make lawful disclosures of that information for specific purposes, those being the provision of certain services to the primary care service provider. This will ensure that there is no disruption to how data flows across the system.
This change will simply enable those who receive essential data to continue to do so following the abolition of NHS England. I commend the clause to the Committee.
Question put and agreed to.
Clause 48 accordingly ordered to stand part of the Bill.
Clause 49
Health and social care information: delegation of functions
The Chair
With this it will be convenient to discuss the following:
Clause 50 stand part.
Amendment 6, in schedule 7, page 96, leave out lines 38 and 39 and insert—
“For section 255 (power to request NHS England to establish information systems), substitute—
‘255 Powers to request the Secretary of State to establish information systems
(1) Any person (including a devolved authority) may request the Secretary of State to establish and operate a system for the collection or analysis of information of a description specified in the request.
(2) A request may be made under subsection (1) by a person only if the person considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the person to have in relation to the person's exercise of functions, or carrying out of activities, in connection with the provision of health care or adult social care.
(3) The Secretary of State must comply with a mandatory request unless the Secretary of State considers that the request relates to information of a description prescribed in regulations.
(4) For the purposes of this Chapter a request under subsection (1) is a mandatory request if—
(a) it is made by a principal body, and
(b) the body considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the body to have in relation to its discharge of a duty in connection with the provision of health services or of adult social care in England.
(5) Subsection (6) applies where the Secretary of State has discretion under this section as to whether to comply with—
(a) a mandatory request, or
(b) any other request under subsection (1).
(6) In deciding whether to comply with the request, the Secretary of State —
(a) must, in particular, consider whether doing so would interfere to an unreasonable extent with the exercise by the Secretary of State of any of its functions, and
(b) may take into account the extent to which the principal body or other person making the request has had regard to—
(i) the code of practice prepared and published by the Secretary of State under section 263, and
(ii) advice or guidance given by the Secretary of State under section 265.
(7) In this section “principal body” means—
(a) the Care Quality Commission,
(b) the National Institute for Health and Care Excellence, and
(c) such other persons as may be prescribed in regulations.
(8) In this Chapter “health care” includes all forms of health care whether relating to physical or mental health and also includes procedures that are similar to forms of medical or surgical care but are not provided in connection with a medical condition.’”
This amendment would enable the Care Quality Commission and NICE to continue to make mandatory requests to the Secretary of State to establish an information system, following the transfer of NHS England’s functions.
Amendment 7, in schedule 7, page 100, leave out paragraph 14.
This amendment is consequential on Amendment 6.
Schedule 7.
Karin Smyth
Clauses 49 and 50 explain our approach to the transfer of NHS England’s existing data and information functions to the Secretary of State. Slightly counterintuitively, I will start with clause 50 before turning to clause 49.
Clause 50 inserts schedule 7, which takes existing NHS England information functions and transfers them to the Secretary of State for Health and Social Care, as part of a single centre for data and digital policy in the NHS. The schedule also includes changes to existing information functions. This will support the shift from analogue to digital and allow us to make the most of opportunities from data and AI, as set out in the 10-year health plan. The changes will not weaken the fundamental safeguards in place to protect health and care data, nor fundamentally change rules relating to how confidential patient information can be used.
I will now outline some key changes made by the clause. It will ensure that information systems for the NHS are set up, where appropriate, not just for the collection and analysis of data but for processing more generally. This will make it easier to support machine learning and artificial intelligence activities, among other uses of data.
The clause extends the extent of chapter 2 of part 9 of the Health and Social Care Act 2012 to the whole of the UK, and provides for the Secretary of State to establish information systems in the interests of the health service or adult social care in England, or in connection with the provision of care across the British Isles, as NHS England currently can.
The clause enables the Secretary of State to issue guidance to health and social care bodies on the processing of information. It transfers to the Secretary of State NHS England’s powers to require and request information, and such requests will be able specify the form, manner and time within which the information requested is to be provided.
The clause also allows the Secretary of State to publish information obtained in the operation of an information system, including information about service providers. Where NHS England had a duty to publish such information, it is right that the Secretary of State should retain discretion in that regard. Obviously, there may be circumstances in which the publication of data would not be appropriate, and the clause does not give the Secretary of State complete freedom to publish personal information. The Secretary of State may publish personal information without patient consent only where it is for the protection of life or health, or for the protection of public safety or security. It is possible that there could be circumstances—for example, in relation to infectious disease—in which information is published that could lead to an individual being identified. None the less, the change simplifies the process of publication while maintaining a high bar for the publication of personal information.
The Secretary of State’s power to disclose information—for example, to health bodies—other than by publication will be slightly different from NHS England’s current power. The grounds for disclosing personal information will largely mirror the current grounds, with a few additions, including in respect of facilitating clinical trials or other research. This will help to address barriers to data access for research while preserving existing rules on confidentiality. As with his powers of publication, the Secretary of State will also be able to disclose information for the protection of life or health, or for the protection of public safety or security.
The Secretary of State will be bound by certain existing duties on NHS England, including a duty to have regard to any relevant advice from the Confidentiality Advisory Group when publishing or disclosing information in accordance with his data functions. The Secretary of State will retain the regulation-making power to establish an accreditation scheme for information service providers, which will now include a broader range of providers, including public bodies.
Clause 49 permits the Secretary of State to delegate certain functions relating to health and care information. Currently, some of those functions can be delegated by NHSE via arrangements with third parties or under regulations. The clause will insert new section 251ZF, which allows the Secretary of State, by arrangement, to delegate to persons specified in regulations functions relating to information standards.
Information standards help to reduce fragmentation in digital and data services. They include mandatory requirements for how information is recorded, shared, governed and supported by IT. Increasing interoperability and consistency in digital and data is essential to increasing value for money, reducing the burden on staff and, ultimately, improving the quality of care. The continued use of information standards is key to the 10-year health plan’s aim of improving the interoperability of digital and data services across the health and care system. This will provide the Secretary of State with the flexibility to delegate such functions to persons who have the required technical expertise, where necessary.
Clause 49 will also insert new section 277G, which enables the Secretary of State to direct public bodies to exercise a wider range of his information functions, defined as “relevant information functions”. This includes not only information standards but other information functions, such as the Secretary of State’s duty to establish and operate information systems. The measures will provide the Secretary of State with important flexibility to delegate such functions to persons who have the required technical expertise, where necessary.
In all, the changes are necessary not just to effect the transfer of data functions to the Secretary of State but to enable better data use for the benefit of the NHS now and into the future.
Dr Johnson
I have a couple of questions. In lots of ways the provisions derive from clause 1 and the abolition of NHS England. Schedule 7 refers to operating a system in the interests of the health service, which is not the same as operating it in the interests of the patients. Does the Minister have any comments on that? The Nuffield Trust has pointed out that schedule 7 would not pass over to the Secretary of State NHSE’s duty to report to Parliament. Is that because the Minister thinks that duty is duplicated elsewhere and is therefore not necessary?
Under the previous legislation, the Care Quality Commission was slightly stronger and could make a mandatory request that NHS England establish a system, and NHS England had to comply with that unless it related to an existing exception. Now if the CQC makes a request, it goes to the Secretary of State, and whether it is agreed to is then somewhat more optional. Will the Minister say why she needs to change that power?
Helen Morgan
I want to speak to amendment 6, which is tabled in my name, and amendment 7, which is consequential upon it. Amendment 6 would ensure that the CQC and NICE can
“continue to make mandatory requests to the Secretary of State to establish an information system”,
as they currently can with NHS England. At the moment, NHS England has a duty to co-operate with the CQC and NICE, and that is often enough for a collaborative approach that allows the CQC to access the data it needs.
But the duty that applies to NHS England is not being passed on to the Department of Health and Social Care. The CQC raised the issue in written evidence to the Committee, saying that the duty
“has been an important mechanism”
that has
“supported receipt of patient safety incident reports…information sharing between regional teams, and the development of central data sharing solutions.”
The CQC went on:
“Without an equivalent duty, we would be reliant on there being sufficient capacity and willingness within DHSC to share information, with no statutory backstop. This could inhibit our ability to receive the information”
needed
“to keep people who use services safe. Challenges in this area are often cultural and rely on the subjective judgment of individual data controllers as to whether particular data sets can be shared, how these should be used and what the timeliness of sharing should be, leading to protracted piecemeal conversations and delays.”
As we have harrowingly heard over the past week, there is often reluctance to share data, particularly when there is a defensive culture in certain NHS institutions. Our amendment seeks to address the gap. I hope that what I have outlined is an oversight from the Government, not a deliberate attempt to reduce transparency or reduce regulator access to key data. The wider changes in schedule 11 will omit section 288 of the Health and Social Care Act 2012. The Government are dropping this key wider duty in a schedule entitled “Minor and consequential amendments”. We do not think it is minor. It holds major implications for patient safety and transparency.
On a wider note, it seems counterintuitive that the CQC, as regulator, does not have easy access to the data collected nationally in the health service.
Karin Smyth
Let me respond to the hon. Member for North Shropshire on amendments 6 and 7. As she said, amendment 7 is consequential on amendment 6, so I will take them together.
I think we can all agree that the CQC and NICE should have access to the information they need to undertake their important work. Amendment 6 is not required to ensure that. Clause 50, and the associated changes in schedule 7, maintain the current ability for any person, including NICE and the CQC, to request the establishment and operation of an information system. However, NICE and the CQC will not be able to make the equivalent mandatory request they used to be able to make to NHS England because NHS England is to be abolished.
Amendment 6 seeks to maintain the current position when, in reality, mandatory requests were practically never made under the current arrangements. They were thought necessary when a separate arm’s length body had responsibility for collecting data about healthcare. There is no need for the Secretary of State to be subject to the same mandatory requirement as they are responsible for oversight of the entirety of the NHS and the adult social care system, and for its effective regulation.
Furthermore, the CQC has a statutory power, under section 64 of the Health and Social Care Act 2008, to require the provision of
“documents, records (including personal and medical records) or other items”
the CQC considers “necessary or expedient” for the purposes of its regulatory functions, from a range of health and social care commissioners and providers.
On amendment 7, the Government agree that a code of practice setting out strict standards for how health and care organisations must handle confidential patient information is an important component of a healthcare system that uses data safely and effectively. That is why clause 50 allows for the insertion of new section 252ZA into the National Health Service Act 2006, to transfer to the Secretary of State the duty to publish a code of practice on confidential patient information. For those reasons, I ask the hon. Member for North Shropshire not to press amendments 6 and 7 to a vote.
The hon. Member for Sleaford and North Hykeham asked about duplication. I think the answer to her question is yes, but if that is not correct, I will make sure that I respond to her accordingly.
Question put and agreed to.
Clause 49 accordingly ordered to stand part of the Bill.
Clause 50 ordered to stand part of the Bill.
Schedule 7
Health and social care information systems etc
Amendment proposed: 6, in schedule 7, page 96, leave out lines 38 and 39 and insert—
“For section 255 (power to request NHS England to establish information systems), substitute—
‘255 Powers to request the Secretary of State to establish information systems
(1) Any person (including a devolved authority) may request the Secretary of State to establish and operate a system for the collection or analysis of information of a description specified in the request.
(2) A request may be made under subsection (1) by a person only if the person considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the person to have in relation to the person's exercise of functions, or carrying out of activities, in connection with the provision of health care or adult social care.
(3) The Secretary of State must comply with a mandatory request unless the Secretary of State considers that the request relates to information of a description prescribed in regulations.
(4) For the purposes of this Chapter a request under subsection (1) is a mandatory request if—
(a) it is made by a principal body, and
(b) the body considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the body to have in relation to its discharge of a duty in connection with the provision of health services or of adult social care in England.
(5) Subsection (6) applies where the Secretary of State has discretion under this section as to whether to comply with—
(a) a mandatory request, or
(b) any other request under subsection (1).
(6) In deciding whether to comply with the request, the Secretary of State —
(a) must, in particular, consider whether doing so would interfere to an unreasonable extent with the exercise by the Secretary of State of any of its functions, and
(b) may take into account the extent to which the principal body or other person making the request has had regard to—
(i) the code of practice prepared and published by the Secretary of State under section 263, and
(ii) advice or guidance given by the Secretary of State under section 265.
(7) In this section “principal body” means—
(a) the Care Quality Commission,
(b) the National Institute for Health and Care Excellence, and
(c) such other persons as may be prescribed in regulations.
(8) In this Chapter “health care” includes all forms of health care whether relating to physical or mental health and also includes procedures that are similar to forms of medical or surgical care but are not provided in connection with a medical condition.’”—(Helen Morgan.)
This amendment would enable the Care Quality Commission and NICE to continue to make mandatory requests to the Secretary of State to establish an information system, following the transfer of NHS England’s functions.
Question put, That the amendment be made.
Karin Smyth
Clause 51 makes changes to section 42 of the Statistics and Registration Service Act 2007, which governs how information collected at the registration of births, deaths and other life events may be shared for specific purposes. That information plays a vital role in supporting public services, including health service planning, population analysis and the delivery of care. The UK Statistics Authority may already share this registration data directly with a range of public bodies, including the Secretary of State and integrated care boards.
Clause 51 adds NHS trusts and NHS foundation trusts in England to that list, providing a clear statutory route for sharing statistically codified registration data with trusts and foundation trusts responsible for delivering services on the ground. The clause is not about expanding the type of information that can be shared or widening the purposes for which it may be used, and does not create new datasets or weaken existing safeguards. All information sharing remains subject to the same statutory controls and protections that already apply. I commend the clause to the Committee.
Question put and agreed to.
Clause 51 accordingly ordered to stand part of the Bill.
Clause 52
Arrangements with devolved authorities etc about information services
Question proposed, That the clause stand part of the Bill.
Karin Smyth
Clauses 52 to 57 are vital. The Committee has discussed our relationship with colleagues in the devolved authorities; these clauses ensure that arrangements with devolved authorities and the Crown dependencies can continue following the abolition of NHS England.
Turning first to clauses 52 to 54, although healthcare is devolved in England, Scotland and Northern Ireland, the devolved Governments currently make arrangements with NHS England to deliver a number of functions on their behalf. Clauses 52 to 54 enable those existing arrangements to continue following the abolition by giving the powers to the Secretary of State. The policy intent is not to impact or reach into devolved competencies, but to secure continuity and legal clarity through existing cross-border and UK-wide arrangements involving Scotland, Wales and Northern Ireland. This is about making sure that the current expertise and resources of NHS England remain available to devolved authorities once these functions merge with the Department of Health and Social Care.
The clauses will not give the Secretary of State any ability or power to do anything in relation to devolved authorities other than as mutually agreed. Arrangements will be fully voluntary and do not create a power for unilateral action; rather, they ensure that, where co-operation is wanted, there is a proper legal basis for it.
Under clause 52, the Secretary of State takes on the data functions of NHS England and, on request from the devolved authorities, to make arrangements for the provision of information services. Clause 52 additionally applies to Crown dependencies. There are a number of such arrangements already in place between NHS England, the devolved authorities and the Crown dependencies.
For example, NHS England provides the NHS login service for the NHS Wales app, as well as the electronic prescription service for Wales, and NHS England collects and analyses data for audits that span multiple devolved authorities, such as the national audit of pulmonary hypertension. These provisions will support continuity of those arrangements. We are making sure that, if it is appropriate, data functions that are transferring to the Secretary of State can be delegated. Proposed new section 294B of the Health and Social Care Act 2012 will allow that power to likewise be delegated to an appropriate public body.
Clause 53 provides a clear statutory basis for the Secretary of State, by agreement with the devolved administrations’ health bodies, to make commissioning arrangements for the Scottish, Welsh or Northern Ireland health services. This clause will help to ensure continuity for patients across the United Kingdom, reducing the risk of disruption, and support the effective commissioning of services where cross-border work remains the right approach.
Clause 54 enables the Secretary of State, by agreement with a devolved authority, to exercise certain education and training functions on that authority’s behalf and to provide services or facilities in connection with those functions. Education and training arrangements often work best when they are co-ordinated efficiently and supported by shared systems. At a time when every part of the health service needs a strong pipeline of skilled staff, it is vital that useful joint arrangements can continue with clarity and confidence as responsibility is transferred from NHS England to the Secretary of State. The clause updates the statutory framework and helps to ensure that shared arrangements supporting recruitment, training cycles and workforce planning can continue following the abolition of NHS England.
Clause 55 relates to clauses 53 and 54. The agreed arrangements are effective only if they can deliver in a practical and efficient way, which is why this clause enables the Secretary of State to direct a public body to exercise some or all of the Secretary of State’s functions under arrangements made with the devolved authorities in relation to commissioning or education and training under section 295 or section 296A of the 2012 Act. In short, it provides a mechanism to ensure that functions under agreed commissioning and education and training arrangements with devolved authorities can be exercised by the most appropriate public body in England. The clause also allows the Secretary of State to direct the public body in how those functions are to be exercised, including in relation to information obtained in the course of exercising them. It also requires directions to be published. Those features support both operational clarity and accountability.
On clause 56, public authorities in the Crown dependencies may seek expert advice or practical assistance from the health system in England. Following the abolition of NHS England, this clause transfers the existing power from NHS England to the Secretary of State, and provides a clear legal basis for the Secretary of State or ICBs to provide that advice and assistance for purposes connected with the provision of healthcare. The clause also makes clear that advice or assistance may be provided on such terms as a provider considers appropriate, allowing support to be given in a practical and transparent way that is tailored to the circumstances of the case, whether that involves technical advice, specialist expertise or other practical assistance in connection with the provision of healthcare.
Finally, on clause 57, clarity and consistency in legislation depends on clear definitions, particularly where a group of provisions are intended to operate together as a coherent scheme. This clause does not create any new powers or duties; rather, it provides the necessary interpretive framework to support the operation of the preceding clauses and ensure legal certainty and clarity. As a group, these clauses play a vital role in ensuring that existing arrangements with our devolved authorities and the Crown dependencies can continue following the abolition of NHS England. I commend them to the Committee.
Question put and agreed to.
Clause 52 accordingly ordered to stand part of the Bill.
Clauses 53 to 57 ordered to stand part of the Bill.
Ordered, That further consideration be now adjourned.—(Emma Foody.)
Health Bill (Twelfth sitting)
Tuesday 7th July 2026
(2 weeks, 6 days ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 7 July 2026 - (7 Jul 2026)
The Chair
Good morning, ladies and gentlemen. Electronic devices switched off, please, and no teas or coffee in the Committee Room. Members may remove their jackets if they wish to do so and, exceptionally, if any Members wish to remove ties, because of the weather I am prepared to permit that as well.
Clause 58
NICE recommendations: decisions about time for compliance
Helen Morgan (North Shropshire) (LD)
I beg to move amendment 78, in clause 58, page 43, line 40, at end insert—
“1. (8B) Regulations under subsection (8A) must include provision about the period within which NICE guideline NG206 on myalgic encephalomyelitis (ME) must be complied with.
2. (8D) The Secretary of State must publish an annual statement on compliance with NICE guideline NG206, including the extent to which integrated care boards and relevant NHS bodies have implemented recommendations relating to ME specialist services and severe or very severe ME.”
The amendment would require that a period must be set within which the NICE guideline NG206 on ME must be complied with by ICBs and other health bodies. Furthermore, the Secretary of State must publish an annual statement on compliance with NICE guideline NG206 across the NHS in England.
Helen Morgan
The amendment was tabled by my hon. Friend the Member for Wells and Mendip Hills (Tessa Munt) on behalf of the approximately 1.2 million people in England who live with myalgic encephalomyelitis, because five years after the introduction of National Institute for Health and Care Excellence guideline NG206, little has changed. Service provision according to NG206 remains patchy and poor, with many patients having traumatic experiences. The amendment would require a period to be set in which integrated care boards and other health bodies must comply with the guideline, and the Secretary of State must publish an annual statement on compliance with NG206 across the NHS in England.
The introduction of the guideline after sustained campaigning represented a major reform after years in which ME was treated as a psychiatric condition and patients were pushed to follow graduated exercise therapy. Often, GET had disastrous consequences, precipitating serious deteriorations that patients never recovered from. Credit is due to the hon. Member for Washington and Gateshead South (Mrs Hodgson), the current Minister for Public Health and Prevention, for her determination when in opposition to bring about the change.
In a written answer published last week, the Minister for Public Health and Prevention confirmed that all ICBs have a statutory obligation to ensure sufficient care provision for their population, but the experience of those with ME is that that obligation is far from being fulfilled. In some ICBs, no services for ME are commissioned; in others, the provider has a history of providing services that reflect not NG206, but the old and condemned approach of GET. Some services are provided out of psychiatry departments, which is a huge red flag for those with ME, and information on the quality of services is patchy. Results from a big survey of more than 5,000 people with ME or long covid in late 2025 painted a bleak picture: more than half said that they had been disbelieved by an NHS healthcare official, one in three had been made to feel that their ME was their own fault, and almost two in five had had an encounter with a clinician that was traumatic or traumatising.
Five years after its introduction, NG206 is far from being complied with, and so members of the ME community—approximately 1.2 million people, as I said—are desperately asking that something be done to address the situation. The amendment represents a route that offers hope for many long-neglected and mistreated people. I do not intend to press the amendment to a vote, but I hope that the Minister will be able to reassure us about improving the consistency of provision for people with ME.
Moving to the clause generally, we broadly support the intention, but think that more safeguards need to be built into the principle, given the powers that are being handed to the Secretary of State. The clause makes provision for the period for compliance with a NICE recommendation, but gives no detail of how that will work in practice or how often the Secretary of State will change the standard three-month rule that NICE requires. No ceiling is put on the compliance period, no criteria govern when the period may be extended, and there is no duty to consult or set out reasoning.
What will the process be when the Secretary of State intervenes in the period of time for compliance with a NICE recommendation? We thought that there would be some mix of evidence requirements, consultation, statement of reasons, impact assessment and some kind of parliamentary scrutiny. The Secretary of State should at least have to set out their reasoning why the new power has been used. The value of the current requirement is almost entirely due to the compliance period being short and fixed. The three-month rule gives a positive NICE recommendation practical force. A power to lengthen or vary that period without constraint weakens the requirement in substance while leaving it formally intact. The right is not removed but its timing is made discretionary. For a patient awaiting treatment, that does not amount to the same thing.
A variation power is not new. Since the introduction of the budget impact test in 2017, NHS England has been able to apply to NICE to extend the funding period for medicines with a budget impact above a defined threshold, but, importantly, that period is criteria-based, triggered by a defined financial threshold, subject to a defined process and time-limited in effect. We are not overtly opposed to the power in principle, but more safeguards should be built into the criteria for its application. I would be grateful for some guidance from the Minister on that.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I have sympathy with the principle behind amendment 58, in the name of the hon. Member for Wells and Mendip Hills. The hon. Member for North Shropshire is right to say that individuals with ME have not always received the best quality care. In many cases, ME is a debilitating and incredibly frustrating condition, and around 10% to 25% of sufferers have severe ME, meaning that they are housebound or bedbound. We know that some patients are sadly not believed by medical professionals.
In 2021, NICE said that most medical students have little or no training on the condition. The Government have previously committed to increasing the uptake of ME modules among NHS professionals. What progress has been made on that in the last couple of years? The Government also committed in the ME/CFS action plan to develop and run a public awareness initiative, with implementation expected by May this year. Has the Department developed that initiative yet? If not, what is responsible for the delay? It is not marked as complete on the Government website.
The amendment would put guidance for medical professionals into legislation, though, and my concerns about that are twofold. First, it may slow down improvements in the future. If individuals have to legally follow that guidance, how can they innovate and improve treatment without having to come back to Parliament for more primary legislation? That will take time and may mean that people with ME get worse rather than better care in the short term.
The requirement would also limit clinical judgment. A patient may have a particular set of symptoms or conditions or be on a particular set of medications that mean that the doctor or clinician looking after them needs to vary from the guidance. NICE intends the guidance to be just that, guidance, not law, but if guidance becomes law, the doctor or clinician will not be able to vary from it. My concern is that the amendment would be overly restrictive. Although it is well-intentioned, and it is a good idea to ensure that guidance is followed where possible, it would be too rigid. I therefore do not support the amendment, while continuing to support the aim of better treatment.
Clause 58 amends the Health and Social Care Act 2012 by inserting a new section 237(8A), which states:
“Provision made under subsection (8)(b) may include provision about the period within which a recommendation is to be complied with (including provision for the period to be determined by NICE or the Secretary of State).”
At the moment, NICE technology appraisals check the value of a product, whether a drug or a technology, then NICE makes a recommendation. It is then supposed to be the case that within 90 days or three months, ICBs ensure that those technologies are available, but we know that in the real world it can take longer—sometimes 12 to 24 months—for some things to become available. That could be because technology needs to be bought or training needs to take place.
I understand why there could be variation and why the Government may want to consider varying the period, but it is not clear why they need to do so in legislation, because it is possible now to vary the period on an individual basis. For example, the Government imposed a five-year limit rather than a 90-day limit for the introduction of hybrid closed loop systems for diabetes, because that is a technology that requires proper training and they were never going to be rolled out in such a short period. The other product that notably has a longer time is tirzepatide, which is more commonly known as Mounjaro. I suspect that that is down to cost, but I am not certain.
Why do the Government want to change the 90 days? The patient’s right to treatment with a NICE-approved product within 90 days will become a right to getting the product when the Secretary of State says so. That is not really a right at all, because it does not give patients any comfort and may mean that products are received later. The Government have put this power into the Bill, so they clearly intend to use it. Given that they have the power to vary on an individual basis, why do they need the power to vary on a blanket basis? Do they intend to extend the 90-day limit across the board? If so, by how much? There is no ceiling. The Committee received written evidence from Henry Burkitt from Oxygen Strategy, who made the point that there is no ceiling, no maximum time, no duty to consult and no necessity for the Secretary of State or NICE to give reasons why a delay has occurred.
The life sciences industry talks about how it wants products to be rolled out. When it is investing and doing research in this country, it wants to see new products rolled out as quickly as possible once they have been approved, and the clause is a sign that roll-out might be delayed. I understand that the Government might want to be able to vary on certain products, but they already can; why do they want to vary on a more general basis? It is presumably to slow down roll-outs, but by how much?
Gregory Stafford (Farnham and Bordon) (Con)
On a point of order, Sir Roger. I am a parliamentary patron and champion of Action on ME. I feel I ought to put that on the record, as we have an amendment on ME.
The Minister for Secondary Care (Karin Smyth)
Clause 58 is about the time period for compliance with NICE recommendations on health and social care provision. As we have heard, it will enable that period to be determined by NICE or the Secretary of State.
NICE’s technology appraisals and highly specialised technology guidance play a vital role in ensuring that patients in England can access treatments that are clinically effective and a good use of NHS resources. When NICE recommends a new treatment, the NHS is usually required to make funding available within three months. That means that patients can consistently benefit from innovative treatment.
That said, there are cases where the three-month timeframe is just not realistic. That might be because of affordability pressures or practical challenges such as a stretched workforce. In those situations, a longer implementation period is needed to ensure that complex new treatments can be introduced in a safe way that does not disrupt services for other patients. For example, the period for NICE’s guidance on the drug Paxlovid for the treatment of covid was extended to 12 months to allow time for the NHS to put the necessary routine testing systems in place and train healthcare professionals.
I do not think the hon. Member for Sleaford and North Hykeham raised this issue, but the opposite is sometimes true, and the NHS issues guidance that provides swifter access to medicines and medical treatments. For example, cancer medicines can be funded from the point of a positive draft recommendation. At present, NHS England decides whether a NICE treatment is funded more quickly or in a shorter timeframe, while NICE determines whether the funding period should be extended, typically following a proposal from NHS England. The abolition of NHS England means that those roles and responsibilities will need to be reconsidered. The clause provides flexibility for the final decision on funding timelines to sit with either NICE or the Secretary of State, but it will not mandate which.
To the point raised by the hon. Member for North Shropshire, the Government intend to set out further details of these arrangements in regulations using the enabling power granted by this Bill. Importantly, the clause will not reduce NICE’s independent role in assessing the clinical and cost effectiveness of new treatments, nor will it weaken the NHS’s obligation to provide timely treatment. Instead, it will ensure that decisions on funding timelines remain flexible and sustainable, and that the system is equipped to respond effectively to future pressures.
I will now speak to amendment 78, which was moved by the hon. Member for North Shropshire. I recognise the vital role that NICE guidelines play in improving quality and consistency of care across the NHS. NICE’s guidance is developed by experts on the basis of rigorous assessment of the available evidence and provides an important benchmark for best practice, including for patients with myalgic encephalomyelitis. I know that the hon. Member intends to withdraw the amendment, but if she were to press it, the Government would not accept it.
To be clear—again, partly to the point of the hon. Member for Sleaford and North Hykeham—it is a long-standing and deliberate position that NICE guidance is not mandatory, which reflects the role it plays in supporting patient care. Crucially, guidelines do not override the professional judgment of clinicians, and it is essential that clinicians retain the flexibility to determine the most appropriate course of treatment for individual patients based on their specific circumstances. It is also important to recognise that NICE guidelines are often complex frameworks for care that must be adapted to local service configurations and patient need. Requiring full compliance with the NICE guideline would remove the ability of local service providers to ensure that ME services are appropriate to the needs of their local populations.
The hon. Member for North Shropshire made some important points about treatment of ME over the years, and many of us have encountered constituents with similar stories. I pay tribute to the hon. Member for Farnham and Bordon for his work supporting constituents with the condition. To be clear, the Department fully recognises the need for more consistent implementation of the NICE guidelines on ME. That is why we are already taking forward practical measures. In particular, the Department and NHS England are developing a service template specification, aligned to NICE’s guidelines, to support commissioners and providers in delivering appropriate services for people with ME. We will continue to work with stakeholders, the industry and the NHS in doing that.
Those steps will help to drive improvement in care without undermining clinical judgment or imposing inflexible statutory requirements. With that, I commend clause 58 to the Committee.
Helen Morgan
I thank the Minister for her words, particularly on amendment 78. As I said, I will not press the amendment to a vote, but I hope that the Minister will continue to bear in mind that provision for people with ME is extremely patchy and that a number of our constituents are suffering in the long term. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 58 ordered to stand part of the Bill.
Clause 59
Transfer of HSSIB’s functions to CQC
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
Amendment 55, in schedule 8, page 110, line 23, at end insert—
“(10) If the Secretary of State certifies that it is in the interests of national security that the powers conferred by subsection (1)—
(a) should not be exercisable in relation to certain premises in which there is a Crown interest, or
(b) should not be exercisable in relation to certain specified premises for other purposes,
those powers are not exercisable in relation to those specified premises.
(7) In this section, ‘Crown interest’ means—
(a) an interest belonging to a government department or held in trust for His Majesty for the purposes of a government department;
(b) an interest belonging to His Majesty in right of the Crown;
(c) an interest belonging to His Majesty in right of the Duchy of Lancaster;
(d) an interest belonging to the Duchy of Cornwall.”
This amendment makes provision for the Secretary of State to disapply investigation powers under subsection 51J(1) to the Health and Social Care Act 2008, inserted by Schedule 8 of this Bill.
Amendment 56, in schedule 8, page 116, line 8, leave out subsection (9).
This amendment would allow the Commission to recoup charges in excess of the costs incurred in providing assistance.
Amendment 5, in schedule 8, page 120, line 16, at end insert—
“(2A) After paragraph 6(8) insert—
‘(9) A committee of the Commission is to be appointed in accordance with regulations.
(10) The purpose of the committee is to oversee the health services safety investigation functions formerly conducted by HSSIB, transferred to the Care Quality Commission under the Health Act 2026.
(11) The committee is to be operationally independent from the Care Quality Commission.
(12) The committee is to consist of a chair appointed by the Secretary of State, and not less than six and not more than twelve other members appointed by the chair.
(13) A majority of the members of the committee must not be members of the Care Quality Commission.
(14) So far as is reasonably practicable, the persons appointed to the committee must include persons with knowledge or experience relevant to the discharge of functions under this paragraph.’”
This amendment would ensure that oversight of HSSIB’s functions would remain operationally independent of the Care Quality Commission (CQC) following the transfer of its functions to the CQC.
Schedule 8.
Clauses 60 and 61 stand part.
New clause 42—Funding for Care Quality Commission (CQC) investigations—
“The Secretary of State has a duty to make provision for adequate funding and resources for patient safety investigations conducted by the CQC, including some initiated by the CQC themselves.”
Karin Smyth
Clause 59 provides for the abolition of the Health Services Safety Investigations Body and the transfer of its functions to the Care Quality Commission.
Under the new arrangements, the Care Quality Commission will assume responsibility for carrying out investigations into incidents that have or may have implications for patient safety. It is really important to stress that the core purpose of that function remains unchanged: to identify systemic risks, support learning and drive improvements in the safety of health services, rather than determine blame or liability. It is a central measure in strengthening the framework for patient safety investigations and ensuring a more coherent and effective system for learning from incidents across health services.
With more than 70 types of channels or organisations through which patients or users can share feedback, the current landscape has led to fragmentation between investigation, regulation and improvement activity, thereby diluting the impact that insights from investigations might otherwise achieve. HSSIB has been isolated, undermining its efficacy. We will bring HSSIB into the mainstream as a core but distinct part of the CQC. That will enable HSSIB to use its functions more strategically, working in partnership with the national quality board. Clause 59 achieves that by conferring responsibility for those investigatory functions on to the Care Quality Commission through the provisions set out in schedule 8. In doing so, it embeds a comprehensive investigatory framework with an established statutory regulator.
The CQC will be one organisation with separate functions—a regulatory function and an investigative function—to preserve the integrity of each. Within the CQC, HSSIB will continue to operate as a discrete unit and retain its independence from providers, allowing it to identify learnings and take a no-blame approach.
Janet Daby (Lewisham East) (Lab)
The Minister will recall that in evidence, Dr Rosie Benneyworth, interim chief executive officer of HSSIB, spoke about the vital work of the organisation, especially with regard to investigations where vulnerable staff and workers do not feel confident about coming forward for fear of reprisal. HSSIB did great work in that area, and I am wondering whether the CQC will carry it on and take on board that learning.
Karin Smyth
I thank my hon. Friend for that point. I have met HSSIB and others on this issue, and it is a concern that staff are fearful of speaking up. That is obviously unacceptable, but we understand that it happens. That is absolutely the culture that we need to drive out, and we need to ensure that HSSIB’s learning about making sure there is a safe space to speak out, which I will come on to, is a core part of future work.
Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
What we are talking about is not so much the safety of staff when they come forward, but the safety of patients, and whether we genuinely believe that the proposed modification to the arrangement will improve patient safety. That is the underlying point. Although the safety of staff is important, it is the safety of patients that we must bear in mind.
Karin Smyth
Of course, patient safety is what we need to get right. I will come on to that point, but there is a lot to get through with this clause. We can see its importance from the number of organisations and channels that exist. I have said that before, and I am sure we have all struggled as constituency MPs to support our constituents—either patients or staff—through the system and to understand the best route forward on patient safety. We all have the same aim, and we should be clear that the issue is how best to achieve that aim. My hon. Friend is absolutely right. The test is about impact, learning and making the system and the culture change.
My hon. Friend the Member for Lewisham East asked me about confidence, and the fear that staff sometimes have about speaking up, which is obviously an important part of that landscape. We want to make sure that we take forward the learning on both those points into the new body.
The new framework ensures that the essential characteristics of safety investigations are preserved. The commission will have a flexible power to investigate qualifying incidents that have or may have implications for patient safety, with a clear statutory purpose of identifying risks and improving systems and practices. We are maintaining the principle of safe space and introducing strong safeguards in the process, so that staff and the public can trust that they can speak of their experiences openly, without fear or favour, to provide learnings for the system.
We have included protections for safe space materials and restrictions on disclosure, including within the regulatory functions of the CQC, and limits on the use of reports in legal proceedings. That is designed to support openness and candour, and to provide confidence in the impartiality and independence of patient safety investigations. There are clear mechanisms for transparency and accountability, including the publication of reports, requirements to respond to recommendations, and oversight through a statutory review of the commission’s investigatory functions.
Clause 59 also provides the commission with the necessary powers to carry out investigations effectively, including powers to require information, enter premises and co-ordinate with other bodies while maintaining appropriate protections such as legal privilege and safeguards against self-incrimination. Although the commission will decide which incidents to investigate, the clause preserves a power for the Secretary of State to direct it to investigate a specific qualifying incident or category of incidents. That ensures that where issues of significant public concern arise, or where urgent scrutiny is needed or there is particular risk, there is a clear mechanism to ensure that issues are investigated.
The struggles of the Care Quality Commission have been well documented. We will only commence these provisions when we are satisfied that the CQC has improved. The CQC has been supported and held to account to recover its effectiveness, and we will continue to support it and work closely with the newly appointed chair on its journey to rebuild. We will work closely with the CQC to ensure its readiness to receive the investigations functions from the Health Services Safety Investigations Body. Maintaining a centre of excellence for investigations will be integral to the CQC’s culture. Without the clause, the opportunity to deliver the ambitions of the 10-year health plan would not be realised, nor would the broader patient safety landscape, as set out in the Dash review, be fully addressed. It is therefore a necessary and integral reform.
Clause 60 makes provision for the transfer of property rights and liabilities from the Health Services Safety Investigations Body to the Care Quality Commission in connection with the abolition of the former and the assumption of its functions by the latter. It is a key technical provision to ensure an orderly and legally complete transition between the two bodies. Where functions are transferred between public bodies, it is essential that all associated assets, obligations and legal arrangements are also transferred in a way that ensures continuity and legal certainty. The clause provides the statutory mechanism to achieve that.
The clause provides a flexible framework to enable the continuation of HSSIB’s actions and ongoing matters, including legal proceedings, and ensures that references to HSSIB in existing documents are treated as references to the Care Quality Commission to avoid legal uncertainty. The clause provides for staff protections equivalent to TUPE and allows for shared ownership or use of property where needed, supporting a smooth and effective transition.
The overall effect of the clause is to enable a smooth, comprehensive and legally robust transfer of HSSIB’s property rights and liabilities to the Care Quality Commission, ensuring continuity of function and avoiding disruption to ongoing operations. Without the provision, there would be risk of legal uncertainty and operational disruption during the transfer process.
Clause 61 is a necessary and practical provision. At its core, it provides a power through regulations for His Majesty’s Treasury to ensure that transfers made from HSSIB to the CQC are delivered smoothly and on a tax-neutral basis. Like the equivalent provision for the NHS England transfer in clause 3, it allows the Treasury, by regulations, to vary the way in which relevant tax legislation applies in relation to anything transferred under a transfer scheme or anything done in connection with such a transfer. That will ensure that the tax consequences of the transfer can be properly aligned with the policy intention of a smooth and orderly transition.
Importantly, the scope of the clause is limited to specified “relevant taxes”, including income tax, corporation tax, capital gains tax, VAT, stamp duty and stamp duty reserve tax. As with clause 3, without this power there is a risk that the transfers could trigger unintended tax liabilities that would divert public money away from frontline services and undermine the policy intent of the legislation. Clause 61 therefore protects value for money and ensures that organisational change does not come with avoidable fiscal cost.
Clauses 59 to 61 and schedule 8 are necessary to strengthen the framework for patient safety investigations and ensure a more coherent and, crucially, effective system for learning from incidents across health services to make all our constituents and patients safer. I therefore commend them to the Committee.
Dr Johnson
These clauses are about patient safety. As has been pointed out this morning, patient safety is the absolute key here: that is well recognised across the House, among the public and across the national health service. Before going any further, I declare an interest as a patient of the NHS, a member of the British Medical Association, a member of the Royal College of Paediatrics and Child Health and a consultant paediatrician.
When I was interviewed in 2012 for my current consultant role, I was asked to deliver a presentation about how I could demonstrate to the trust board that the paediatric services in the hospital were safe. The first question I posed—Members will be pleased to know that I will not go through the whole presentation—was: “What is safe?” Are football stadiums safe? Is the London underground safe? Are aeroplanes safe? Broadly, yes, I think we would say they are safe, but they have not been without incident or safety issues.
Healthcare is similar. It involves millions of people, clinical judgment, human decision making and huge variability in the way that patients can present with different symptoms for different problems at different times. Is healthcare safe? Yes, it is safe. Again, however, we know from the many reports we have read that there is a long way to go to make it better and we need to prepare for that. We need to make sure that we design out room for error—that we design processes that limit the opportunities for error—use technology to limit the risk of error, and train people in a way that reduces the risk of error.
One of the key factors in that work is accepting that where there is human decision making, mistakes can happen, and that we need to identify and learn from those mistakes. One of the main ways of doing that is striking a balance between accountability and blame. If there is insufficient accountability, there can be an unclear escalation process, such that people do not know who to go to when they identify a problem. There can be a careless culture, which can develop in places where there is not enough accountability. However, if there is too much focus on fault and determining whose fault something is, we can get a blame culture. That can lead to a failure for people to come forward and therefore to a failure to learn from mistakes. It can lead to a culture of cover-up, whereby people try to avoid getting either themselves or their colleagues into trouble.
That is where HSSIB comes in because, like the air accidents investigation branch and the similar bodies for rail and shipping, it provides a safe space. That safe space is important in ensuring that people can speak up freely without fear, and know that we can get to the bottom of a problem and understand why and how something went wrong, because that is how we fix it.
At the time that HSSIB was established, there was consensus about it. The General Medical Council said:
“We support the creation of a ‘safe space’ approach to investigation. This is consistent with our guidance to doctors about their responsibilities to learn from mistakes and reflect on their practice, and their duty to take part in systems of quality assurance and quality improvement to promote patient safety.”
The British Medical Association told Parliament:
“We welcome the establishment of the HSSIB…Doctors must feel able to report errors and reflect on their own mistakes openly, without the fear of these reflections being used against them at a later stage. Only then can true improvements to patient safety be made.”
Similarly, NHS Providers told Parliament:
“NHS Providers welcomes the creation of the HSSIB as an opportunity to develop a just culture in the NHS and a focus on learning…For the HSSIB to succeed in contributing to improved patient safety, any investigations associated with it must be carried out independently and without conflict of interest, and be perceived as such.”
Indeed, the Minister for Secondary Care herself is on the record as having said:
“HSSIB is a really important new body…It must absolutely be built on the highest standards of trust when it comes to the wider system and the general public.”––[Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 564-565.]
I think that I have demonstrated that the creation of HSSIB was a matter of consensus and it was confirmed that it was the right thing to do.
In order to work, HSSIB needed to be independent and without conflict of interest. NHS staff backed it, the providers backed it, the patients backed it and even the Minister backed it. That is what makes the Government’s plans for HSSIB so perplexing. I am not aware of a single royal college or union that supports folding it into the CQC.
Essentially, Ministers have said that this is being done because of the Dash review. “The Dash review says so,” they argue, “so that’s what we’re going to do.” I have huge respect for people who say, “I’ve asked for some experts’ advice, and they have given it, and therefore I should follow it.” However, Ministers also commissioned the report by Lord Darzi, which said that
“a top-down reorganisation of NHS England and integrated care boards is neither necessary nor desirable”,
and yet here we are, doing exactly that. It is perfectly possible for Ministers to take one report as gospel and another as guidance. I would be grateful if the Minister could explain that.
The other reason given for this measure is that it will declutter the landscape, yet few people outside Government seem to think that HSSIB is responsible for cluttering the landscape. For example, the Health Foundation wrote in its submission that
“the government needs to do more to explain how the abolition of HSSIB and transfer of its functions to CQC will meet its aim of reducing complexity and, most importantly, maintain the essential focus on improving patient safety.”
Dr Danny Chambers (Winchester) (LD)
This subject is of particular interest to me. For quite a few years I was a trustee of a charity that supported evidence-based medicine and quality improvement. The hon. Lady talked about a no-blame culture. We now tend to use the term “just culture” but it is the same kind of thing: we must have a safe space for people to come forward, like in the airline industry. We want to encourage reporting not only of mistakes but of near misses so that improvements can be delivered without tragic incidents having to take place. If we are to create a culture in which people will come forward to admit even potential mistakes and near misses, they cannot in any way fear punitive punishment under regulations. Does the hon. Lady agree that folding HSSIB into the CQC will make it difficult to create a culture in which people feel confident enough to want to come forward with and overtly discuss mistakes and errors?
Dr Johnson
The hon. Gentleman is right. When someone comes forward, they need to have trust in the system. If they think that coming forward will harm their job or career, or perhaps their colleagues’, they may be more reluctant to do so. There is a difference between a mistake and a reckless act. If people behave recklessly and badly, that needs to be dealt with for the sake of accountability, but if an individual is aware of a mistake, or aware of a loophole through which a mistake could have been made if only something else had not happened at that moment, they need to come forward and say so. It would be much more difficult for them to do so if there was a culture of fear.
Dr Benneyworth made it clear to the Committee that
“we are still working in a culture of fear”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 24, Q40.]
and that makes it difficult for people to come forward. People come forward now because they know that HSSIB is independent, but they will be less likely to come forward when HSSIB is an office in the CQC that is independent in name only. The Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), said that
“people cannot sit at desks near other people who are making decisions and at the same time be perceived as entirely independent. The perception of independence cannot be legislated for—the perception is everything”.—[Official Report, 1 June 2026; Vol. 786, c. 915.]
Gregory Stafford
As my hon. Friend said earlier, the problem comes when this new body within the CQC has to investigate the CQC. In the oral evidence session, I asked Dr Dash what would happen if the problem was CQC, and she gave what is probably the most extraordinary answer out of the many extraordinary answers she gave. It is worth repeating:
“Well, we then have to deal with that as a problem. That is the same as saying, ‘What happens if the problem is this organisation or that one?’…What if the GMC is a problem? What if the Nursing and Midwifery Council is a problem?”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 8, Q9.]
She did not answer my question at all. In fact, she entirely sidestepped it. How can we have confidence in the Government’s proposal if the architect of the procedure cannot answer the most basic questions about the investigatory framework?
Dr Johnson
My hon. Friend is absolutely right. That answer was quite shocking, really. The pause before it and the reaction was remarkable. The purpose of HSSIB is to investigate without fear or favour, and to enable people to come forward in a safe way, but if it was folded into the CQC, as the regulator, and the problem was the regulator, how would it investigate itself? How would it make recommendations to itself? What if it thinks the board that it works for is incompetent? Is it going to tell its boss that it is incompetent? How does that work? No one seemed to know the answer.
It also seems that Ministers have not thought about how the HSSIB unit will be vulnerable to political pressure. Under the Bill as drafted, the Government are planning to direct the “vast majority”—according to the impact assessment—of the investigations, and the quality board is going to have some influence over the recommendations, again under the direction of the Secretary of State.
The Liberal Democrats have tabled amendment 5, which would require the appointment of a committee. That idea is well intentioned, and we recognise the same problems and the same flaws in the Government’s approach, but I do not think it is enough to solve the problem. Even if the law says that the oversight of the investigative units will remain operationally independent, I just do not see how that is possible. I can see that the hon. Member for North Shropshire is trying to help by creating something better than what the Government have produced, but I do not think it is enough.
We have also tabled some amendments, including new clause 42, which would ensure that there is some operational independence in the choice of investigation by requiring the Secretary of State to adequately fund and resource patient safety investigations, including some of those initiated by this unit within the CQC.
Amendment 55 is a probing amendment. We noticed that much of the legislation has been lifted and shifted from the previous Act, but some things are missing, including national security grounds. We want to understand why that ground has not been included in the Bill. Very occasionally, health events have national security connotations—the Salisbury chemical weapons attack, for example. In such circumstances, restrictions on investigatory capabilities could be necessary. I do not know—I was just interested in why the Government have chosen deliberately to remove that particular clause.
Amendment 56 would allow
“the Commission to recoup charges in excess of the costs incurred in providing assistance.”
The HSSIB programme is world-leading. People look at it from across the globe, and some have asked for training or information on it, for which we have been able not just to recoup costs but actually charge. I do not understand why the Government have removed that provision, because it is an opportunity for them to get extra money without taking it off people in taxes. Do the Government want HSSIB to lose its international standing, or do they want British taxpayers to subsidise training for foreign health services? It is not clear. I would be grateful if the Minister explained that.
We need to come back to what the hon. Member for Bury St Edmunds and Stowmarket said at the beginning: what is the purpose? The purpose is patient safety.
Sojan Joseph (Ashford) (Lab)
The point about patient safety is absolutely important, as every Bill Committee member would agree. The number of patient safety incidents has been going up for the last 10 years. Between 2015 and 2022, there was a 62% increase in patient safety incidents in this country, and since the creation of HSSIB, the number of incidents has again gone up. Does the hon. Member agree that the CQC, which has access to all patient records and all documentation in any healthcare settings in real time, would be able to monitor the improvement and progress that each provider is making following the learning from each incident? That would be important and helpful, as the HSSIB has limited ability to look into documentation and clinical notes.
Dr Johnson
I thank the hon. Gentleman for that intervention, but I think this comes to part of the problem. When producing a list of faults—of things that are wrong with the service—and saying, “We need to improve the culture; it needs to be better”, we need to ask, “Okay, but how? What will be the deliverable, measurable way of doing that? How will we go about improving things?” For example, let us say that there is a problem with patients with aortic dissection, so how will we prevent that? The benefit of HSSIB is that it produces a plan, the plan is implemented and patients are safer. Part of this is about the delivery plan.
As for the other part, the hon. Member talked about monitoring progress, but that is not the job of HSSIB. If a mistake or an event happens, it is investigated by HSSIB—HSSIB produces a set of investigations based on understanding how and why it happened, because of the safe space—and then those recommendations are put forward to the Government. The Government then, ideally, implement those changes. The Minister is there to ensure that those are implemented. It will be her job to ensure, having decided which recommendations are to be implemented, that that is done fully and properly. It is a separate function. The CQC is a regulator, HSSIB is an investigator, and the Minister is there to ensure that things are delivered properly.
Going back to patient safety, at the end of my interview, I essentially told the panel, “I cannot tell you that anything is 100% safe”. The assurances that can be provided are that the staff and equipment are available, that training is available for people to do the job, and that processes are in place to identify shortcomings and learn from them, so that they are not repeated. That is key: to find the learning and spread it more widely. As the hon. Gentleman said, implementation is a challenge. It is possible to implement this on an individual basis or to implement a lesson in a unit that has had an error or mistake. Spreading it more widely, so that this is heard in every unit across the country, is more challenging. Fundamentally, I do not think I have heard anything from any of the Ministers, and I do not think it is in the Dash report either, to explain why the Government believe that rolling HSSIB into the CQC with all the problems that it might cause—the risk of it suing itself over whether the safe space is available or not—makes patients any safer.
Helen Morgan
I declare an interest as a member of the all-party parliamentary group on patient safety, which is opposed to the changes to HSSIB proposed in the Bill. Over the last couple of weeks, we have been reminded why we need an appropriate safety landscape when things go wrong. We have had the Donna Ockenden review into Nottingham maternity services. We have had Baroness Amos’s national review into the picture following a range of maternity scandals across the country. Yesterday evening, I attended the debate on the regulations to compensate victims of the infected blood scandal. Safety is at the top of all our minds at the moment, as it should always be.
Something that has come across very strongly from Members of all parties, on both sides of the House, is that culture is critical to ensuring that those types of issues—the huge scandals—never happen again. Indeed, smaller scandals must never happen again, because people need to be free. Staff in particular need to have the confidence that, if they report concerns about the way they operate, they will be safe to do so without jeopardising the rest of their career, and that those concerns will be acted on and the lessons learned. Everybody here wants to achieve that. I do not think anybody is arguing about the fundamental principle that, when there are concerns, they need to be raised in a safe place and that the lessons from those concerns need to be learned.
That is why I share the lack of understanding of the shadow Minister, the hon. Member for Sleaford and North Hykeham, about why rolling HSSIB into the CQC will change that culture, because the CQC is a regulatory body and HSSIB is an investigatory one. Their missions are fundamentally different. Putting them together compromises the independent investigation element in a way that is very difficult to overcome. We were told in the evidence to the Bill Committee by HSSIB’s chief executive that it is often told, “We tell you this; we wouldn’t tell a regulatory body.” It is clear that this perception of safety is critical to the way in which people interact with HSSIB.
We also heard in evidence to the Committee that the CQC warned that, as it stands, the Bill could leave it fighting against itself in the High Court. We could get a scenario where the regulatory arm of the CQC sought access to HSSIB’s confidential investigation reports, while HSSIB, the investigative branch, tried to keep them secret to protect its independence. That is not a situation anyone wants to end up in, and I am sure that is not the intention of this clause.
I think the shadow Minister has already made this point, so I will not labour it, but it is also important that the investigatory body must be able to examine the regulatory frameworks, commissioning decisions and oversight arrangements without institutional conflict. When I look back, for example, at the scandal that unfolded at Shrewsbury and Telford hospital NHS Trust over the maternity failings, I see that the CQC had given that trust a good rating during the course of all those terrible things going wrong. The CQC’s process clearly failed in that situation. It is difficult to imagine an arm of the CQC turning around in that scenario and saying that the CQC got its own assessment wrong. If it had tried to do that, it is difficult to imagine how that might have played out and that people might have had confidence in raising that problem.
I am also concerned about this because, as the Minister has alluded to, the CQC has faced significant criticism and publicly admitted that it has failed to carry out its functions to the best of its abilities over recent years. Although I welcome the Minister’s assurance that the transfer would happen only once the CQC was in a better place, the CQC might—again—be part of the problem in some instances, and HSSIB must be able to point to that where appropriate.
Lib Dem amendment 5 attempts to introduce the principle that, if this must happen, there needs to be a firewall in the CQC to keep HSSIB operationally independent. To achieve that, the amendment proposes to insert into the process a committee that is operationally independent of—with a majority of people who are not on—the CQC. Opposition new clause 42 seeks to do the same thing. I would be open to any suggestions that the Minister might make to reassure us that HSSIB will continue to be operationally independent, for all the good reasons that hon. Members have outlined.
Gregory Stafford
Before I address the clauses, I say for the record that 21 years ago this morning, 52 people were murdered and 784 injured by Islamist terrorists in London. I pay tribute to all the medical professionals who treated those people in such difficult circumstances.
I will speak to clauses 59 to 63 together because they all concern one of the most significant structural changes proposed in the Bill: the abolition of the Health Services Safety Investigations Body as an independent statutory organisation, and the transfer of its functions to the Care Quality Commission. At first glance, that may appear a relatively modest machinery-of-government change. The Minister argues that HSSIB’s functions will continue, its statutory safe-space protections will remain and operational independence will somehow be preserved. However, when one examines the evidence presented to the Committee, and that given to the Health and Social Care Committee, of which I am a member, it becomes increasingly difficult to identify the problem that this merger is intended to solve. Instead, what emerges is a remarkable degree of consensus among those with the greatest expertise in patient safety that this proposal carries significant risks while offering little measurable benefit.
The question before us is therefore not whether HSSIB’s statutory functions can be transferred to another organisation, but whether Parliament should abolish an institution that it deliberately created to be independent. That distinction matters. Across public life, we recognise that effective scrutiny depends on institutional independence. Government expenditure is examined independently by the National Audit Office, citizens complain to independent ombudsmen rather than to the organisations about which they are complaining, air accidents are investigated independently by the Civil Aviation Authority, and rail accidents are investigated independently of the regulator. In each case, Parliament has recognised that organisations charged with investigating failures should not also be responsible for regulating, inspecting or enforcing against those they investigate. Healthcare should be no different.
Indeed, if anything, healthcare should demand an even greater degree of independence. Learning from failure depends on the confidence of patients, clinicians and families that they can speak openly and without fear that the information that they provide will later be used for regulatory or enforcement purposes. That is precisely why HSSIB was created. Its purpose was never to attribute blame but to understand why systems fail, identify the underlying causes of patient harm and ensure that lessons are learned before similar tragedies occur again. That philosophy represented a deliberate shift away from a culture of blame and towards one of learning. It was modelled consciously on the air accidents investigation branch, whose success over many decades has demonstrated that independent, no-blame investigations produce better safety outcomes than investigations driven primarily by enforcement.
It is therefore difficult to understand why the Government now seek to move away from the model that other safety-critical industries continue to regard as fundamental. Clause 59 would abolish that independent body and transfer its functions to the Care Quality Commission. In doing so, it would bring together two organisations with fundamentally different statutory purposes, different powers and, perhaps most importantly, different cultures. HSSIB investigates and the CQC regulates. One exists to ask why the system failed; the other exists to ask whether the organisation complied with required standards—those are not the same questions. Nor do HSSIB and CQC require the same relationship with those from whom evidence is obtained. An investigation depends on trust; a regulator depends on compliance. An investigator encourages candour; a regulator necessarily retains enforcement powers. The different roles are not a weakness of the system; they are precisely why Parliament chose to establish separate organisations.
I would be grateful, therefore, if the Minister could explain what assessment has been made of the impact on public confidence of the investigator and the regulator becoming part of the same statutory organisation. More specifically, what assessment has been made of the likely effect on clinicians’ willingness to speak openly if the organisation receiving confidential evidence also contains the regulator responsible for inspecting and enforcing standards? That concern has been expressed not only by the Opposition, but repeatedly by independent experts—and indeed, we just heard the hon. Member for Lewisham East asking similar questions.
Even the Care Quality Commission has expressed reservations. Evidence that it submitted to the Health and Social Care Committee earlier this year acknowledged that a lack of clarity remains regarding the respective roles of HSSIB and the CQC. Rather than resolving that uncertainty, the proposed merger risks deepening it. The CQC warned that preserving an effective separation between its investigatory and regulatory functions would be essential if confidence in HSSIB’s safe space were to be maintained, and it recognised the genuine risk of perceived conflicts of interest if those functions become blurred.
I think that should give the Committee pause for thought. When the organisation receiving the additional responsibilities is itself warning about the difficulty of maintaining the boundaries, we should listen very carefully. If the CQC believes that the risks exist before the merger has even taken place, what confidence can Ministers offer that those risks will somehow disappear afterwards? Similarly, the all-party parliamentary group on patient safety, of which I am a member, has expressed concern that HSSIB should remain institutionally independent so that its evidence-based recommendations can continue to command confidence across the health system.
Such concerns, as I said, are not confined to Parliament, nor are they confined to one political party. They are shared by patient safety organisations, healthcare professionals and those directly involved in investigating serious incidents. During our oral evidence sessions, I put a straightforward question to Dr Penny Dash. I observed that I could find almost no one apart from her and the Department who believed that moving HSSIB into the CQC was the right course of action. That was not intended as some sort of rhetorical flourish; it reflected the evidence before us. Former Secretaries of State, patient safety experts, independent investigators and numerous professional organisations have all questioned the proposal.
Despite the breadth of concern, the Government have not produced compelling evidence that HSSIB, as presently constituted, is failing. Nor have they demonstrated that the separation between investigation and regulation is itself creating harm. Instead, Ministers have repeatedly assured us that HSSIB’s operational independence will remain, that safe space protections will remain and that independent investigations will remain. If that is indeed the Government’s position, an obvious question follows: if HSSIB will continue to operate independently, if its investigations will continue to be conducted independently and if its statutory protections will remain intact, why is it necessary to abolish the independent organisation at all?
That question goes to the heart of clauses 59 to 63, and throughout the evidence presented to the Committee, I have heard no convincing answer. The Government ask Parliament to believe that everything that makes HSSIB valuable will continue unchanged, but at the same time, they ask Parliament to dismantle the very institutional structure deliberately designed to protect those characteristics. That is not merely an administrative contradiction, but a constitutional one. If institutional independence genuinely matters, it should be preserved. If institutional independence does not matter, Ministers should explain why Parliament was wrong to establish it in the first place.
That question of necessity leads directly to the Government’s principal justifications for clauses 59 to 63, the Dash review. The Government have repeatedly relied on that review as the intellectual basis for abolishing HSSIB as the independent body, yet when one examines the report and the evidence given by its author to this Committee, the case becomes increasingly difficult to sustain.
Without doubt, the review identifies a genuine problem: it concludes that the patient safety landscape has become crowded and in places confusing. Dr Dash told the Committee that she had identified more than 150 organisations operating across the wider patient safety landscape, and that clinicians were spending considerable time responding to different organisations, requesting information, completing forms and participating in overlapping reviews. She said that the system had become “busy and confusing”, and that that was distracting clinicians from improving the quality of care.
Joe Robertson (Isle of Wight East) (Con)
My hon. Friend is making a comprehensive speech and getting to the nub of all the relevant points. He talks about the system failing; to me, that is the absolute nub. The CQC is absolutely part of the system and of the establishment. If anyone is put off from making a complaint to the CQC when they think the CQC may be to blame, how on earth can the functions currently exercised by HSSIB continue in any effective way?
Gregory Stafford
My hon. Friend makes several key points, and he is absolutely right: what problem are the Government trying to solve here? If we believe in independence, believe in an investigatory body and believe it is working well—and it demonstrably is working well—why on earth would we change it? That goes to a further point: these clauses not only potentially provide for a transfer of HSSIB into CQC but add risk and failure in that procedure.
My hon. Friend asks how we can be confident that the system is going to work if a patient or a clinician does not want to put their head above the parapet because they are frightened that there will be regulatory consequence. That is a fundamental problem with the Government’s proposal. As I have said several times in this speech, we have not had the answer to that and no answer seems to be forthcoming. I may touch on that in a bit more detail in a moment.
My right hon. Friend the Member for Godalming and Ash was clear on this topic when he gave evidence to the Committee:
“My concern was that the NHS and actually health systems across the world are not very good at learning lessons when there are tragedies.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 29, Q52.]
That is the problem that HSSIB was created to address and why I struggle with the Government’s argument. If the problem is that the NHS does not learn lessons effectively, the answer should be to strengthen the organisation designed specifically to help it to learn, not to weaken the independence of that organisation. My right hon. Friend the Member for Godalming and Ash identified the precise part of the system that remains broken. He said:
“the Bill does not do anything to address the bit that is not working well, and that bit is that the NHS is still very poor on acting on recommendations that are made”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 30, Q52.]
That is the crucial point. The Government’s justification for the merger appears to be based on a concern that there are too many recommendations, too many reviews and too much duplication, but the evidence of my right hon. Friend highlights a different problem. The issue is not that we do not know what needs to change but that we too often fail to act on what we already know. The answer to that problem is not fewer independent investigations but stronger accountability for implementing recommendations. Indeed, my right hon. Friend made that point powerfully in his evidence. He explained that
“What there needs to be is a formal system with a legal obligation on the Government.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 30, Q53.]
He warned that too often recommendations disappear into what he described as “agree in principle”, which allows organisations to acknowledge a problem without committing to a timetable for fixing it.
The Government are proposing structural change because recommendations are not always acted on, but the problem is not the existence of HSSIB; it is the absence of sufficient accountability when recommendations are made. The Government appear to be addressing the wrong failure. There is another important point from my right hon. Friend’s evidence. He explained that one of the long-term purposes of HSSIB was to reduce the need for expensive public inquiries. He told the Committee that
“Ideally, when something goes wrong, what you want is for there to be an investigation and for lessons to be learned, so that grieving families can say, ‘Well, at least we are confident that this wouldn’t happen again.’”
However, because families often lack confidence that lessons will actually be learned, they understandably seek public inquiries. My right hon. Friend explained:
“families still think the only way they can get real change is through a public inquiry”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 32, Q56.]
That is an important warning. If confidence in HSSIB is reduced, the unintended consequence may be more public inquiries, not fewer—more cost, more delay and, most importantly, more time before lessons are learned and acted on. That is the opposite of what the Government say they want to achieve.
The Government’s second argument is that safe space can be protected through legislation. I accept that Ministers intend to preserve those protections; however, the evidence we have heard demonstrates that the issue is not simply one of statutory wording but of culture and confidence. My right hon. Friend the Member for Godalming and Ash gave a particularly important example: he explained that the CQC plays a vital role because it rates healthcare organisations. Hospitals and GP practices care deeply about whether they are rated “outstanding”, “good”, “requires improvement” or “inadequate”. His concern was this:
“If a staff member is talking openly to HSSIB about a failure of governance in their organisation, and that is the same organisation that could decide whether they get stripped of their ‘outstanding’ rating and downgraded to ‘good’ or ‘requires improvement’, my concern is that some people may worry and say, ‘Maybe I shouldn’t be open, because this could affect my hospital’s rating.’”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 33-34, Q59.]
That is the practical problem: the Government’s argument relies on the assumption that staff will distinguish perfectly between different parts of the same organisation, but the concern is that a frontline clinician may not see those internal distinctions. They may simply see that the investigator and the regulator now sit under the same roof. When people are deciding whether to disclose something that may have consequences for themselves, their colleagues or their organisation, perception matters. As my right hon. Friend said,
“we have to be really careful that people still have confidence in the safe space function if this merger goes ahead.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 34, Q59.]
A similar point was made by Professor Carl Macrae from the University of Nottingham. While giving evidence to the Health and Social Care Committee, he said that it is difficult to conceive how legislation alone could overcome the fundamental conflict created by merging an independent safety investigation body with a regulator, given that the two organisations perform inherently different functions.
The Government’s case depends on trust surviving that merger, but the evidence tells us that trust is precisely what is at risk. Dr Benneyworth made a similar point from HSSIB’s perspective. She told this Committee:
“There needs to be much more clarity about governance and how that will work in the legislation to protect independence.”
She went further and suggested that if the Government proceed, there would need to be much stronger safeguards, including
“a legal duty on the CQC to protect the safe space.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 26, Q44.]
That evidence is significant because it is not a witness arguing that change is impossible; it is the organisation at the centre of this proposal telling this Committee that the legislation, as drafted, does not provide sufficient reassurance.
The Government’s response cannot simply be that they intend to be careful. The former Secretary of State, the right hon. Member for Ilford North (Wes Streeting), said that the integration would be approached with “enormous care”, but we have to ask what that actually means in legal terms. Where are the enforceable safeguards? What prevents a gradual erosion of independence once HSSIB is part of the regulator? History tells us that institutional safeguards matter precisely because they protect against future changes in culture, leadership or priorities. A body can begin with the best of intentions, but still drift over time—that is why Parliament creates independent institutions in the first place. It is not because Ministers are untrustworthy; it is because good governance recognises that structures matter. In this case, the structure matters enormously.
Those concerns become even more significant when we consider the legal framework around protected information and the practical operation of safe space. The Government’s argument appears to rest on the belief that if the right protections are written into legislation, the independence of HSSIB can be preserved, but the evidence we have heard suggests that the challenge is much more fundamental. The question is not simply whether information is legally protected but whether staff, patients and families will continue to believe that it is protected. That distinction matters.
During our evidence session, Dr Benneyworth highlighted a very specific concern about the drafting of the legislation. She explained that, at present, the clauses related to connected individuals could create uncertainty about who in the CQC might have access to protected material. She said:
“The legislation needs to be much clearer around the protection of protected disclosure materials, to give the system confidence in our ability to hold and not share confidential information.”—[Official Report, Health Public Bill Committee, 16 June 2026; c. 25, Q41.]
That is the crucial point: the success of HSSIB depends on confidence that information provided in confidence will remain within the investigation process. If there is uncertainty about whether information could move elsewhere in the organisation, the very existence of that uncertainty risks undermining safe space.
Dr Benneyworth went further. She explained:
“There needs to be a legal duty on the CQC to protect the safe space.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 25, Q41.]
That is a remarkable admission. The organisation whose functions are being transferred to the CQC is telling Parliament that the Bill, as drafted, does not provide that sufficient certainty. The Government’s response cannot simply be that everyone involved will act in good faith. Good governance requires more than good intentions; it requires a structure that protects independence, regardless of who happens to lead an organisation in future, who is Secretary of State or who is in government. That is why Parliament creates these independent bodies in the first place.
There is also a practical issue that cannot be dismissed. Dr Benneyworth explained that HSSIB is unique because it can investigate every part of the healthcare system, including national bodies. She told the Committee:
“At the moment, we have the ability, being an independent organisation, to investigate any part of the system where there is a concern.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 23, Q38.]
That includes looking at how national systems operate, how regulators function and how different parts of the health service interact. That independence is important, because sometimes the problem is not the provider delivering care; sometimes the problem is the system around it.
A regulator may look at whether an organisation has complied with standards; an independent investigator may ask a different question: why did the system make it possible for failure to happen? The questions are complementary, but not interchangeable. Dr Benneyworth made precisely that point when discussing national failures. She explained that some problems cannot be solved by regulating an individual organisation, because the underlying issue sits elsewhere in the system. She said that is not something that can be changed by a regulator—a fundamental distinction. Regulation can identify whether standards have been met and independent investigation can identify whether the system itself needs to change. Both functions are necessary, but combining them risks weakening both.
Those concerns sit within a wider challenge on candour in healthcare. The statutory duty of candour was introduced following the Francis inquiry into the failures of the Mid Staffordshire health trust. The duty’s purpose was straightforward: when something goes wrong, patients and families should receive an honest explanation. Despite that legal duty, however, evidence remains of a defensive culture within parts of healthcare. Legal advice can sometimes encourage organisations to think first about liability, rather than about learning. Administrators can understandably become concerned about litigation risk—and where fear dominates, openness suffers. That is precisely why the safe space matters.
HSSIB was created to provide an environment where the priority is not defending an organisation, but understanding what happened. If we weaken confidence in that environment, we risk making the wider culture of candour even harder to achieve. The irony, of course, is that the Government argue that the merger will strengthen patient safety, and yet the evidence suggests that it could weaken one of the most important ingredients of patient safety: openness.
I also want to express concerns shared with me directly by people working within HSSIB. During a meeting with some of my constituents who work in the organisation, individuals involved in patient safety investigations raised significant concerns about the proposed move. They believe that bringing HSSIB into the CQC represents a backward step for patient safety. They also expressed concern that the rationale for the merger has shifted. Initially, the argument appeared to focus on streamlining and reducing duplication; increasingly, however, it appears to be about reducing the number of safety recommendations being made. That misunderstands the problem.
As I have pointed out before, the challenge is not the existence of recommendations but ensuring that those recommendations lead to action. Indeed, I was informed that HSSIB has already been developing a recommendations monitoring system, specifically designed to improve implementation and oversight. In other words, the organisation is already working to address the very issue now being used as justification for restructuring it. That brings me back to the evidence given by my right hon. Friend the Member for Godalming and Ash. He identified what I believe to be the central weakness in the Government’s argument:
“the Bill does not do anything to address the bit that is not working well, and that bit is that the NHS is still very poor on acting on recommendations that are made”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 30, Q52.]
That is the point that Ministers need to answer. If recommendations are not being implemented, strengthen implementation; if accountability is weak, strengthen accountability; and if learning is not embedded, create mechanisms to ensure that learning happens—but do not weaken the independence of a body responsible for identifying those lessons. The risk is that the Government solve the wrong problem. They will remove the independence of the investigator, while leaving untouched the failure to act on what investigators discover.
After considering the evidence presented to this Committee, the evidence that we heard in the Select Committee and my conversations with my constituents and others, I remain unable to support clauses 59 to 63. That is not because I oppose reform or believe that the patient safety landscape cannot improve—of course it can. The NHS must continue to learn, adapt and improve, but improvement requires honesty about what is working and what is not. The evidence suggests that HSSIB’s independent investigative model is one of the things that is working and that failure lies elsewhere. It lies in whether recommendations are being implemented, whether organisations learn quickly enough and whether staff feel safe enough to speak up. The answer to those problems is not to remove independence, but to strengthen it.
The creation of HSSIB represented a recognition by Parliament that healthcare needed the same principles of independent safety investigation that serve aviation, rail and other high-risk industry so well. Those principles exist for a reason: when something goes wrong, society needs an organisation that people trust to ask what happened, why it happened and what must change to prevent it from happening again. That organisation must be separate from those responsible for regulating the system. It must be able to investigate without fear or favour. It must command the confidence of patients, families and healthcare professionals.
The Government say that the protections will remain, but the evidence we have heard overwhelmingly demonstrates that confidence in those protections is precisely what is at risk. Once institutional independence is removed, it simply cannot be recreated through internal guidance or assurances. The structure matters, the culture matters and the trust matters.
For those reasons, I urge the Minister to reconsider clauses 59 to 63. If the Government believe that improvements can be made to co-ordination, accountability or implementation, discussions on that should absolutely continue and the Opposition would welcome them. However, the clauses go much further. They remove the independent status, which is so important. Given the enormous human and financial cost of avoidable harm in healthcare, Parliament should be extremely cautious before weakening one of the few mechanisms specifically designed to prevent it.
Edward Argar (Melton and Syston) (Con)
I am particularly keen to speak on clauses 59 to 63, because HSSIB was a key part of the Health and Care Act 2022, which I took through as a Minister. At that time, I was grateful for not only the fearless and tough questioning from the now Minister, who was on the Opposition Benches, but for her support. She said:
“HSSIB is a really important new body”––[Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 564.]
She also said that it is a
“new and important body, which we are all desperate to ensure works well.”––[Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 566.]
It is fair to say that it does work well, as my hon. Friend the Member for Farnham and Bordon set out clearly in his detailed remarks. The thread running through his remarks, which is particularly important in this context, was trust. People who have had something go wrong and have reported a problem need to trust that it will be looked at independently and dispassionately.
I fear that what is proposed here results from a deeply misguided decision, which has at the heart of its logic a fundamental flaw. As the hon. Member for North Shropshire set out, the decision fails to recognise that HSSIB’s role is fundamentally different from the role of CQC. It is an independent investigator; it is not a regulator or an enforcer, yet that somehow seems to be conflated in what the Government are trying to do here. They have simply failed to make a logical case for the change.
The hon. Member for Bury St Edmunds and Stowmarket, who I always listen to with great interest on these matters, highlighted that patient safety should be at the heart of this legislation. That is absolutely right, but patient safety goes hand in hand with the confidence of those working in the system to speak out and put forward evidence that will improve patient safety. It is not an either/or; one is complementary to the other. It is important that this safe space remains, because that provides the conditions in which patient safety can be improved.
In her evidence during the first session of this Committee, Dr Dash stated that she found more than 150 organisations operating in this space when she undertook her review. However, in Hansard, she went on to say:
“I was asked by the Department of Health and Social Care to look at that landscape. I was asked to focus on six organisations”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 5, Q2.]
Only six out of 150? That does not ring true. That is not a tidying-up of the landscape but a very narrow focus. When the Minister comes to her concluding remarks, can she answer who specifically determined those six organisations for Dr Dash and told her to look only at those, ignoring the other 144-plus organisations? We all know that what a review comes up with is, to a large degree, determined by the scope set for it. By picking a mere six out of 150-plus organisations, I fear there is a risk that the scope has effectively, to a degree, stacked the outcome of what would be looked at and what would be concluded.
Before addressing specific concerns about the approach being adopted with the abolition of HSSIB, I want to highlight a real challenge with—even if one accepted the premise, which I do not—where it is proposed the functions are transferred to, as my hon. Friend the Member for Farnham and Bordon set out.
Dr Dash said in her evidence that the CQC
“still has a way to go, and we all need to acknowledge that.”
She went on to say:
“I would have hoped that, by now, many of those challenges had been addressed. Some of them have been, but some of them have struggled.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 4, Q2.]
We are talking about moving an effective organisation into another organisation which, quite apart from whether the merger is appropriate given their different remits, is—by the review author’s own admission in evidence—basically not in a fit state to receive those new functions. I think that has been tacitly acknowledged by the Minister in saying it will only be done at an appropriate time, when the CQC is ready. Therefore, why make those changes at all? At the moment, it does not look like the CQC will be ready, at least in the near future, based on the evidence we have heard.
Dr Johnson
My right hon. Friend will be aware that it is not the only thing that the CQC is being asked to take on. It is also being asked to take on the regulation of event healthcare, which is another new function for the CQC, all at a time when, as he says, it has its own difficulties to manage.
Edward Argar
My hon. Friend the shadow Minister is right to highlight, for want of a better way of putting it, the cumulative challenges that will potentially be piled on the CQC, on top of the pre-existing challenges with how that organisation is functioning.
I read with great care the Adjournment debate that took place last night in the Chamber, which has been referred to by a number of hon. Members, in the name of my hon. Friend the Member for Harwich and North Essex, and I pay tribute to him for his work in this space. I worked closely with him in the context of the passage of the Health and Care Act 2022, and I know that the issue of patient safety is fundamental to what he seeks to improve and achieve in this House. I agree with him: I fear the Dash review simply fails to make the case for those changes. Also, as hon. Members have set out, it sadly appears to contain a number of errors and assumptions that are inaccurate, which I will turn to in a moment.
The fundamental challenge is to establish a way for people to feel confident and trusting in challenging a culture of denial and blame. We have seen this most recently in the context of maternity failings and scandals. The need for that safe space, and for an organisation able to challenge the institutions, is very clear, and I fear that this change actually weakens the ability to do that. Dr Dash’s review, I fear, fails to fully recognise just how important the safe space concept is—not just in how it is drafted and framed legally but, as my hon. Friend the Member for Farnham and Bordon said, in how it is perceived by those who need to use it. The CQC, of course, has a legal duty to act on information it receives, but that risks being conflated here.
I saw this illustrated last night, for example, in the Adjournment debate, in a comment made by the Minister’s colleague, the Under-Secretary of State for Health and Social Care, the hon. Member for Birmingham Edgbaston (Preet Kaur Gill), when she was responding to my hon. Friend the Member for Harwich and North Essex. She was talking about the criteria for disclosing protected information outside the investigative function. She said:
“Those criteria set a high bar for any disclosure—as high as it is currently with HSSIB—and the CQC will publish further guidance setting out much more detail.”
This is the key point. She went on to say:
“As the Bill sets out, the CQC will appoint a responsible person who will decide whether the case matches the criteria and whether it warrants information sharing outside the safe space.”
And this is the crux of it:
“That person is likely to be the CQC’s chief executive officer.”—[Official Report, 6 July 2026; Vol. 789, c. 147.]
That is an inherent conflict. If the person who is the head of the regulatory body is making the decision on whether information should be disclosed by HSSIB in its folded-in form, that will do nothing to inspire confidence in disclosure and the safe space provisions. I fear that drives a coach and horses through some of the arguments being made that there are sufficient safeguards within this merger to ensure HSSIB can continue as it has done thus far.
The crux of some of Dr Dash’s arguments appears to be that there are, as the Minister also alluded to, too many recommendations being made and that it is a complex landscape. Yet HSSIB, as my hon. Friend the Member for Harwich and North Essex set out yesterday, has made 56. He went on to say that the 30 or so public inquiries and other investigations have delivered 1,400, so it simply does not follow that HSSIB is the problem in that complex landscape.
What was made very clear by, again, my hon. Friend the Member for Farnham and Bordon is that, of course, the concern is not the recommendations. It is not the organisation making the recommendations that is responsible for the fact that they are not implemented. It is the NHS itself, its inertia, its unwillingness and the Department’s unwillingness to take them forward in a coherent fashion—to drive the recommendations through and monitor whether they have been delivered on by the NHS.
Dr Johnson
On pages 8 and 9 of the Dash review, Dr Dash talks about this. She states:
“Recommendations are…focused on inputs, rather than outputs or outcomes, and fail to…balance…risks within organisations and across systems…the existence of so many recommendations causes considerable confusion for staff. They result in more clinical staff moving into supervisory roles to check that other…staff are adhering to the recommendations. The overwhelming majority of recommendations lack data as to the cost of implementation or the expected impact.”
She recognised, did she not, that there was a problem with people being asked to check up on one another’s work and check up on their work? But the recommendations do not deal with that, perhaps because the scope, as my right hon. Friend has described, is so narrow.
Edward Argar
I do think that the scope of the review, who determined the six organisations and how that was looked at is important, and I am sure that the Minister will be able to clarify that when she makes her concluding remarks. However, there are a couple of other issues that concern me in terms of some of what was in the review, which seems to be the basis on which this is being done. Finding 6 suggests that HSSIB has expanded its
“scope of work beyond the original remit.”
It goes on to say:
“HSSIB was originally established, along the lines of safety investigatory bodies in other industries, to look at specific cases or incidents of severe harm, but it has since broadened its work into making more systemic recommendations.”
I have to say, as the Minister who took the Health and Care Act 2022 through, that is simply not the case. That Act does not limit HSSIB investigations to individual incidents. If I recall correctly, in some of the debates on the HSSIB clauses in the Bill, we alluded as a Committee to the need for it to be able to look beyond individual incidents and try to draw out common themes. What has been said simply does not accord with my recollection of the purposes of the legislation.
Again, my hon. Friend the Member for Farnham and Bordon highlighted this. Recommendation 3 states:
“Most investigations into safety incidents should continue to be managed within provider organisations”.
That is the real challenge here. HSSIB’s independence is what allows it to range across the piece—to have issues raised with it and look at individual organisations. The challenge so often is that the provider organisations are marking their own homework and are simply not getting to the truth, or being as candid with those who have made the complaint as they have a right to expect.
Helen Morgan
I wonder whether the right hon. Gentleman has had the experience that I have had as a constituency MP of very senior clinicians who work in the NHS attending my surgery and explaining that if they have raised concerns within their organisation, they have been encouraged either to leave or to retire. They feel frightened to raise concerns about safety that they have experienced in carrying out their duties, so it is really important that this safe space exists. Does he agree with that?
Edward Argar
The hon. Lady makes her point extremely clearly, and I do agree with exactly the point she makes, because in any organisation it is a big step for an individual employed by or working in the organisation to make a complaint about their organisation or to whistleblow on something that has gone on or that they feel has not been got right. Key to getting people to do that is that they feel safe and empowered to do it in the public interest, and that is exactly what is at the heart of the air accidents investigation branch and the rail accident investigation branch model, so that the information is brought forward and learnings can be driven by it to improve safety for everyone. As the hon. Member for Bury St Edmunds and Stowmarket said, that safety is patient safety and that has to remain the golden thread that runs through everything we are debating. Whatever difference of perspective we have on this set of clauses, that must remain at the heart of what we are looking for.
Joe Robertson
It is a pleasure to serve under your chairmanship, Sir Roger. The issues relating to clause 59, principally the abolition of HSSIB, have been well articulated, not least by my colleagues on this side. I wish to add some of my own views too.
The debate has been framed as a transfer of the functions of HSSIB to the CQC, and indeed that is the title of the clause. The Minister has certainly articulated her arguments in that way. Effectively, it is the abolition of HSSIB. In fact, clause 59(1) plainly says:
“The Health Services Safety Investigations Body is abolished.”
Its functions may be transferred, but that is quite a significant change, and I do not want that to be lost within the context of this debate. At the heart of it is this idea around investigatory and regulatory functions. While the argument remains technical—and it is of course easier for the Government and indeed Dr Dash to make the arguments to abolish HSSIB in the abstract—when we talk about the real-life implications and how real people react to different circumstances, it is plainly very significant and negative.
That is particularly true when it comes to investigating where things went wrong and when the system is at least in question and could be at fault. When there are things that need airing that people are afraid to air, confidence in the new framework is essential. Regardless of the systems, processes or protocols that the Government may wish to put in place to ensure that the safe space concept continues to exist, who on earth, if they are worried about making disclosures, will be satisfied and confident that those in the CQC, who may themselves be at fault, will not learn about a disclosure to the arm of the CQC that is empowered and entrusted with investigating the problem? An independent organisation, which HSSIB currently is, provides not just technical confidence but genuine confidence that people can speak freely on matters that may well be extremely unhelpful to their employer or the CQC—the national regulator itself.
As the hon. Member for North Shropshire noted about the Shrewsbury and Telford situation, it developed while the CQC gave a good rating. It may be that the CQC was fair in doing that, but it does not look good in the eyes of the public, and it will be a consideration for individuals seeking to make disclosures to an investigation. What will the public think?
Gregory Stafford
As I said throughout my speech, I am against this proposal whatever the nature of the CQC. However, does it strike my hon. Friend, as it strikes me, that the problems of moving the functions of HSSIB into the CQC are compounded given that the CQC, as he alluded to, is not functioning well and does not have the confidence of patients and clinicians?
Joe Robertson
My hon. Friend leads me to a point I was going to make later, but I will make it now. He is absolutely right: the CQC has not had a lot of good press and does not instil a high degree of confidence in professionals and the public. That is a very real issue. The Minister and, I think, Dr Dash have said that the transfer of powers from HSSIB to the CQC will not happen until it is in a better place, and that is all very well, but these changes are intended to last for a long time—indefinitely, presumably. To merely wait until an organisation is in a better place to transfer those powers, and to expect that organisation to remain in a better place in perpetuity, is wishful thinking.
The CQC has had leadership issues. We all hope and I am sure that the leadership will be in a better place in the near future, but if an organisation can be in such a bad place because of a failure of leadership, those circumstances can return in the future. Of course, it might be leadership failings within the regulator that HSSIB is asked to investigate. Again, if its functions are delivered by a regulatory organisation with leadership failings, there will be no confidence whatever that a truly independent and meaningful investigation can take place.
Let us not forget that the public are somewhat jaded by investigations, inquiries and reports—justifiably so. They clearly have a valuable function, but their function is far more valuable if there is confidence in them. If a powerful organisation such as the CQC—the regulator—can effectively mark its own homework, that does nothing to help the reputation of investigations and inquiries with the public. I suspect that the problem with them in the public’s mind is that it always looks a little bit like the establishment is looking at itself and coming up with an argument it can then justify. There is a perception that that does not lead to meaningful change. With this Bill, we will create an environment where that perception is even stronger.
Edward Argar
My hon. Friend is rightly highlighting the importance of independence, and trust in the independence, of the organisations investigating failures and making recommendations. Does he agree that that is only half of it? Those organisations are not at fault when recommendations are not implemented, so the other half of this is that the NHS and the system need to act on those recommendations when they are made.
Joe Robertson
It is, of course. I have been focusing on public perception, and my right hon. Friend is absolutely correct that that is only one part of it—an important part of it. Probably, the most important part is what actually happens, and that requires the NHS to learn and improve, which is very unlikely to be improved by this proposal.
Dr Johnson
My hon. Friend is making a very important case about the importance of the perception of independence and the safe space actually being safe. There is a risk that people feel that they will be hounded or—
Health Bill (Fourteenth sitting)
Thursday 9th July 2026
(2 weeks, 4 days ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 9 July 2026 - (9 Jul 2026)
The Chair
Before we begin, I remind hon. Members to switch electronic devices to silent. Tea and coffee are not allowed during the sitting, but there is loads of water—silver is fizzy, blue is flat. I am happy to give a blanket permission for people to take off their jackets. Officially, you are meant to ask me individually, but given the heatwave, take them off if you like.
New Clause 6
Health Data Charter
“(1) The Secretary of State must, within six months of the passing of this Act, establish an independent body (to be known as the "Sovereign Health Data Trust”) for the purpose of creating a Health Data Charter.
(2) The membership of the Trust should include—
(a) people with a diverse range of backgrounds; and
(b) health data experts, clinicians and patient representatives.
(3) The Charter must—
(a) set out the fundamental principles and responsibilities for assessing whether a data sharing partnership is in the interest of the public and the NHS;
(b) include the primary goal of protecting people’s privacy and their data from exploitation, while promoting trust in data systems and the handling of health data;
(c) ensure patients have control of their data, including providing relevant opt-outs;
(d) provide that all health data is held anonymously and accessed through a trusted research environment;
(e) set out ways to retain and protect the value of health data in England, including providing measures to invest a share of the income generated from new medicines or treatments developed with that health data to be invested back into the NHS;
(f) be designed in such a way as to render it interoperable with the European Health Data Space in technical terms, including through the promotion of Findable, Accessible, Interoperable and Reusable (FAIR) data principles within the NHS.
(4) The Sovereign Health Data Trust will—
(a) hold continuous oversight of all health data and oversee the trusted research environment;
(b) have power to recall or restrict an organisation’s access to data if it has reason to believe that the data is not being used for public or patient benefit;
(c) ensure that all data sharing arrangements with a non-NHS organisation are transparent, with all health data contracts entered into by a public body made publicly available;
(d) publish detailed minutes of all meetings discussing potential uses of health data; and
(e) ensure all health data collection and sharing initiatives are preceded by public consultation, involvement and awareness.”—(Helen Morgan.)
Brought up, and read the First time.
Helen Morgan (North Shropshire) (LD)
I beg to move, That the clause be read a Second time.
It is a pleasure to serve with you in the Chair, Dr Huq. The new clause would require the creation of a health data charter, and includes measures to protect data so as to ensure privacy and reasonable usage.
Patients should be in control of their data. As we have discussed in previous sittings, we do not think that the Bill goes far enough to provide reassurances in that regard. Everyone agrees with the need for the single patient record, but there is genuine risk—one that I do not think anyone in this room wants—that it could be derailed over very understandable and reasonable data privacy concerns. Sufficient guardrails and transparency are key, especially for secondary uses of health data. As we have discussed on many occasions, trust is essential for the system to succeed.
That is why we have tabled this new clause on a health data charter that would set out guiding principles for data sharing across the national health service, including for the single patient record. It would be led by data experts, as well as, importantly, clinicians and patient representatives. Ensuring that the voices of doctors and patients are heard is central to building trust and the widespread use of any data-sharing systems or technologies.
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship again, Dr Huq.
New clause 6 raises an important question on how we govern health data, which one of the greatest assets of the NHS. The development of the single patient record platform and database, and the wider use of the linked NHS data, present enormous opportunities.
When used responsibly, healthcare data can support much more personalised care, improve NHS planning, accelerate medical research, enable earlier diagnoses and help develop new medicines and treatments. It can also improve efficiency and strengthen the evidence base for healthcare decisions. However, those benefits can be realised only if the public have the confidence that their data will be used safely, ethically and transparently. Public trust must be the foundation of any successful health data policy.
NHS health data is currently overseen by NHS England, following the merger of NHS Digital into that organisation. With the Government proceeding with the abolition of NHS England and the transfer of its functions elsewhere, it is right that we consider future governance arrangements. In principle, I agree that an independent body may be needed to ensure and maintain the security, integrity and responsible stewardship of NHS data. There is definitely scope for an independent body to oversee the management and regulation of the public’s health data. That proposal places patient privacy at its heart, and would strengthen safeguards against misuse, give patients greater control over how their information is used, and provide meaningful mechanisms to opt out of certain forms of data sharing. It also promotes the use of anonymisation and trusted research environments, allowing valuable research to take place while reducing the risk of inappropriate disclosure. We have discussed inappropriate disclosure by a malign actor, or even inadvertent disclosure, during debate on other clauses.
The Liberal Democrat new clause also seeks to address a concern that has attracted significant public attention: where commercial organisations derive substantial value from NHS data, the NHS itself should share in that benefit. Although we did not support a number of Liberal Democrat proposals because of the inadvertent implications of their drafting, I still have sympathy with the overall thrust of what they were trying to achieve. There is a strong argument that the value generated from the data contributed by NHS patients should help to support future patient care and research.
Transparency is another important feature. Publishing data-sharing agreements, increasing openness around decision making and consulting the public on significant new data initiatives would help to strengthen public confidence. The proposed trust would bring those principles together by overseeing data use, monitoring compliance with governance standards, ensuring transparency and, where necessary, suspending access for organisations that misuse their data.
Of course, any new governance framework must avoid creating unnecessary bureaucracy or delaying important research. To reassure the Committee that the framework would not create a block or dampener, or insert inertia into the system, will the hon. Member for North Shropshire tell us what evidence she found when drafting the new clause? If we are going to do something like this, the oversight should be proportionate, and it should complement, rather than duplicate or frustrate, any existing regulatory responsibilities.
Ultimately, the new clause has potential benefits. It would establish a clear social contract for NHS health data, which would hopefully protect privacy, support research and innovation, maintain public trust and ensure that patients and the NHS share in the benefits arising from the responsible use of a very valuable national asset. In terms of what it could be used for, that data is probably second to none in the world, but I am concerned about adding extra bureaucracy and inertia to the system, when we want a vibrant life-sciences industry that is able to use the data for the benefit of British citizens and patients. What does the hon. Member for North Shropshire think would happen in that case?
Joe Robertson (Isle of Wight East) (Con)
It is a pleasure to serve with you in the Chair, Dr Huq.
My hon. Friend the Member for Farnham and Bordon has set out the arguments clearly; I will just add some of my own views. As he stated, the single patient record provides a unique and special opportunity to improve efficiency across the whole health and social care space and to empower patients, but it faces significant challenges. As I said in an earlier sitting, perhaps one of the biggest challenges is ensuring that it means something in practice. In a previous debate, the Minister helpfully clarified that the data currently held on a great variety of databases and electronic record-keeping systems in the NHS will remain on those wide and disparate recording systems. It seems that the advantages will be realised only if those systems are able to speak together and are fully interoperable.
I know from a previous time in my career that, in reality, many such systems are not interoperable or are only part-interoperable, and that, even where they do speak to one another, the data is collected and recorded in different ways. Simple things—someone’s name, their age or the principal field of the issue for which they are presenting to a clinician—are recorded, but because the systems are not standardised, that data cannot be transferred between them easily.
The advantages of the single patient record will be realised only when all those systems are unified in some form, but the Bill does not address that directly. I am not necessarily suggesting that it should, but I do not see the Government acknowledging anywhere that systems are contracted and provided by private providers through procurement processes at a local level, and asking, “How do we knit that all together?” It seems that somebody somewhere will have to produce some gateway software or system to allow the single patient record to be accessed. If every other existing system needs to be able to feed into that, the public sector will have a huge role, and the private sector will sit behind it to try to deliver that. It seems a huge project that could be fraught with difficulty, it could take many years before the single patient record is established, regardless of when the Bill is passed—although I am sure it will be passed fairly soon.
New clause 6 seeks to address another significant issue with the single patient record: security and the control of data. The single patient record, if fully realised, will make it easier for data to be accessed and shared. Its very purpose is to ensure that systems and services are more integrated and data flows more freely, to avoid the ridiculous situations in which a GP fills out a patient note but cannot share it with a secondary care provider, so must print it out for the patient, or attach a PDF to an email, so that somebody at the other end can input it to their database.
One issue with making it easier to share data—including personal data of the most intimate kind—is that once it has been accessed by bad-faith operators, it is easier for them to run riot and cause an awful lot of damage. It is also much easier for wider access to be shared accidentally, because the whole system is lubricated by the single patient record. I therefore understand the reason for the health data charter as a cure for potential ills.
New clause 6(3)(b) states that the charter must
“include the primary goal of protecting people’s privacy and their data from exploitation”.
That is a fantastic goal that we all support, but I do not necessarily agree that the measure will achieve that. It is an added layer of bureaucracy. My hon. Friend the Member for Farnham and Bordon asked a rhetorical question about the bureaucracy and effectiveness. I endorse that question and hope that the hon. Member for North Shropshire will answer it.
I am minded not to support the proposal, though I agree with what it tries to achieve. If the Minister does not support the new clause, will she explain how its aim of protecting people’s privacy will be delivered by the Bill? There seems to be great scope for the undermining and abuse of privacy, not just deliberately by bad faith actors, but inadvertently.
A second issue aim of the charter is the balance between the security of personal data and the recognition of the value of anonymised data gathered by the NHS for research and development. Fully anonymised data that cannot be unpicked through reverse engineering is of huge value, both commercially and for the public good. Commercial value and the public good are not necessarily opposed to each other; in fact, they often come together. The NHS should be able to exploit the value of that anonymised data—“exploit” is probably seen as a negative word—for the public good. How do we balance that with people’s right to privacy?
Again, there is the possibility of inadvertently using for a wider public good data that was intended to be anonymised but in which people can be identified. The charter tries to get to the heart of that issue as well, which I welcome. Indeed, new clause 6(4)(a) states that the sovereign health data trust will
“hold continuous oversight of all health data and oversee the trusted research environment”.
The Minister may not agree with the new clause, but how will the Government’s proposals balance the security of an individual’s personal data while exploiting, for the public good, the value of the huge depth of anonymised data that the NHS holds and will hold? It could be used to drive so much innovative research and development, for the benefit of health delivery not only in this country, but across the world. Such a valuable commodity has commercial value that could deliver financial benefit to the NHS. I think we all agree that we have not yet exploited that area to the fullest. There is an opportunity to do so with the single patient record—if it is done properly, with all the necessary safeguards.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
As my hon. Friend the Member for Isle of Wight East just said, new clause 6 seeks in essence to ensure that we have good data security and control, with which I agree. Trust is important, data security is important and supporting research with anonymised data is a good thing to do.
What would the new clause do? First, it would establish an independent body known as a sovereign health data trust. In essence, that is a group of people who have been put together. The new clause does not say how big the group would be—I do not know whether the hon. Member for North Shropshire had its size in mind—but it describes a group of people with
“a diverse range of backgrounds…and…health data experts, clinicians and patient representatives.”
Are the first group intended to be laypeople, rather than experts? What does the hon. Lady mean by a “diverse range of backgrounds”? Does that relate to protected characteristics, or is she looking for a farmer from Northumberland and a lawyer from Islington, because they have different backgrounds? It is not entirely clear what she means, so I would be grateful if she clarified that. Additionally, however big that group is, who would decide how it is composed and by what criteria? Who would be responsible?
The sovereign health data trust would be charged with creating a health data charter. That leads me to my second question: what is a health data charter? In essence, a health data charter—as defined in the new clause—must
“set out the fundamental principles and responsibilities for assessing whether a data sharing partnership is in the interest of the public and the NHS”,
and, as my hon. Friend the for Isle of Wight East said,
“include the primary goal of protecting people’s privacy and their data from exploitation, while promoting trust in data systems and the handling of health data”.
That is important, because we have heard in the media several examples of data being put up for sale or leaked, and the problems caused by that.
The charter must also
“ensure patients have control of their data, including providing relevant opt-outs”.
I am glad to see that bit about relevant opt-outs. We have talked about the importance of the record being shared not as a whole, but in pieces. Things such as obstetric or sexual health ought perhaps to be consented to separately. Patient control of the data is important. How would the hon. Member for North Shropshire deal with safeguarding issues in the control of data, particularly in relation to children?
The new clause sets out that the charter must
“provide that all health data is held anonymously and accessed through a trusted research environment”—
which seems reasonable—and must
“set out ways to retain and protect the value of health data in England, including providing measures to invest a share of the income generated from new medicines or treatments developed with that health data to be invested back into the NHS”.
Earlier this week, the hon. Member for Lichfield and I discussed the important value of the NHS data—I think he said that it was the most valuable dataset in the world, and he might well be right. I was a bit confused by that part of the new clause, because we talked earlier this week about the Health Services Safety Investigations Body being able to sell time and training and share expertise, including with private sector organisations overseas. The Government changed that in the Bill, so that they would only be able to retain costs and not make any money for the Treasury. When we put amendment 56 to a vote, the Liberal Democrats abstained. I do not know what the difference is between using NHS data for research and the HSSIB using their expertise for training overseas organisations. I would be grateful to understand that.
The charter must be
“designed in such a way to render it interoperable with the European Health Data Space”.
The European Health Data Space regulations were introduced in March 2025. We are in a transition period, and they will be implemented in 2027 and 2029. It should be interoperable in technical terms
“through the promotion of Findable, Accessible, Interoperable and Reusable (FAIR) data principles”.
What is the European Health Data Space? Essentially, it is a single patient record for Europe. Its instructions say member states may—I underline the word may—offer
“an opt-out option for the cross-border exchange of electronic health data under EHDS.”
I do not understand the Liberal Democrats’ argument for that, because they have made a strong argument throughout Committee stage that data needs to be shared carefully. They advanced some clauses that will ensure that data is held in the United Kingdom and that we use British tech where possible. New clause 6 would make us interoperable with the European system and presumably move us towards European systems.
Gregory Stafford
I do not mean this as a cheeky point, but is it not the case that clearly, as with everything, the Liberal Democrats think that the European Union can do no wrong? They do not see the same problems of data that they have expressed in other clauses because they want to rejoin the European Union. Therefore, they conceive that it can have no possible harm to British subjects.
Dr Johnson
Indeed. When reading it, it is ironic to me that they seem comfortable with data being shared across the EU but not across our own country. It did not make complete sense to me, but the hon. Lady for North Shropshire may be able to tell us more about that in her summing up.
What else will the sovereign health data trust group do? It will have
“continuous oversight of all health data and oversee the trusted research environment”.
Having oversight over “all health data” is quite a big job. Again, what sort of resources does the hon. Lady think that will entail, and what does she have in mind in terms of the cost and bureaucracy of that? It would also
“have power to recall or restrict an organisation’s access to data if it has reason to believe that the data is not being used for public or patient benefit.”
What is the threshold for that? A lot of these organisations will be working in a commercial environment; if they receive a letter, potentially from a competitor, saying there is a concern, does that meet the threshold? What would the threshold be?
Having decided that the data might not be used for public benefit, what investigatory powers does the hon. Lady envisage the trust having to establish whether that is the case or not? What if it does receive some concerning correspondence, it does the investigation under the investigatory powers that it has been given, it decides that it does not think it is being used for public or patient benefit, and it restricts the organisation’s ability to access data? That will potentially have a significant financial penalty and it may affect patients’ access to healthcare, too. What right of appeal would the organisation have? Who would they appeal to and how would it work? On the wording, commercial activity may well benefit patients, which is sometimes forgotten.
The next thing the data trust will have to do is
“ensure that all data sharing arrangements with a non-NHS organisation are transparent, with all health data contracts entered into by a public body made publicly available”.
I would like some more detail about that. Would that include anonymously provided data? What effect would that have on the research environment and the integrity of research done under commercial arrangements? What about the costs? Would any costs be shared and what effect would that have on future commercial negotiations when the Government are trying to get the next organisation to look at the data? What level of detail made publicly available in the contract would need to be provided?
The trust would need to publish minutes of their meetings, which seems reasonable. It would need to
“ensure all health data collection and sharing initiatives are preceded by public consultation, involvement and awareness.”
Do the Liberal Democrats really intend for all data collection to go through public consultation? If, as we talked about regarding corridor care, the Government wanted to know how many people are waiting more than 24 hours in A&E, would they have to do a public consultation to collect that data? It seems overly bureaucratic.
Gregory Stafford
Is that not part of the problem with the wording of the new clause? It is not clear, from the new clause, what is NHS data and what is the patient’s data, and who owns which bit of it. The problem with the drafting of the new clause is that it appears to cover every single piece of data held by the NHS, whether it directly relates to a patient or not. Additionally, if the Government were to collect any other sort of data, even if on an aggregate basis, it would come under this. That would be totally unworkable and put an enormous burden of bureaucracy on the health service.
Dr Johnson
My hon. Friend is, as ever, correct. I would be interested in whether the hon. Member for North Shropshire has made any estimates of personnel time or cost that the proposal would entail.
In summary, the new clause would create an unelected committee removing democratic control. Essentially, it is asking a committee of unelected individuals to write and implement policy, which is the job of the Minister. That should be under ministerial control.
Joe Robertson
Does my hon. Friend agree that there is an overarching issue here of public confidence in the safety of their data? That is not about one company or another; it is about ensuring that robust safeguards are in place for everyone and for every provider of a data and record-keeping system. If the public do not have confidence, they will understandably withdraw consent for their data being held. That will undermine the single patient record and the whole way in which health can be delivered efficiently in the best interests of patients.
Dr Johnson
I agree. I am sure that the purpose behind the new clause is to ensure that data is safe, but it removes democratic accountability from the process of developing the policy, which may reduce the public’s confidence in it. I agree with its underlying principles, but much of it is cumbersome and, as yet, undefined, so it is important that we get more detail and specificity.
The Minister for Secondary Care (Karin Smyth)
It is good to see you in the Chair, Dr Huq. I am grateful to the hon. Member for North Shropshire for tabling this new clause. I am sympathetic to its intentions: the security of data, the transparency of use and even realising the value of data. Its principles are in the interests of the public and the NHS, but we do not consider it necessary to achieve our aims. It would impose onerous operational requirements and could have a damaging impact on the ability of the NHS to function.
There is also a significant overlap with the role of the independent national guardian and potentially that of the information commissioner. Once the functions of NHS England have transferred to the Secretary of State, the Secretary of State must have regard to the need to respect and promote the privacy of recipients of health services and of adult social care in England, which is in addition to the requirements already set out in UK GDPR. The Secretary of State will be able to issue guidance to the health and care sector relating to the processing of information to which NHS bodies must have regard. The Secretary of State will be under a duty to have regard to guidance given by the Health Research Authority on the disclosure of confidential information.
The proposed trust functions would also encroach significantly on the operational role intended for the health data research service, and would place cumbersome constraints on vital data collecting and sharing within the NHS. The new clause would mean that all health data collections and data-sharing initiatives would have to be preceded by public consultation. That would capture any of the essential collections that NHS England undertakes, and indeed any collection by NHS organisations, not to mention the use of that data. The burden would be considerable, with very real consequences for the ability of the NHS to use that data to improve outcomes for patients.
Likewise, I cannot see how requiring all health data to be held anonymously and accessed only through a trusted, secure research environment would be compatible with delivering direct care to a patient or using confidential patient information for planning and commissioning services or research. It seems that the new clause would prevent such uses. For those reasons, I ask the hon. Member to withdraw the motion.
Helen Morgan
Hon. and right hon. Members on the Committee will understand that we are talking about a single patient record that we do not understand much about yet, because most of the detail will come later. This new clause is attempting to establish what guardrails we would like to see for the protection of patient data when the single patient record is brought into existence
There are very genuine concerns about people’s health conditions becoming individually identifiable. If there is an individual in a single postcode with a rare condition, anonymising the data can essentially never happen. That is a genuine concern that people have. I hope that, when we get to Report stage, the Government will be able to give us a little more detail on what safeguards they intend to put in place over the use of that data. To that end, I do not intend to press this new clause to a vote, but I hope that the Government will take into account the concerns we have expressed about building trust and protecting data privacy, and will give us further reassurance at a later stage. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 11
Directors of public health
“After section 7B of the National Health Service Act 2006 insert—
‘7BA Directors of public health
Each integrated care board must, for the purposes of exercising any public health functions directed by the Secretary of State, appoint a lead director of public health.’”—(Dr Caroline Johnson.)
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss new clause 24—Directors of public health: requirements and functions—
“After section (73C) of the National Health Service Act 2006 insert—
‘73D Directors of public health: requirements and functions
Directors of public health must—
(a) be an officer of the local authority and shall have responsibility for its public health functions,
(b) be an NHS consultant in public health responsible for giving independent professional public health advice and for promoting public debate on health matters,
(c) be a corporation sole and NHS body for working with others to initiate measures to improve the health of the people,
(d) be an officer of the Crown responsible for such functions as the Secretary of State may specify,
(e) as an officer of the Crown have power to draw the attention of the Chief Medical Officer and the Attorney General to events within the area of the local authority creating circumstances in which it might be appropriate to bring proceedings in the name of the Crown for public health purposes,
(f) be an officer of the National Health Service responsible for promoting the provision of services which are outcome-focused, are provided following a proper needs assessment and pay attention to the promotion of health and the prevention of illness,
(g) as an officer of the NHS, have power either personally (in the case of a body which primarily serves the population of the local authority which appointed the DPH) or through joint arrangements with other Directors of Public Health (in the case of a body which primarily serves the population of several local authorities) or through a collective arrangement established by the Chief Medical Officer (in the case of a body with a national remit) to appoint, or approve arrangements for the body to appoint, a consultant in public health to serve on the governing body of any NHS body (other than an NHS body which is a local authority), any NHS Foundation Trust, any of the bodies established under this Act or any of the bodies established under the Health & Social Care Act 2012 or any other legislation relating to the governance of the NHS (for the avoidance of doubt the consultant so appointed may be, but need not be, the Director of Public Health personally).
(h) as an officer of the NHS and of the local authority, have power either personally (in the case of a body which primarily serves all or part of the population of the local authority which appointed the DPH) or through joint arrangements with other Directors of Public Health (in the case of a body such as a joint board or combined authority which primarily serves the population of several local authorities) to appoint a consultant in public health to attend any local authority meeting and to advise the meeting whilst it is in session on matters affecting the health of the people (for the avoidance of doubt the consultant so appointed may be, but need not be, the Director of Public Health personally and a different consultant may be appointed for different meetings).
(i) be contractually required, subject to law, to carry out the functions in subsections (b) to (h) herewith as an independent health professional treating a population as a patient and pursuing the improvement of its health and to be contractually entitled not to be subject to any detriment by the local authority or by the Crown for so doing.’”
Dr Johnson
I want to briefly discuss these new clauses because I think that they are important, particularly because they were tabled by the hon. Member for Worthing West (Dr Cooper), who is an expert in the field. New clauses 11 and 24 relate to directors of public health. We know from the Government that prevention, and therefore public health, is extremely important. New clause 11 says:
“Each integrated care board must, for the purposes of exercising any public health functions directed by the Secretary of State, appoint a lead director of public health.”
New clause 24 sets out the requirements and functions of directors of public health—what such an individual will do.
Currently, every local authority must have a director of public health, which is set out in statute. They focus on three areas: health protection, health improvement and healthcare public health. They take the evidence in relation to their population, produce a vision, develop aims, deliver those aims and then produce a report annually to say how they are getting on with that process. The National Health Service Act 2006 says that that must be done across an upper tier or unitary local authority area, and that directors of public health must provide advice about public health to any ICBs that overlap with their area. ICBs also have a legal duty to seek advice on protecting public health when they are exercising their functions.
I think that we all agree across the Committee that public health is important, but I do have some questions. Unfortunately, the hon. Member for Worthing West is not a member of the Committee, so she is not able to respond to any questions today. We have talked in this Committee about the representation of local authorities on ICBs and the fact that Government cuts of 50% have led to a merging of ICBs in a somewhat haphazard fashion, which means that there can be a clash between different areas.
I guess that my question for the Minister would be this: if this clause were to come into force and the ICBs that are no longer coterminous with the local authority upper-tier or unitary authority areas, would there be a duplication of work? My other concern would be that it would lead to a situation where there might be one director of public health with a vision to go one way, and another with a direction to go the other way. If that happened, how would the negotiation process work? I think this measure was brought in with good intent by a lady who is an expert in the field, but I have more questions than answers about how the clause will work in practice.
Gregory Stafford
It is very important that we consider these new clauses and amendments carefully, not least because, as my hon. Friend has just outlined, the hon. Member for Worthing West, who tabled them, has considerable expertise, being a public health consultant herself. I have the pleasure of sitting with the hon. Member on the Health and Social Care Committee and she brings her expertise to every single sitting. I am sure that the Minister has welcomed her questioning when she has appeared before that Committee.
It is really clear that, if we are going to make a success of the Bill, public health in all its guises needs to be at the forefront of our thinking about how we achieve better patient outcomes, better health and, more specifically, the Government’s stated aims in the 10-year plan to, first, shift care closer to home and, secondly, focus more on prevention rather than treatment. I am sure that across the House we agree with that ambition and therefore I can totally understand why the hon. Member for Worthing West has tabled these new clauses.
I suspect that the new clauses are also a reaction to something that we have already discussed in this Committee, which is the dislocation and now the separation of local authorities from ICBs, with the removal of their statutory functions on those boards, to be given to strategic mayoral authorities. Some of those strategic mayoral authorities exist but, as we have discussed at some length in the Committee, many of them do not exist and might never exist. I can see why the hon. Member for Worthing West is trying to ensure that the vital work of directors of public health in local authorities for their population areas is somehow safeguarded and included in the Bill.
That being said, I have some reservations about how these new clauses are currently drafted. My hon. Friend the Member for Sleaford and North Hykeham has already outlined many of them. Although strengthening public health leadership is an essential objective, new clause 24 defines the statutory role and legal status of directors of public health in this context without providing sufficient clarity about accountability or governance, or about how these new powers would interact with existing NHS and local authority structures. Potentially, there is a risk of creating overlapping responsibilities, blurred lines of accountability and additional bureaucracy at a time when integrated working should be simplified rather than made more complex.
Obviously, the hon. Member for Worthing West is not here to answer my questions. I ask the Minister this: if these new clauses are not pressed to a vote, or if they are but are not accepted by this Committee, how can she reassure me and the hon. Member for Worthing West that public health will still be at the forefront of the Bill, and that the removal of local authorities from ICBs will not have the impact that I think the hon. Member, who tabled these new clauses, is concerned about?
Karin Smyth
Further to that point, I absolutely want to assure my hon. Friend the Member for Worthing West, who is not a member of this Committee, and indeed the members of this Committee that the Government fully appreciate the important role of public health professionals. They bring critical expertise in population health intelligence, epidemiology and community co-design, and those capabilities are integral to the role of ICBs as strategic commissioners.
On new clause 11, there is already a statutory duty on ICBs to seek advice, and a statutory duty on local authorities to provide public health advice to ICBs. However, that does not mean that ICBs should be required to employ a director of public health directly. Local authorities already employ a director of public health and we expect ICBs to work collaboratively with their local authority partners and not to duplicate their work.
NHS England recently published the strategic commissioning framework and guidance for ICBs on strengthening the public health advice, both of which are clear that ICBs should work with local public health teams and stakeholders to draw upon their expertise to ensure a strong evidence base for commissioning decisions.
As the responsibilities of ICBs for commissioning NHS public health services grow, we expect them to continue to draw on the skills and expertise of local authority directors of public health, as well as other specialist public health expertise, including screening and immunisation leads, and the UK Health Security Agency. I absolutely agree that public health expertise is essential for ICBs to commission effectively and we have set out how they will access that; the basis for all this is of course the joint strategic needs assessment. However, I do not believe that it is necessary to require an ICB to appoint a lead director for public health in order to have access to such advice.
On new clause 24, as the Committee is aware, local authority directors of public health are advocates for the health of their population. They have a professional leadership role across the three domains of public health: health improvement, health protection and healthcare public health. Their work spans organisational boundaries. Although they are employed by local authorities and appointed jointly with the Secretary of State, their role is designed to bridge local government and the NHS. They are also required to provide objective, evidence-based advice, without political interference, and they are expected to be suitably qualified and regulated public health specialists who take a population-wide perspective to health outcomes and health inequalities.
At the heart of their role is their statutory responsibility to prepare an annual report on the health of their local population. That crucial document underpins the plans of health and wellbeing boards and, through them, the ICBs. Directors of public health are also required to be members of health and wellbeing boards, which will be the central mechanism for partnership working between local authorities and ICBs in the new neighbourhood health system. As such, directors of public health will be well placed to help to shape ICB system-wide plans and strategies on public health issues going forward, something that we discussed earlier in the Committee.
There is a statutory duty on ICBs to obtain appropriate and expert public health advice, and a legal duty on local authorities in turn, carried out by the director of public health and their team, to provide public health advice to ICBs. Beyond those requirements, the NHS, including ICBs, is of course free to employ its own senior public health professionals.
The proposed new clause risks creating some significant ambiguity around accountability and risk, constraining rather than enhancing the independence of directors of public health, which I am sure is not the intention of the hon. Member for Sleaford and North Hykeham or of the Committee. I hope I can offer reassurance to the hon. Member and indeed to the Committee that we are proud of our strong and coherent public health system, that this Bill does not alter its importance and that we will continue to champion the role of directors of public health and ensure clarity in the new architecture. I ask that the new clause be withdrawn.
Dr Johnson
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 12
Corridor Care Accountability
“(1) Six months after the passage of this Act, and every 12 months thereafter, the Secretary of State must produce and lay before Parliament a report on the prevalence of corridor care in NHS hospitals.
(2) A report under subsection (1) must include—
(a) an analysis of data on the number of corridor incidents at the national, integrated care board, trust, and hospital level,
(b) the steps the Secretary of State has taken that year to reduce the number of corridor care incidents,
(c) the Secretary of State’s plans to reduce the number of corridor care incidents in the coming year, and
(d) information regarding the amount of funding directed toward reducing the number of corridor care incidents that year and funding allocated for such efforts in the future.
(3) Following the publication of a report under subsection (1) the Secretary of State must give evidence in front of a panel (to be called the “Corridor Care Tribunal”) including—
(a) patients,
(b) bereaved or affected families, and
(c) frontline NHS staff who have been impacted by corridor care.
(4) Panel members for a Corridor Care Tribunal under subsection (3) shall be identified by local Healthwatch organisations and NHS Royal Colleges.”
This new clause requires the Secretary of State to publish an annual report about corridor care and give evidence before a panel of affected patients and staff.—(Helen Morgan.)
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss the following:
New clause 56—Accident and Emergency: waiting times—
“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision relating to Accident and Emergency Department admission.
(2) Provision under subsection (1) must include the requirement for every patient to be admitted into an Accident and Emergency Department within 12 hours of approval of their admission being made.
(3) The Secretary of State must establish and implement an Accident and Emergency Scheme (“the Scheme”) to support NHS hospital trusts to achieve the requirement set out in subsection (2).
(4) The Scheme must consider—
(a) creating safety-net social care beds,
(b) increasing step-down care,
(c) publishing a dedicated accident and emergency care workforce plan, and
(d) mandating a qualified clinician is present in every Accident and Emergency waiting room.
(5) The Secretary of State must have due regard to the final report of the Independent Commission on Adult Social Care in establishing the scheme.”
This new clause gives patients a legal right to be admitted into A&E within 12 hours from decision to admit and requires the Secretary of State to introduce a scheme to achieve this.
New clause 84—Publication of data on avoidable deaths—
“(1) The Secretary of State must publish every quarter the number of avoidable deaths where waits of more than 12 hours in accident and emergency departments was a contributory factor.
(2) The Secretary of State must make the data under subsection (1) available by integrated care board area.”
This new clause would require the Secretary of State to publish data on avoidable deaths caused by waits over 12 hours in A&E departments.
Helen Morgan
New clause 12 would require the Secretary of State to publish an annual report about corridor care and to give evidence before a panel of affected patients and staff.
In the main Chamber yesterday, we had a Backbench Business debate on corridor care, introduced by the hon. Member for Tooting (Dr Allin-Khan). There was a great deal of consensus across the House about the harm that corridor care causes to both patients and staff, and the requirement for urgency in dealing with that issue.
I am not going to remake the same speech that I made yesterday on corridor care for the Minister’s benefit, because she heard it yesterday and there is little value in repeating it. What I will say is that it is important that there is an understanding at a ministerial level of the personal impact that corridor care has on patients and their families.
That is the purpose of this new clause: to ensure that the Secretary of State is taking the concerns of patients and staff very seriously, hearing them at first hand and then reporting back progress to the House on dealing with the issue. At the moment, it feels as if every year we acknowledge the problem in the House, every winter there are statements on winter crisis and corridor care, and we never really seem to take any steps forward. The new clause aims to ensure that is no longer the case.
New clause 56 is intended to give patients a right to be admitted to accident and emergency
“within 12 hours from decision to admit”,
and would require the Secretary of State
“to introduce a scheme to achieve this.”
We have discussed the legal right to admit and the legal right of patients on a number of occasions. I just want to clarify our intention, because it always raises some questions. The NHS constitution enshrines legal rights for certain things: for example, the two-week wait for a cancer referral to a specialist and the right to receive elective care within, I think, 18 weeks, if so referred. The other targets in the NHS are pledges; there is an aspiration for the Secretary of State to meet them, but it is not a right of the patient that the Secretary of State meets them. We think that 12-hour waits on corridors in hospitals merit the same urgency as cancer referrals, because they lead to awful outcomes.
Edward Argar (Melton and Syston) (Con)
I agree with the broad thrust of the points made by the hon. Member for North Shropshire in highlighting the impact of corridor care on patients, on families and on those seeking to provide the care for those patients. I suspect that pretty much all of us, in our own lives or as constituency MPs, will have come across examples of that and the impact that it has on our constituents, or on our friends and family members, so it is a very important point.
Before I turn to new clauses 12 and 56, I will briefly address new clause 84, tabled by my hon. Friend the Member for Sleaford and North Hykeham. It is a very moderate and reasonable proposal, in that it seeks simply for data to be made available and published on where 12-hour-plus waits in A&E have contributed to avoidable deaths. That should not be a challenge; I suspect that that data is already extant in some part of the system. She is proposing a very moderate measure, which would pull all that together in one place, and allow it to be focused on and looked at in the round, rather than in disparate little penny packets of data. That is a very reasonable proposition.
The only challenge that I see is, sadly, in proposing it for integrated care board areas. Were the ICBs still what the Conservatives had conceived them to be—a number of geographical areas mapping on to an upper-tier authority social care provider—that data would have been even more meaningful, because it would have been more granular. The risk with the mergers and acquisitions—for want of a better phrase—among ICBs to form ever-larger areas is that that granularity is increasingly diluted. I fear that the genuinely positive benefits of what my hon. Friend is proposing might be somewhat diluted by virtue of what the Government are doing.
Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
On the publication of data on avoidable deaths, new clause 84 states
“where waits of more than 12 hours in accident and emergency departments was a contributory factor.”
Does the right hon. Member consider it likely that there is any great accuracy in the assessment of whether a death was avoidable?
Edward Argar
The hon. Gentleman makes a valid point, and I suspect that he has seen this issue in his professional career. Often, when a death occurs in a clinical setting, multiple factors are contributory. I think that that is why my hon. Friend the Member for Sleaford and North Hykeham framed this as she has, as “a contributory factor”—not the sole factor or the individual most significant factor, but that it could reasonably be deemed by a clinician or by those collecting the data that the long wait contributed to the death, because had that patient been seen, for example, in two hours rather than 12 hours, better clinical outcomes might have been achievable.
I take the hon. Gentleman’s point, however, that with many of these things—both clinicians and coroners grapple with this—it is often complex to determine the actual most significant contributory factor. My hon. Friend the Member for Sleaford and North Hykeham may correct me, but I think that is why she framed new clause 84 as she did, to allow for that degree of a lack of total certainty in such contexts. Nevertheless, the hon. Gentleman makes a reasonable point.
I can see what the hon. Member for North Shropshire is seeking to do in new clauses 12 and 56: not unreasonably, she seeks to cast light on the impact of corridor care on patients, families and those caring for people. My only challenge would be—I will enlarge on this in a little more detail—that a narrow focus on corridor care, while understandable, slightly loses the bigger picture. Corridor care is, for want of a better way of putting it, a subset, a consequence, of a much broader systemic challenge.
The Minister will probably know this as well; when I was first appointed to her job, one of the first conversations I had in the context of secondary care was about the importance of flow through our acute hospital systems, from a patient either presenting at A&E or arriving by blue light at A&E, to being treated, and the ability of A&E to function through those patients being seen, treated, and discharged or put into a hospital bed to become an in-patient. The ability to achieve the latter is dependent on the ability to discharge.
Helen Morgan
New clause 56 speaks about the importance of creating capacity across the system, including social care, and about having regard to the outcome of Baroness Casey’s commission on social care to deal with the issue of capacity and flow through the hospital. We have discussed at length in Committee other amendments that would deal with the front door, in terms of GP access and trying to ensure that people are treated at first in the community, rather than ending up in A&E as a last resort. I wonder if the right hon. Gentleman would just acknowledge those points.
Edward Argar
The hon. Lady pre-empts me— I am afraid I have rather a few more remarks to come to. I planned to through the subsections and paragraphs of her new clauses to acknowledge exactly that. For example, in proposed new clause 56(4), she highlights capacity, and in proposed new subsection (5) she mentions Baroness Casey’s independent commission and the need to pay heed to it. All that is important, but my slight fear relates to the drafting. While the new clauses note such factors, they do not necessarily reflect the overall interdependency of all parts of the system. I believe that what the hon. Lady seeks to achieve is perfectly reasonable, but I am not convinced by how the new clauses are drafted.
The hon. Lady was right to highlight in her remarks the importance of timely discharge from hospital as a key element of whether we can achieve that flow into hospital beds and have hospital bed capacity to allow an A&E department or emergency department to function. I looked at this issue four years ago, so the situation may well be very different today, but post the pandemic I inherited about 13,000 acute beds across the system occupied by patients who were medically fit for discharge, but whose discharge had been delayed due to a variety of factors. Some were because hospital pharmacies were not open through the night to provide the drugs when patients were signed off to go home; some were because of the unavailability of patient transport; some were because all the necessary clinicians were not present to sign in the appropriate order.
The single biggest factor, as the hon. Member for North Shropshire has alluded to, was the availability of step-down or social care provision, so that patients could safely go home or to another NHS or care facility and be looked after. We managed to get the delayed discharge total down from 13,000 at a given time to about 10,000—possibly just a bit under. I would be interested to hear from the Minister what the current total is for beds occupied by those medically fit for discharge at a given time.
I see where the hon. Member for North Shropshire is coming from with her suggestion of a tribunal comprised of a mixture of people to interrogate the figures and interrogate the Secretary of State. I can see that she is seeking to make the experiences of those undergoing corridor care and their families real to Ministers, who will be accountable. I gently say that I suspect that the Minister and her boss, the Secretary of State, are only too aware of the consequences of corridor care. Such patient experiences very much weigh on them as Ministers, as they did on me and others, day in, day out. We were always very cognisant of them.
I can see the hon. Member for North Shropshire’s intention with new clause 12(4), where she suggests that Healthwatch should be involved in helping put such a tribunal together. I fear that the Government’s direction of travel may have rendered subsection (4) redundant, but I do not disagree with the intention, because I think she and I both share a view on the importance of healthwatch groups and the value that they bring locally to our healthcare system.
While I can see the point about waiting 12 hours from arriving at the hospital to being taken into A&E, but the new clause does not reflect how the system might seek to manage that. It does not explicitly reference ambulance handover times and waiting times. A challenge we have seen in the past is that, in a desire to avoid hospital corridor care, some trusts have not admitted patients from ambulances until they feel that they could manage them in the hospital.
Arguably, that is less safe than corridor care, for two reasons: first, because the ambulance is not able to offload and be available in the community again and, secondly, because although corridor care has negative consequences, none the less in a hospital corridor there is a consultant or clinician very nearby, should a medical crisis occur. That is better than someone being in an ambulance in the car park—or waiting at home, having called an ambulance that is not coming, and not having their condition assessed because the ambulance is still holding a patient that a trust does not want to admit, in order to avoid congestion and corridor care.
I worry that, although the new clause has the best of intentions, the way the system might react and the impact on ambulance handovers and the ability of ambulances to pick up patients might have been overlooked. That is not a reason not to try to solve the problem of corridor care, but we must acknowledge the ambulance part of the challenge in A&E and emergency care, and encourage and incentivise the system to work as a whole to solve the problem, rather than focusing purely on the ED. In saying that, I acknowledge that the hon. Lady has referenced social care, step-down beds and community care, which are all hugely important, and I listened to her speech with interest, as I always do her contributions.
I would be grateful if the Minister could update the Committee on the latest daily figure for how many patients who are medically fit for discharge are still in an acute hospital bed. Perhaps, when the hon. Member for North Shropshire winds up on this group, she might be able to address the ambulance point—she addressed the social care point, but I would be grateful for her thoughts on ambulances.
Gregory Stafford
I rise to support a lot of what my right hon. Friend the Member for Melton and Syston said. Across the Committee, I think we all agree that corridor care and care in other inappropriate settings should have no place in the NHS. No patient should be assessed, treated or left waiting in a corridor, in a cupboard or anywhere else because there is nowhere for them to go.
We owe it to patients and our constituents to be honest about the scale of the problem and be serious about ending it. That starts with measuring it properly, because if we do not collect the data, publish the evidence and track progress, inappropriate care settings risk becoming normalised. In May, nearly 3,000 patients were in corridor care, which was a 2.5% increase from the same time last year. In the same month, 50,000 patients waited in A&E for more than 12 hours, which was a 17% increase from the same period last year.
The Government continually miss their target on the 12-hour wait. I am not making a political point; this is a serious problem, and successive Governments are still struggling to ensure that it does not happen. We all know from our casework and our inboxes, and some of us know through personal experience or from loved ones, that too many patients are experiencing unacceptably long waits in A&E after a decision has been taken to admit them. That is bad for patients, bad for staff and bad for the wider functioning of our hospitals.
New clause 56 in the name of the hon. Member for North Shropshire acknowledges that the causes of delays extend far beyond the emergency department itself, and I will touch on that in a moment. Challenges in social care, discharge processes, step-down provision and workforce capacity all contribute to bottlenecks that leave patients waiting longer than they should. Although there might be legitimate questions about the precise mechanisms proposed in the new clause, I do not think there is any disagreement among the Committee about the principle that patients deserve timely access to a hospital bed and that excessive admission delays should not be accepted as the norm.
That is why I fully support new clause 84 in the name of my hon. Friend the Member for Sleaford and North Hykeham. Publishing data on avoidable deaths associated with waits of more than 12 hours would help to ensure that we, as a Parliament and as policymakers, remain focused on outcomes for patients, not just performance indicators. I am particularly persuaded by the proposal to publish that information at ICB level, notwithstanding the concerns raised by my right hon. Friend the Member for Melton and Syston, which I agree with entirely. It would at least give some allowance for those making decisions to look at the local variation and ensure that it is identified, however less local that will become.
Hopefully, good practice will be able to be shared between different areas, and the areas that face the greatest challenges will be able to receive both appropriate scrutiny and appropriate support. Of course, collecting and publishing data will not by itself reduce waiting times, but we cannot effectively tackle a problem that we do not properly measure. Sunlight is often the best disinfectant in these cases, and greater transparency can be a powerful driver of improvement.
At the heart, new clause 84 recognises the simple truth that every statistic represents a person, a family and a life, and if avoidable deaths are occurring as a consequence of prolonged A&E waits, we should have the courage to measure them, publish them and learn from them. That is why I support the new clause. As has been touched on in other speeches, and as I mentioned earlier, the issue of corridor care does not sit in isolation. In fact, it is not a cause of the problem; it is the symptom of many other problems within our health and social care network.
Dr Prinsley
When I was a young doctor—a registrar—in the 1980s, we had 300,000 beds in our health service. By the time I was a senior doctor in the 2020s, we had 140,00 beds—less than half the number of beds we had before. When I was a young doctor, corridor care did not exist; I had never heard the term. The hospitals were simply big enough. Does the hon. Member agree that the many years of decline in the total number of beds in our hospitals is an extremely important factor in the fact that we do not have enough beds for the patients sitting in the A&E departments?
Gregory Stafford
I respect immensely the hon. Gentleman’s experience. He described being a young doctor, but he is still a very young doctor/politician now. Of course, capacity is an essential part of this. He is a clinician, so I will not lecture him on this, but my suggestion would be that it is not about just capacity within hospitals. The Government’s shift is to try to get people out of hospitals and into community settings as much as possible, so it is capacity within the whole system that needs to be looked at. Going back and putting loads more beds into hospitals would not somehow solve this problem or create a healthcare system that is aligned with what the Government want, which is hopefully treating more people at home. On his general point, I accept that the more capacity there in the system as a whole, the more likely we are to solve some of the problem.
That neatly moves me on to my next point, which is about the whole-system approach to this. As hon. Members have mentioned, we have a potential problem with ambulances waiting in carparks, and unfortunately, trusts gamify the system when targets are put in place—they do not admit people through the door because it will hit their targets. As my right hon. Friend the Member for Melton and Syston mentioned, that has a knock-on effect for the people sitting in the ambulances and those who are potentially not receiving an ambulance because the capacity is not there. Likewise, at the other end of the system—though I suppose it is both ends of the system—social care needs to improve significantly. I am deeply disappointed that the Government have pushed another social care review that is probably not going to report until 2028, which is kicking the can down the road. I think it is essential that we get social care correct.
Liz Twist (Blaydon and Consett) (Lab)
Some excellent points have been made about corridor care; I know that all of us want to see that improved. It is a serious issue for all of our residents, and the Minister and others will be working hard to do all they can to address it. May I gently point out the irony of colleagues on the official Opposition side raising all these issues now as if they have had a Damascene conversion, when they had 14 years to try and address them? I remember raising these issues in the House when my party was in Opposition. We are not undermining in any way the concerns about corridor care, because we all care deeply about it. [Interruption.]
Gregory Stafford
I am grateful to the hon. Member; she makes an interesting point. She talks about irony, and I respond in the same manner as that which she intervened on me with a gentle response, which is to ask why, if everything was going so swimmingly well, she and the rest of her colleagues got rid of the Prime Minister?
Joe Robertson
I am grateful to my hon. Friend for giving me an opportunity not to chunter from a sedentary position and to remark that this tedious rhetoric about the last 14 years—when all the public want to do is hear about plans for the future and how they will work—is the reason why we are in the state that we are. Will my hon. Friend continue and address the points that the public want, which he had already begun to do?
Gregory Stafford
My hon. Friend is absolutely right. The public do not want to hear about the last 14 years or the rhetoric around them.
Gregory Stafford
I will give way to the hon. Lady after I finish my sentence, if I may. The public want to know what the solutions are. I think we could look back through history at successive Governments since prehistory and say, “They got some things right, and they got some things wrong.” What the public want to know now is what the current Government will do.
On the point about social care, I was not a member of the last Government, but I stood on an election manifesto commitment, as the Labour party certainly did and I think most political parties did, that essentially said that the Dilnot review had decided how we were going to deal with social care, and we were going to get on with it. It strikes me as very strange that the last Secretary of State, the right hon. Member for Ilford North (Wes Streeting), decided to have another review; he has said himself in interviews since he resigned that it looks like the stalling on social care means that we will not get any movement on it before another general election. I do not think the public should put up with that.
Karin Smyth
As the hon. Member was not here at the time, perhaps it eludes his memory, I remind him that it was a coalition Government agreement to move forward with Dilnot, which had cross-party support. As soon as the coalition finished in 2015 and the Conservative party had dumped their friends in the Liberal Democrats, almost immediately after that election, it also dumped all pretence around the Care Act 2014 provisions at the time. We are where we are. I just wanted to help his memory.
The Chair
Order. I think we are moving a little out of scope here. Could we bring it back to the contents of the Bill?
Gregory Stafford
I will do that. As I have already said, no party has necessarily covered itself in glory with this issue. It might have taken us four years to dump it; it took the Chancellor of the Exchequer less than two weeks.
Liz Twist
I want to touch on the point made by the hon. Member for Isle of Wight East in his intervention. We absolutely agree that the public are concerned with what we do for the future. We are talking about a specific Bill here. There is a huge concentration of effort in getting those figures down. We absolutely agree that people want to look to the future and whether this is the way to do it.
Gregory Stafford
I look forward to the new Prime Minister coming in and, I hope, providing a position where the hon. Member is able to achieve some of that. [Interruption.] I note for Hansard that that received acclamation across the Committee Room.
Getting back to the Bill, as you have suggested I do, Dr Huq—I take your suggestions very seriously—the social care element is extraordinarily important. It is important to ensure that people do not enter the secondary care system if at all possible, especially through attending A&E. When I worked on the Getting It Right First Time programme, our accident and emergency reports put forward some interesting methods that could potentially help with that. Some of that has been implemented and some has not, but I recommend all hon. Members look at that report, because it contains a number of interesting proposals.
This is not only about stopping people entering the system, but about ensuring that people come out of the system in a timely manner, freeing up the capacity we have just talked about. In my constituency, Haslemere hospital had 16 step-down inpatient rehabilitation beds. Unfortunately, last year, that service was “temporarily paused”—that is how it was described, but it has been over a year now, so it has essentially stopped. That service is not happening in my constituency, which is down to the fact that it was a GP-run service and the trust could no longer get a GP who was willing to run that service.
Haslemere hospital and the Royal Surrey NHS Foundation Trust that runs the hospital have some really fantastic ideas, very much in keeping with the Government’s push towards neighbourhood health, and I fully support those proposals, but it is a shame that we have had 16 beds sitting empty for more than a year, which could have been used for rehabilitation. We as a body politic should be looking at how we can improve and expand our step-down/step-up capacity, so that people do not have to go into acute settings.
I turn briefly to the specifics of new clause 12. I am concerned about subsections (3) and (4), which talk about a tribunal system. I do not quite understand how that would work. The way it is set out almost gives it an adversarial, inquiry-type, case-by-case element. It would include patients, bereaved or affected families, and frontline NHS staff. I can see how that kind of body might work if one was investigating a failure around a single patient or at a single trust, but I would be grateful if the hon. Member for North Shropshire could expand on how she sees the national report coming forward and then a group of people being selected to interrogate it. It is also not clear what would be the consequences of the interrogation, or otherwise, once it has happened.
Dr Johnson
New clauses 12, 56 and 84 are about care in our accident and emergency departments and care in corridors. I do not want to rerun the debate on corridor care that we had in the Chamber last night, but corridor care does not provide safety, privacy and dignity, and it is unpleasant for the patient, their family and staff. If someone is in a corridor, how can they get changed, or use a commode or a bed pan? How can they be examined privately, and give information about their medical history without being overheard by a person walking down the corridor or the person in the bed next to them? Corridor care also has safety issues; for example, a patient may not be proximal to as much equipment, such as oxygen supplies and other equipment that might be required in the event of a collapse or arrest. It is not right and should not be the case that patients are cared for in corridors.
The hon. Member for Blaydon and Consett talked about the history, but I agree with my hon. Friend the Member for Isle of Wight East that the current situation and the future are what is important. A&E services are under pressure. Attendances went up by 2.5% last year, but in March 2025, 46,766 people waited more than 12 hours in A&E following a decision to admit before being moved to a more appropriate bed. That figure is up 8.8% on the previous year. The Government’s urgent and emergency care plan sought to improve that poor performance, but things have got worse. The latest NHS figures, from May 2026, show that more than 50,000 patients waited more than 12 hours following a decision to admit—17.1% higher than the May 2025 figure. The narrative that there was a problem but now things are getting better is not necessarily accurate. We keep being told that waiting lists are coming down, but they are higher than they were a month ago, and for those waiting for an admission or procedure, they are than they were a month ago and higher than they were a year ago.
Dr Prinsley
I wonder whether the hon. Member remembers that in 2010, when I believe there was an election—[Interruption.] Yes. The point I wish to make is that at the end of the previous Conservative Government, before Labour came back into office, waiting lists had reached an absolute record. Under the previous Labour Administration, waiting lists came down to almost nothing, but after 2010 they crept up and up, and by the time of the election in 2024 they had reached a record. I think she will recognise that Labour Governments have had strong records of reducing waiting lists, which is what we are doing now. We are only getting started, but it would be good to have some words of encouragement.
Dr Johnson
I am always happy to encourage the hon. Gentleman; I hope that in the impending reshuffle, he is given the opportunity to put his experience into practice. I have one word for him: pandemic. The pandemic made a huge difference to the numbers on waiting lists, and there is no current pandemic. It is possible to make arguments about whether the Government at the time—I was not in the Government at the time—were too harsh in their policies around elective care, whether patients would have come into hospitals for elective operations during covid or whether they would have preferred not to, and whether the waiting lists grew more than they may have done in other circumstances, but to try to say that the pandemic had no effect is going a stretch too far.
Karin Smyth
To correct the shadow Minister, I do not think my hon. Friend the Member for Bury St Edmunds and Stowmarket said that; he said the waiting lists have gone up. To be clear, in case her memory eludes her again, they were at 4 million before the pandemic and the Conservative party—her party, whose manifesto she stood on—did not meet a single target since before 2015. That is important for people to remember: 4 million people were on waiting lists before the pandemic started. The NHS went into crisis under the Conservatives’ leadership. Even if the hon. Member for Isle of Wight East thinks it is tedious to remind them of their record, no member of the public thinks it is tedious; they will never be forgiven for that record.
Dr Johnson
I think what members of the public want is the people who are in government now to do something to improve their lives. I am in danger of repeating myself, which could present an extra concern when so many people are questioning my memory, but there has been a 2.5% increase in the number of A&E attendances, but a 17.1% increase in the number of people waiting more than 12 hours after a decision to admit. That suggests that the Government are not going in the right direction. The public may enjoy a history lesson from time to time, but what they really want to know is what is happening now to make their lives better. I am sure the Minister will give us the answer to that in her summing up, but at the moment the Government are not bringing down the long waits in A&E.
Let me return to the new clauses. Corridor care needs a whole-pathway approach. In last night’s debate we talked about the importance of preventing admissions—I know that is one of the Government’s shifts—in order to increase hospital capacity. The hon. Gentleman for Bury St Edmunds and Stowmarket talked about capacity and the number of beds having reduced over a long period—another history lesson—but when my mum had me, a good few years ago, it was common for women to stay in hospital for quite a long time after having their child, and it was quite common for people to stay in bed for many days after having an operation. We now know that it is better for people to be up and about, and people leave hospital more quickly. That is a good thing. The reason for bed numbers coming down over successive Governments of different parties is clinical as well as managerial. I think that is worth saying.
Will the Minister answer a question that I asked in last night’s debate but, unless I missed it, she did not answer in her summing up? Does the NHS have more beds now than it did when Labour came to power in July 2024, or fewer? I believe the answer is fewer.
Edward Argar
Does my hon. Friend recognise the statistic that between 1997 and 2007, the then Government closed 32,000 hospital beds—more than double the number closed between 2010 and 2022? That is when the big reductions took place, and they failed to put in place an expansion of community beds to match that.
Dr Johnson
I will come to the hon. Gentleman in a minute, but I need to answer my right hon. Friend’s question first. My right hon. Friend has a much better memory than me—I was much younger then—so I am sure his statistics will be accurate.
Dr Prinsley
I think the principal reduction that the right hon. Member for Melton and Syston described was a result of the change of practice in the way that psychiatry was managed. During that period, we closed the asylums—large hospitals on the outskirts of almost every town and city. That was the result of a change in clinical practice—the idea that patients should be managed within the community. However, we continued to close acute beds, and it is the acute beds in the district general hospitals that are the problem we are talking about.
Dr Johnson
I think we are going back full circle to the hon. Gentleman’s intervention on my hon. Friend the Member for Farnham and Bordon, when he suggested that the problem was that beds had historically been closed. Now he is making the point that there were clinical reasons why that happened, not just managerial reasons. I think that is an important thing to note.
Moving on from capacity, we also need to look at the workforce. I would be grateful if the Minister could tell us how soon “imminent” is in terms of the workforce plan. There was also a point picked up earlier—I cannot remember who picked it up; it might have been the hon. Member for North Shropshire—about discharge from hospital and pharmacies. One of the challenges that I find as a clinician is that hospital pharmacies often close relatively early, which means that it is more difficult to discharge patients in the evening. That is something for the Minister to look at. There is also, of course, the importance of social care, and ensuring the provision of social care beds both to prevent admission and to get people out of hospital as quickly as is safely possible.
That is the background to this group of new clauses. New clause 12, in the name of the hon. Member for North Shropshire, would require a report on corridor care to be produced six months after the passage of the Act, and then every 12 months, containing data at the hospital, trust and ICB level on the number of individuals receiving care in an inappropriate place. That seems sensible data to collect, but I believe the Government may already to be collecting it; the Minister may be able to enlighten us on that. The report would also set out the steps taken in that year to reduce the number of patients in inappropriate care spaces, the plans for the coming year to reduce that number further—as I said, it is going up at the moment—and the funding allocated to that. There is some sense to that. Then the Secretary of State would have to give evidence in front of a panel, called the “corridor care tribunal”, which would include patients, affected families and impacted NHS staff, who would be selected by Healthwatch and NHS royal colleges.
I have just a couple of points on that. One is that Healthwatch will be abolished by the Bill, which would make that challenging—perhaps the new clause would need to be redrafted. Also, I am a member of the Royal College of Paediatrics and Child Health and an NHS consultant paediatrician and, as far as I am aware, the royal colleges are independent of the national health service. They are separate; they are connected in terms of training, standards and advice, but I believe that they are organisationally independent. I am sure that the Minister will correct me if I have got that wrong.
I wonder whether the hon. Member for North Shropshire has considered whether the Health and Social Care Committee, which is elected and politically balanced, might be the right body to scrutinise those Government plans. My hon. Friend the Member for Isle of Wight East, who is a member of the Select Committee, is not here now, but—
Dr Johnson
Sorry; I forgot. I am sure that my hon. Friend the Member for Farnham and Bordon will tell me if I am wrong, but that is an elected Select Committee, with political balance, that is set up specifically to scrutinise the work of the Department of Health and Social Care. If the Department is working to try to reduce the number of patients receiving corridor care, and to measure it, it seems to me that the right organisation to scrutinise that work is already in place: the Health and Social Care Committee. I therefore think this measure would be a duplication. However, I understand the need to get patient voice into the picture; that is why it is unfortunate that the Government are choosing to abolish Healthwatch, which I think would do that very effectively.
New clause 56, also in the name of the Member for North Shropshire, talks about A&E waiting times. I will start by saying that we all want A&E waiting times to be shorter—we all want people to be seen quickly and do not want patients to suffer—so the intent behind this proposal, to get people seen more quickly, is obviously a good one.
However, the new clause would require, within six months, provision to be made requiring
“every patient to be admitted into an Accident and Emergency Department within 12 hours of approval of their admission being made.”
I have a question about the wording of that, because my understanding is that someone is admitted to A&E when the decision is made to admit them to A&E and they become an A&E patient. I wonder whether the hon. Lady intends it to mean admission to an appropriate bed, whether in the trust or elsewhere. Usually, people waiting in corridors or in A&E are waiting for admission to the ward, rather than for someone to make a decision.
New clause 56 would also require the Secretary of State to establish and implement an A&E scheme to help trusts to achieve that requirement, and provides that the scheme must consider creating safety nets, step-down beds and a dedicated workforce plan for A&E—it will be nice to see the workforce plan, which the Government are supposed to have written—and mandating the presence of a “qualified clinician” in the waiting room. Will the hon. Member for North Shropshire tell the Committee what she means by a qualified clinician? Does she mean a consultant, a senior nurse or a healthcare assistant? What sort of qualifications does she think that they must have? The Secretary of State must also have regard to Baroness Casey’s report, but that is not due to be written in time for the new clause, which creates a little tension. However, again, I agree with the principle that social care is important in this context.
In summary, the principle of new clause 56 is good and important, but I think that there are some issues with the drafting of it. New clause 84 in my name, which has been well covered by my colleagues, would just require the publication of data. In her speech earlier, the hon. Member for North Shropshire gave a figure of 15,000, but I looked back at Hansard and last night she said that the Royal College of Emergency Medicine reported that long waits caused 15,860 deaths. That figure tells us what a serious problem this is. Being able to measure that figure and, I hope, see it falling would be a helpful step.
Ordered, That the debate be now adjourned.—(Emma Foody.)
Health Bill (Fifteenth sitting)
Thursday 9th July 2026
(2 weeks, 4 days ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 9 July 2026 - (9 Jul 2026)
The Committee divided: - Ayes: 1 / Noes: 7 - Question accordingly negatived.
The Chair
I remind the Committee that with this we are discussing the following:
New clause 56—Accident and Emergency: waiting times—
“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision relating to Accident and Emergency Department admission.
(2) Provision under subsection (1) must include the requirement for every patient to be admitted into an Accident and Emergency Department within 12 hours of approval of their admission being made.
(3) The Secretary of State must establish and implement an Accident and Emergency Scheme (‘the Scheme’) to support NHS hospital trusts to achieve the requirement set out in subsection (2).
(4) The Scheme must consider—
(a) creating safety-net social care beds,
(b) increasing step-down care,
(c) publishing a dedicated accident and emergency care workforce plan, and
(d) mandating a qualified clinician is present in every Accident and Emergency waiting room.
(5) The Secretary of State must have due regard to the final report of the Independent Commission on Adult Social Care in establishing the scheme.”
This new clause gives patients a legal right to be admitted into A&E within 12 hours from decision to admit and requires the Secretary of State to introduce a scheme to achieve this.
New clause 84—Publication of data on avoidable deaths—
“(1) The Secretary of State must publish every quarter the number of avoidable deaths where waits of more than 12 hours in accident and emergency departments was a contributory factor.
(2) The Secretary of State must make the data under subsection (1) available by integrated care board area.”
This new clause would require the Secretary of State to publish data on avoidable deaths caused by waits over 12 hours in A&E departments.
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to see you in the Chair, Ms Lewell. I will speak first to new clause 84, tabled by the hon. Member for Sleaford and North Hykeham. I reconfirm the Government’s focus on reducing long waits by improving patient flow, increasing productivity and delivering better emergency care for patients. Last night in the Chamber, we had a good discussion about corridor care in particular; all our comments are on the record, so I will not delay the Committee by repeating everything, but I will take some time to answer the questions raised in Committee this morning.
We are clear that the Government will end corridor care in this Parliament. It is completely unacceptable. Longer waits for emergency care can be associated with poorer patient outcomes. That is why, through the urgent and emergency care plan in 2025-26, we are investing more than £450 million to expand urgent and emergency care capacity, including new same-day emergency care services, urgent treatment centres, additional mental health crisis provision and nearly 1,000 replacement ambulances. Alongside that, we are implementing new clinical standards and improving patient flow across hospitals, all to reduce the number of patients waiting more than 12 hours.
Sojan Joseph (Ashford) (Lab)
I was pleased to take part in the debate in the Chamber yesterday. I raised some examples from my local hospital, which is expanding its same-day emergency care because of the funding that we received from the Labour Government. We also have a safe haven for mental health patients who do not need to go into accident and emergency. Lots of work is happening in my local hospital area, which will make a big improvement to corridor care and wider emergency care pressures. Does the Minister agree that that is what we need to do, and that the Labour Government are doing it?
Karin Smyth
My hon. Friend has been a strong campaigner. His health community has a lot of problems, as he well knows, but he is always there first, challenging me about the challenges in his healthcare system. He ensures that the people of Ashford are duly represented. He is absolutely right that what will make a difference to patients is improvement on the ground. I do not minimise how far there is to go, but I think patients are already starting to feel that improvement.
In the debate last night, we heard about some great work that is happening. We heard from, among others, my hon. Friend the Member for Ashford; from my hon. Friend the Member for Rossendale and Darwen (Andy MacNae), who talked about the challenged system and the challenged hospital in Blackburn, and the real improvements there; from my hon. Friend the Member for Watford (Matt Turmaine); and from my hon. Friend the Member for Bury St Edmunds and Stowmarket, who talked about progress in West Suffolk. That is really encouraging to see.
Earlier in the debate, statistics in the public domain were raised by, I think, the hon. Member for North Shropshire and others on deaths due to long waits and so on. That is a completely unacceptable situation, but I want to put it on the record that those statistics are not Government statistics. We had a bit of a debate about that. My hon. Friend the Member for Bury St Edmunds and Stowmarket highlighted how one can attribute cause of death to certain provisions. It is a really important measure. We do not want anyone waiting, full stop, but the statistics are not verified as Government statistics. I want to be clear about that.
On new clause 84, I assure the Committee that trusts are already held to account on the number of patients waiting 12 hours from arrival in A&E to admission, discharge or transfer. The medium-term planning framework published in October 2025 sets out the expectation that trusts will reduce the percentage of patients waiting 12 hours or more, year on year until 2028-29, as part of our overall ambitions to return to meeting the NHS constitutional standards.
The Government already produce comprehensive data on urgent emergency care performance, including on waiting times and on 12-hour waits. Those data provide transparency, support the oversight of the NHS’s performance and enable independent analysis of patient outcomes. We have been very keen to ensure that those statistics are published.
Another issue raised this morning was bed numbers. We had a bit of a historical throwback to the 1990s; I will not detain the Committee further by doing that again. My hon. Friend the Member for Bury St Edmunds and Stowmarket talked about changes in clinical practice, mental health beds and so on. I could talk for many hours about that. As a junior manager coming into the health services, one of my first tasks was to define what a bed is. That is not an easy thing to do. Most people think they know what a bed is but, as we discussed earlier, a trolley without wheels could be a bed. Counting beds and defining what they are and what they are used for is a complicated business in the health service. I know you will tell me not to deviate from the new clause, Ms Lewell, but this is important. Practice changes, and it is important that we make the most effective and efficient use of NHS resources. That means making changes to bed numbers, where they are and how we count them.
In June 2026, an average of 13,618 adult patients in acute hospitals per day were waiting for delayed discharge. We have improved data collection, so we have a better sense of the scale of the problem and, crucially, where it is; it is different in different places. We are seeking to improve that data. I gently remind the Committee that the NHS England website produces an awful lot of really good data so that Members of Parliament and our constituents are able to keep track. As my hon. Friend the Member for Bury St Edmunds and Stowmarket made clear, we need to keep up with best clinical practice, as well as the best use of resources. We are very happy to share that information and keep it transparent.
New clauses 12 and 56 were tabled by the hon. Member for North Shropshire, who is right to raise the unacceptable waits for care that some patients experience in A&E after the decision has been made to admit them. That includes patients being treated and cared for in corridors at times because of hospitals’ lack of capacity to admit them. As we discussed last night, the Government are clear that corridor care is not an acceptable standard of care and must not be normalised. We inherited an NHS under severe pressure with long waits and increasing numbers of patients receiving care in non-designated clinical areas. It is unacceptable, but I am afraid it was allowed to happen under the Conservatives. We are committed to eradicating corridor care, and we have a plan to do so.
To improve transparency, we have already established a clear national definition of corridor care. Again, the Conservatives could have done so in the past 14 years but chose not to. We have introduced daily reporting arrangements and strengthened the data quality processes. We are working hand in hand with stakeholders, including the royal college. In addition, we have published national guidance to support safe care where such situations cannot be avoided.
We are working hard to tackle the causes of corridor care; we are not just reporting on the consequences. That is why we want to improve patient flow. We have had good discussions about patient flow, both pre-admission and post-discharge, involving social care and primary and community care to support people who need care homes. We do not want people—particularly frail, elderly people—turning up at hospitals if it is better for them clinically to be treated where they are. We are improving patient flow, strengthening the discharge arrangement and investing £215.5 million in new and expanded urgent care services across England. We are also providing targeted support to the trusts facing the greatest challenges in relation to corridor care so that improvements can be delivered where they are needed most.
I gently remind the hon. Member for North Shropshire—and the hon. Member for Sleaford and North Hykeham, as a clinician, will be clear on this information about admissions—that when a patient presents at A&E, a clinician decides whether to admit them to the hospital, provide treatment, transfer their care to another location or discharge them. Under the current reporting rules, the clock starts running on a patient’s arrival in A&E and stops when one of those actions is taken. As a result, no decision is made to admit to A&E itself. Instead, if someone requires admission, it should be to somewhere elsewhere in the hospital.
Although I fully recognise the concerns that underpin these new clauses, I do not believe that further statutory requirements are the right approach. In the debate last night, we outlined in full the Government’s absolute commitment to addressing the issues and improving the situation for all our constituents. I hope that I have suitably reassured hon. Members that these new clauses are not required, and that they will not press them.
Helen Morgan (North Shropshire) (LD)
I will speak briefly to new clauses 12 and 56, about which we had quite a long debate this morning. Let me respond to a couple of questions. The shadow Minister asked about the role of Healthwatch in selecting the panel that would interrogate the Secretary of State, as we envisage in new clause 12, given that Healthwatch will be abolished by the Bill. She also asked about new clause 56, which would require the Secretary of State to have due regard to Baroness Casey’s final report. The shadow Minister said that those things are essentially inconsistent, but, considered as a suite of amendments, the provisions we have tabled are consistent. We oppose the abolition of Healthwatch; had that been successful, Healthwatch would still be there. We have also tabled new clause 60, which we will get to later and which would require Baroness Casey’s commission to report much more quickly. That is why that apparent inconsistency exists; I hope I have sorted that out for the shadow Minister.
The right hon. Member for Melton and Syston, a former Minister, talked about capacity in the system as a whole and its impact on corridor care. His concern was that if we focus on corridor care, we will end up with more people being treated in ambulances, have longer ambulance handover times and very long ambulance wait times. He will know, having been the responding Minister to my first Adjournment debate, that ambulance wait times have been a significant problem where I live. I am pleased to say that they are becoming less of a problem, because the new management of the hospital have focused relentlessly on the A&E department and on ensuring that ambulance patients can be taken into it very quickly, or certainly much more quickly than they used to be. I recognise his concern, but I think it is a manageable one.
Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
Although it is true that hospital management could concentrate on dealing with the waits in A&E, surely it needs to concentrate on the flow through the entire hospital. Every department and everybody involved in the hospital has to be thinking all the time about the flow through the entire hospital. That involves having a pharmacy that is open at night and ensuring that social workers are there when they need to be—it involves all manner of things. Simply concentrating on a particular statistic in an A&E department will not actually deal with the problem.
Helen Morgan
I think our new clause addresses that point. As I mentioned, my own hospital trust, Shrewsbury and Telford, has improved ambulance wait times simply by improving the flow through the hospital and addressing some of the issues. I recognise that our new clause does not deal with pharmacy availability at weekends and overnight, which I know is a critical issue in many hospitals; on Report, we will certainly tidy it up to ensure that it does, but I take the hon. Member’s point.
My new clause would address the system-wide capacity issue that the hon. Member highlighted so carefully, both in last night’s debate and here today. We need more capacity across the whole system. Otherwise, we are just trying to push a lump in the carpet to a different place, but there will always be a lump somewhere. The new clause seeks to provide 6,000 more beds across the whole system, to allow flow through the system and to ensure that waits do not back up in the ambulance service, on corridors in A&E or outside wards, as they do currently.
Critically, we should address the point about NHS pledges and rights. The constitution is broadly agnostic about the time people wait on corridors, but is not agnostic about the time it will take for them to get cancer treatment. That is an inconsistency and we should sort it out, because I think our constituents consider the two things equally important.
I take the Minister’s point about new clause 12. I will not push it to a vote, but although trusts are held to account on their A&E performance, the missing piece is that the Secretary of State is not. That is what new clause 12 seeks to address, and I hope that the Minister will consider that on Report. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 14
Healthy life expectancy target
“(1) Within six months of the passage of this Act, the Secretary of State must—
(a) make regulations to set a statutory target for improving overall healthy life expectancy for the population of Great Britain, and
(b) publish a cross-governmental strategy, renewed every 24 months, to set out how the target set by regulations under subsection (1)(a) will be achieved.
(2) The strategy under subsection (1)(b) must be laid before both Houses of Parliament.
(3) Upon publication of a strategy under subsection (1)(b) the Secretary of State must make a statement before the House of Commons regarding progress made towards the target set by subsection (1)(a).”—(Dr Chambers.)
This new clause would require the Secretary of State to make regulations to establish a statutory target for healthy life expectancy in Great Britain and publish a strategy every two years setting out how this target will be achieved.
Brought up, and read the First time.
Dr Danny Chambers (Winchester) (LD)
I beg to move, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss the following:
New clause 79—Public Health Committee—
“(1) The Secretary of State must establish a Public Health Committee within six months of the passage of this Act to ensure a cross-governmental focus and consideration of the promotion of public health in government policy and address national health inequalities.
(2) The Public Health Committee under subsection (1) must—
(a) include at least one minister from each government Department in its membership,
(b) include all cabinet ministers in its membership,
(c) be chaired by the Prime Minister, and
(d) meet once in each annual quarter.
(3) Under subsection 2(b), cabinet members must attend at least three quarters of the Public Health Committee's meetings each year.
(4) Each government Department must publish an annual report on their department's consideration of public health in its policy and the extent of joint policy formulation with other government Departments.
(5) The Secretary of State must establish a Health Creation Unit to support the Public Health Committee.
(6) The Health Creation Unit must submit an annual report on its activities, decision-making and cross-government progress to the Liaison Committee.”
This new clause would establish a Public Health Committee and Health Creation Unit to promote public health and cross-government policy making.
New clause 80—Duty to promote public health—
“All Ministers of the Crown have a duty to consider health outcomes and the promotion and protection of public health when exercising their duties.”
This new clause will place a duty on all ministers to consider health outcomes and the promotion of public health when exercising their duties.
Dr Chambers
New clause 14 is about healthy life expectancy. It would require the Secretary of State to make regulations to establish a statutory target for healthy life expectancy in Great Britain and publish a strategy every two years, setting out how the target would be achieved. New clause 79 would establish a public health committee and health creation unit to promote public health and cross-Government policymaking. New clause 80 would place a duty on all Ministers to consider health outcomes and the promotion of public health when exercising their duties. All three new clauses are closely related.
Over the last 100 years, life expectancy in the UK has been increasing for a variety of reasons, including vaccination, improved hygiene and medical advances, but worryingly, between 2022 and 2024, it decreased by 1.8 years for men and 2.5 years for women. That is the first time it has decreased in a while. There is an 11.1-year gap between the highest and lowest life expectancies, which is partly due to demographics and different socioeconomic situations. Socioeconomic disparity is causing a very significant difference in life expectancy.
We need wider whole-of-Government working to address the root cause of and contributing factors to ill health. DHSC, the NHS and social care deal with too much in silos, which is a problem across the whole of Government. There is too much siloed working. All Departments should be working with at least one eye on the health of the nation. That is what our new clauses seek to foster. A healthy life expectancy target would provide the basic metric for that aspiration, forcing wider thinking on prevention and ill health, rather than on waiting lists and hospital performance, as important as they are.
New clause 80 would place a duty on all Ministers to consider health outcomes and the promotion of public health when exercising their duties. That should aim to focus the minds of non-DHSC Government Departments that have a central role to play in the promotion of good health and longevity, whether that be housing standards or environmental regulations. We included health protection—areas such as clean water, for instance—as well as health promotion, which includes areas such as active travel.
New clause 79 would create a public health committee and a health creation unit to support its work, especially between Departments. This is an idea originally introduced under the coalition Government, designed to tackle obesity, alcohol abuse and other public health problems. Although we recognise that it was not perfect, given the Tories’ lack of engagement and spotty attendance, the desire to foster cross-Government thinking was definitely right.
Dr Prinsley
Would the hon. Member comment on what I consider to be almost the most successful and important Bill that our new Government have passed, on the effective abolition of cigarette smoking? As time goes by, that will save more lives than anything else we could possibly think of. I recognise that it was the initiative of the previous Government, but the fact that the new Government have managed to get it over the line is a massive achievement. That is very much underappreciated and certainly not spoken about anything like enough. We will never do anything as important as the abolition of cigarette smoking.
Dr Chambers
Yes, I sat on the Tobacco and Vapes Bill Committee for six weeks, going through the legislation line by line. One of the most interesting things about that Bill is not only that it will improve public health and life expectancy, but that it is probably one of the single most impactful pieces of legislation in terms of improving inequality and especially socioeconomic health outcomes. So many of the disparities in life expectancy between wealthy people and those living in relative poverty are due to levels of smoking—it is not just smoking, but that is a significant factor. It is good of the hon. Gentleman to highlight that.
During the coalition, the Tories recognised that the approach I described would send a powerful message that public health is the responsibility of all Government Departments. When it was scrapped, the then shadow Health Secretary, the right hon. Member for Makerfield (Andy Burnham), said that we could tackle Britain’s looming obesity crisis only if all Government Departments pulled together. We completely agree with that statement.
New clause 79 tries to address some of the issues that occurred back then, including by placing requirements on ministerial attendance and giving the Liaison Committee oversight to drive accountability. I am sure the Minister will agree that greater cross-Government working is needed. What are the Department’s plans to support that? If we want to tackle the various public health crises facing our country, we cannot do so without proper cross-Government working.
In my professional life, I was made an honorary lecturer at Bristol University veterinary school in the area of One Health, recognising that animal health, human health and environmental health are completely interlinked. It is difficult to improve one without looking at the factors that improve the others, and we need that kind of approach throughout all Government Departments.
Sojan Joseph
It is good to see you in the Chair, Ms Lewell. I strongly believe that public health is very important to our health system because it focuses on prevention, so that people do not end up in A&E or in hospital beds. Unfortunately, over the last 10 or 15 years we have seen the opposite. If we are serious about improving the nation’s health, prevention must sit at the heart of every decision we make.
Public health professionals bring a vital perspective—one that looks beyond treating illness to understanding and tackling its root causes. They consider the wider determinants of health, from housing and education to inequality and the environment, and they help us design services that keep people well, rather than responding only when they become unwell. We need to identify our priorities, ensure resources are allocated appropriately and develop a long-term strategy.
New clause 79 proposes to create a new committee. As somebody who worked in the NHS for many years, I have seen that there is no shortage of committees, senior leaders, management or meetings in our healthcare system. In fact, there are too many. What is missing are people to work on the frontline; that is what we saw over the 14 years under the Conservatives—and the Lib Dems were part of that.
One reason why I became active in politics was that I saw the frontline struggling. I worked as a nurse on the frontline in mental health services, and what we saw was money being diverted to create more senior leadership, more groups, more meetings and more management, while we were missing the people who actually did the work on the frontline. The new clause asks us to create a new committee, but we have enough committees and managers. In fact, through the Bill, we are trying to modernise the system by getting rid of some of those managers—that is the most important thing I can identify in the Bill. However, lots of the new clauses I have seen today and in the last Committee sitting have proposed creating more committees and directors. We are missing a point here. The Committee has an opportunity to reform our health system. If Members speak to a nurse or doctor who works in a hospital in our system, they will say, “We need more nurses, healthcare assistants and doctors, not more managers or directors.”
Not only in this new clause, but in many of the new clauses we are talking about, we need to think about embedding the public health voice within integrated care boards. Stronger integrated care boards will enable us to act early, reduce health inequalities and deliver care closer to home.
Natasha Irons (Croydon East) (Lab)
My hon. Friend is making powerful comments. I was struck by his argument that we need to focus more on what we do in communities. In Croydon East, a community diagnostic centre has opened, which is important because people in my community have a healthy life expectancy 10 years lower than that of people living a mile down the road. Does my hon. Friend agree that we should be focusing on those real, tangible interventions at the heart of the communities that need help the most? That is what this Government are trying to do.
Sojan Joseph
I absolutely agree, and I can give an example. Last week, as part of the ICB’s new independent neighbourhood health centre, one of the GP practices in my constituency started to proactively go and see all elderly patients. It is not just giving those patients appointments when they fall ill; it is proactively visiting them. We need that kind of support so that we can prevent illnesses and prevent people from needing to go to hospital.
Liz Twist (Blaydon and Consett) (Lab)
Does my hon. Friend agree that, as well as the physical aspects of health and extending life expectancy, we need to look at preventive measures for mental health? That will ensure that people live as good and full a life as they can, and receive the treatment they need. Does my hon. Friend see that as integral to any public health strategy?
Sojan Joseph
My hon. Friend makes a sensible comment. I work closely with her on mental health, and she is absolutely right. Some of the policies the Government have introduced, such as giving children early access to mental health provision, will be absolutely vital to prevent them from becoming unwell later on. The Government are also rolling out a new mental health strategy focused on prevention, which will be important. We need to be more lean and productive, rather than creating more managers and committees.
Edward Argar (Melton and Syston) (Con)
The hon. Gentleman will probably be aware of the King’s Fund report from late last year, which covers the years 2010 to 2025. It highlighted that the growth rate was only 5% for managers during those 15 years, but 94% for children’s nurses and 55% for doctors, and other groups had similar increases. We are seeing investment and workforce increases in the right areas.
It is right that we acknowledge, as I suspect the hon. Gentleman will, that the one group where we have not seen that same growth is community health visitors and community health workers. Alongside the massive investment and increase in doctors in the past 15 years, that group, and the role it plays, deserves focus from whichever party is in government.
Sojan Joseph
I agree. We need more band 5 nurses or healthcare assistants who can check blood pressure or blood sugar in patients’ homes. When someone rings their GP surgery, they should be able to meet a nurse or a healthcare worker to carry out some basic checks, rather than being delayed from seeing somebody until, a few weeks, months or a year later, they end up in A&E. That is where the focus should be.
I do not support the new clauses, and I urge the Committee to think about some of the other new clauses that propose creating more directors or committees. We need to focus on making our health system more productive.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I rise to speak to new clauses 14, 79 and 80, tabled by the Liberal Democrats. New clause 14 would require the Secretary of State, within six months, to establish a statutory target for healthy life expectancy in England and then to produce a strategy every two years to meet that target. This is not the first time the House has heard about life expectancy targets; as I am sure you will remember, Ms Lewell, the previous Government’s 2022 levelling-up White Paper talked about narrowing the gap in healthy life expectancy between the areas where it is highest and lowest, and aimed for healthy life expectancy to rise.
As the hon. Member for Winchester said, life expectancy has increased quite dramatically over the last century, but that is largely due to improvements in child mortality. That is a good thing, but it is worth looking at how healthy life expectancy is calculated. The Sullivan method starts by looking at mortality rates over a specific timeframe for a specific population, and then takes data from a cross-sectional study where people are asked to rate their own health, multiplies them together and produces a figure for healthy life years. Therefore, the main element that separates healthy life expectancy from unhealthy life expectancy is survey responses; it is not a clinical metric. If somebody on a huge amount of medication and treatment feels healthy, they are healthy. If someone on very minor treatment feels unhealthy, they are unhealthy. It is a self-reported measure.
The Government’s website says that if mortality improves by 2%, healthy life expectancy increases a very small amount; if self-reported feeling healthy goes up 2%, there is a much bigger increase in healthy life expectancy. We want people not just to live longer but to live well, but it is a case of how we measure it and how we ensure that there are no perverse incentives. We should look at it over time in the same individuals. How do people feel when they get up in the winter, when it is cold, dark, raining or icy? They may feel less healthy than when the sun is shining, it is the weekend or England have won the world cup.
The Government’s own figures show that musculoskeletal health is particularly important. Musculoskeletal conditions are prevalent among 17.2% of the population, and people with them are three times more likely to have self-reported ill health. We have asked before if the Government will introduce a modern service framework on musculoskeletal disease, having scrapped our long-term conditions strategy. I would be grateful if the Minister could say whether the Government have given more consideration to that and are now willing to do an MSF on musculoskeletal health.
New clause 79 would require the Government to create a committee across Government, including the Prime Minister, all Cabinet members and one Minister from each Department. The idea behind the new clause—that we need to work together—is important, but I would be grateful for the Minister’s comments on how feasible, practical and effective that would be.
Finally, new clause 80 concerns the duty to promote public health. Of course, it is the Minister’s duty to do his or her job, and part of that is promoting public health. What does the Minister think the practical effects of that new clause would be on bureaucracy in Departments?
Dave Robertson (Lichfield) (Lab)
It is always a pleasure to see you in the Chair, Ms Lewell. I will speak briefly on new clauses 79 and 80. I really like the intent of these new clauses, and the idea of Government working better and more together, public health being more of an agenda, and trying to get people working together in that framework. I am pretty sure that every Member in the House would support that. I do, however, have some serious concerns about the wording.
New clause 79 proposes a new committee, whose membership would include at least one Minister from each Department and all Cabinet Ministers—I presume that that is in addition, so it would be all Cabinet members plus one other Minister from each Department, which makes it seem like quite an unwieldy committee. There comes a point when a committee, if it has 70 people in it, ceases to be a committee, particularly when it will also need to be chaired, have clerks and have various people in the room. I have concerns about its size. I also have concerns about the frequency with which it would meet, and the requirement that every single Cabinet Minister must attend a minimum of three times a year, which is the implication of the wording.
Dr Prinsley
Public health used to be clearly under the aegis of the national health service. Some years ago, public health officers became employees of the local authorities, and the thing became somewhat separated from the NHS. Does my hon. Friend agree that we must join public health more closely to the activities of the national health service? Public health was at the very foundations of the national health service. I do not know whether other Members have, like me, read A. J. Cronin’s famous book, “The Citadel”, which describes the health service’s origins; in fact, I understand it was the book that the original politicians had all read. It has a marvellous description of a typhus epidemic, caused by an infected drain running down the middle of a street in a little Welsh mining village. The doctors had been completely unable to get any of the authorities to deal with it, so one night—they were ex-military—they put a little dynamite in the drain and blew the whole thing up. That is well described in the book, and it just shows how public health was absolutely integrated into the foundational principles of the national health service.
Dave Robertson
My hon. Friend makes an important point about the centrality of public health to the founding of the NHS. Earlier in Committee, I said that the NHS was the greatest gift the Labour party had ever given the country, and I fundamentally believe that. He is absolutely right to mention the centrality of public health in that process. I also thank him for his recommendation of a book to read over recess—that is always a pleasure.
To return to new clause 79, I want to focus on what we are asking when we say that all Cabinet members have to attend this new committee. That would include the Secretary of State for Defence, and although I understand cross-Government working and the need for Departments to work more closely together, I am scratching my head over what actions we expect the Secretary of State for Defence to take to support public health, and especially over the fact that they will be required to attend this committee a minimum of three times a year with, in my reading of the wording, another Defence Minister.
Dr Chambers
I pay tribute to the Royal Army Veterinary Corps. It does good work in trying to eradicate rabies in countries with street dogs, as part of hearts-and-minds engagement. We can work public health into pretty much any Department.
Dave Robertson
I absolutely join the hon. Member in thanking those service personnel who do so much good around the world, but I wonder whether it is appropriate to ask the Secretary of State for Defence to focus on public health. It is absolutely right that the Defence Department could do things, but does the Secretary of State need to be so centrally involved in this committee that they will have to attend three times a year, in addition to another Minister, who will have to attend a minimum of four times a year? Yes, a variety of Departments would be able to do that.
Dr Chambers
Just to blow my own trumpet, my greatest academic achievement was getting correspondence published in Nature on the impact of conflict on antimicrobial resistance. It might interest Members to know that, in Ukraine, 80% of wounds have novel bacteria that are displaying multi-drug resistance, which has become a limiting factor in getting soldiers back on to the frontline. We are trying to reframe issues such as antimicrobial resistance as national security and defence issues, rather than purely public health issues.
Dave Robertson
I very much appreciate that intervention, and I congratulate the hon. Gentleman on getting published in a very important journal. I am not in any way saying that the Secretary of State should not have any regard—[Interruption.] Now that he has made a joke, I want to say that I think he looks like a trombonist, rather than a trumpeter.
There is a very important point to draw out here. Although Departments can think about the public health impacts of the work that they undertake—I am sure many Ministers will do so—I am not sure there needs to be such a requirement to focus on public health for the Ministry of Defence, which obviously has a very significant, serious role.
New clause 80 would require all Ministers to have regard to public health. I really appreciate and value that—I think this is a good debate for us to have—but if the Minister for investment has managed to secure an investor to save a large business that is essential to the economy of an area, do I want them to be held up by having to demonstrate that the investment will ensure public health? I am not sure I do. A lot of decisions have to be made very quickly. I am not going to go through a long list of Ministers; we would all be here until next week. I just think the wording of the new clause is too broad, and I am not sure I can support it in its current form because it would place too much of a requirement on too many Departments to focus too much on areas that are not their core responsibilities.
Joe Robertson (Isle of Wight East) (Con)
It is a pleasure to serve with you in the Chair, Ms Lewell. I find myself unequal to the level of analysis and detail that the hon. Member for Lichfield brought to public health in the Ministry of Defence.
I will add just a few brief thoughts. The good intention of extending the life expectancy of the people in this country—although my hon. Friend the Member for Sleaford and North Hykeham made the good point that it is about living well, not just for a long time—is not always best served by creating committees, and additional duties, reports and responsibilities in legislation.
The hon. Member for Winchester argued—I paraphrase, but it is a matter of record—that he would like all Departments to have an eye on the health of the nation. That sounds sensible. There are other things that I would hope all Ministers have an eye on in everything they do, such as the wealth of the nation and inequality, but I would not advocate for embedding those things—I hope they would come with good governance, public duty and responsibility—in legislation as a duty, a committee, a set of meetings and a report. Indeed, it is things done with good intentions that lead to growing bureaucracy, which slows down decision making and requires more people to be employed to discharge those duties at a growing cost to the public purse. It is something that western democracies do all too well, and not always for the good. I would not want this well-intended set of new clauses to lead to growing bureaucracy with very little benefit. The benefit that the hon. Gentleman wants to see, which I agree with, can be best delivered in other ways.
Karin Smyth
I am grateful to hon. Members for bringing this discussion to the Committee. The Government are clearly committed to enabling people to live longer. It is one of the successes of recent years that, at the foundation of the health service, the average life expectancy was I think 60 or 62, while, now, it is in the early to mid-80s. That is a massive change in the last 80 years or so.
As well as improving the healthy life expectancy of the population, we are determined to address the stark inequalities that blight our nation’s health. We know that the most disadvantaged in society often face the biggest health challenges, and that the current model of care works least well for those who already experience disadvantage, who are also far more likely to have complex needs.
In fact, my own entry into working for the NHS, back in the 1990s, was on the back of the 1980 Black report, which some Members might remember well. The then Conservative Government sat on that for ages; it was such an awful reflection on the first 35 years of the health service, that health inequalities had not improved, that they sought not to publish it. That struck me as so shocking that it led me to want to pursue a life doing something about it.
I see that in my own constituency, where the legacy of the tobacco industry—which my hon. Friend the Member for Bury St Edmunds and Stowmarket mentioned—has led to a very high prevalence of smoking-related disease. In some parts of my constituency, that is up to 34%.
Liz Twist
I would point to examples such as in the north-east of England, where the work on smoking has been incredibly effective and still continues, and makes that real shift and change. Does my hon. Friend agree that it is those practical examples that we need to see, and to support along the way?
Karin Smyth
I thank my hon. Friend for that point about prevalence in the north-east. Often, the prevalence of these diseases is also to do with post-industrial work, which many people had to do without concern or knowledge about the effects on their health.
My hon. Friend the Member for Croydon East mentioned practical examples as well: the opening and building of things such as community diagnostic centres in places that are accessible and open to the public, and neighbourhood health. That is entirely the drive that we have: for services where people are, and where the greatest health need is, and not expecting people to travel.
In terms of smoking, one of the greatest legacies of the last Labour Government was of course the ban on indoor smoking. My mother was a barmaid for all her adult life; it is hard to imagine that people were just standing there at her place of work, blowing smoke at her while she was working. I tell my children, “Yes, we used to sit on aeroplanes with people smoking,” and that, unbelievably, some people smoked at the back of buses on the way back from school, and so on and so forth. It is really quite shocking.
The Tobacco and Vapes Act 2026, which we have also talked about in this Committee, is also a real testament to the work of this House, but didn’t it take a long time, Ms Lewell? I pay tribute to the right hon. Member for Richmond and Northallerton (Rishi Sunak) for pursuing that in the face of great adversity from his own party at the time. That was not, obviously, by the Members present, who all have a high concern about health, but perhaps by others on the Conservative Benches at the time, and then indeed in the Lords, who sought to thwart it—thwart is a strong word in this context; obviously, they made their points, but they sought to stop that Bill making progress at various stages.
Some of my colleagues were coming back at different times, saying that they were working on the Tobacco and Vapes Bill, and I said, “What, still? Really? Has it not come through yet?” That showed how hard it is, when something so well evidenced and so supported by public health experts, on something so detrimental to public health—particularly for people living in poorer communities, such as the one I represent in Bristol South—still takes such a time to get through.
Dr Johnson
The Minister is very, very aware of my views and opinions on the Tobacco and Vapes Act, particularly on vaping and stopping vaping among children. That Act, a bit like this Bill, left lots of opportunities for the Government to provide for regulations. Anyone who has been in a shop in the past few days will have seen vapes still behind the counter, still very visible, very colourful and in lots of different flavours and suchlike. Can the Minister update the Committee, and therefore the House, on when she expects the regulations provided for by the Tobacco and Vapes Act to come into force, so that we can actually apply the law, as opposed to just having it sat on the statute book?
Karin Smyth
Well, I thank the hon. Member for her support. As I said, I did not expect that people here present, who understand the impact of that work, were the ones who were thwarting that. I do not have off the top of my head exactly when the regulations under that Act will come forward, but I am sure we can furnish the hon. Member with details as soon as possible. We all want to see that happening—in particular, the work going on around high streets, such as prevention of fraud by shops for all sorts of things, not just vapes. Obviously, that is high on the agenda, as it is for some of my colleagues as well. Those places and people are blighting our high streets.
Dr Prinsley
I sit on the Home Affairs Committee, and we have lately been discussing the matter of serious organised crime, and vape shops in particular. It turns out that many of the vape shops are in fact not really shops; they are places for laundering money. Specifically, they launder money in relation to drug businesses and the drug trade, which is another huge public health matter that I am sure the Minister will agree needs to be dealt with. We were informed that about 10% of this country’s adult population are using illicit drugs, and that for the most part those are being delivered via the post office. Does the Minister agree that that is a massive public health issue that will also need to be urgently addressed?
Karin Smyth
I thank my hon. Friend for his expertise and that work on the Home Affairs Committee. Again, it shows the Committee the wide range of work that goes on. Of course, many hon. Members are campaigning and working hard. Those shops are blights on our communities, and as with most illicit drug dealing, they affect the most vulnerable in places where they can pick on the most vulnerable. They are in areas of high deprivation, and that is something we need to stop. I commend all the communities and community leaders that work so hard to stop that happening in their areas. We must address it.
Returning to new clause 14, while I fully recognise and share the ambition that sits behind the new clause, introducing a new statutory duty is not the right way to achieve it. A healthy life expectancy is a long-term outcome shaped by a wide range of factors across society and Government, many of which cannot be meaningfully addressed through a rigid statutory timetable. Requiring the Secretary of State to set a statutory target within six months, publish a refreshed cross-Government strategy every two years and make formal statements to Parliament risks creating a process-heavy framework that prioritises reporting over delivery.
What matters most is sustained practical action to improve prevention, tackle health inequalities, expand access to care and address those wider determinants of health. That is why the Government have already published our 10-year health plan to improve the nation’s health, of which healthy life expectancy is one measure. That is central to us in bringing forward the 10-year plan. Publishing a new strategy every two years would be duplicative and would not help to deliver the plan that we already have in place. Work is already underway, and I am sure the House will hold us to account for the progress we make, as it rightly should. I believe we share the same aim that the new clause seeks, but we differ on the best means to get there.
On new clause 79, I assure the Committee that the Government are already working across Departments to improve health and reduce inequalities, ensuring that action on health is embedded across Government. For example, through the warm homes plan and rented sector reform, we are supporting healthier homes and reducing health harms associated with poor housing. Through the “Keep Britain Working” review, we are addressing the links between work, health and wellbeing. Through the environment improvement plan, we are tackling the health harms of air pollution, and in lifting hundreds of children out of poverty, we will transform their health and life chances.
Those endeavours demonstrate that improving health outcomes is already embedded across Government activity and does not depend on the creation of a new statutory committee. While I have considerable sympathy with the aim of the new clause, and I am a strong supporter, as I hope I have assured the Committee, of supporting those wider determinants of health, I am not persuaded that placing detailed internal Government structures into primary legislation is either necessary or desirable. We heard well from my hon. Friend the Member for Lichfield about some of the unintended complications about the new clause.
As we have repeatedly said, in the Bill we are not seeking to be unduly prescriptive or create unnecessary bureaucracy that may risk slowing down delivery. Indeed, we are aiming to reduce that bureaucracy. Furthermore, the Government must retain the flexibility to organise in a way that best supports delivery as the context evolves. The Government already bring Departments together to advance shared goals and will continue to strengthen collaboration wherever it is needed.
On new clause 80, I am again not convinced that creating a new statutory duty on every Minister is either necessary or the most effective means of achieving the objective of the hon. Member for Winchester. The Secretary of State for Health and Social Care already has a statutory duty to protect public health and powers to take the appropriate steps to improve the health of the people of England. We have already discussed clause 4, which reformulates the Secretary of State’s duty on health inequalities. Those provide a clear statutory framework for improving health and addressing inequalities.
Beyond that, the Government do not operate in departmental silos. Ministers consider the implications of decisions and work collectively in the public interest, including on health impacts where relevant, which is particularly important to this Government. The proof is in the action we have started to take across Government to improve health. Although I agree entirely that health should be considered across Government, imposing a broad new legal duty on every Minister would risk creating unnecessary bureaucracy without meaningfully improving outcomes, as my hon. Friend the Member for Lichfield highlighted.
Creating new procedure and reporting requirements is not in the spirit of this Bill, which has flexibility and a focus on delivery at its heart. We also heard that from the shadow Minister. Our focus is and must remain on delivering improvements in health outcomes, supporting prevention and tackling the causes of ill health, rather than creating additional statutory red tape. The objective of new clause 80 can be achieved without placing a new statutory requirement on every Minister.
The shadow Minister asked me about plans for a modern service framework for MSK, and we currently do not have plans to develop one. The national quality board will assess all proposals for new MSFs against clear criteria, which we have highlighted before, ensuring that we prioritise the area where a framework will have the greatest impact for patients.
Dr Johnson
I understood that one of the Government’s greatest priorities was to reduce waiting lists, but one of the things that people are waiting for the most is musculoskeletal or orthopaedic treatment. Why is it not a priority for the Government?
Karin Smyth
There is a long priority list for MSFs that was left by the last Government for different reasons. There are lots of things will bring down MSK waiting lists, such as more diagnostic facilities. As the shadow Minister knows, 80% of people on the waiting list are waiting for diagnostics, which is why we are fast-tracking and pushing more. As my hon. Friend the Member for Croydon East said, community diagnostic centres in places such as Croydon East will get people through for the diagnostics they need. There are also some things that the shadow Minister’s party seems to continue to oppose, such as advice and guidance for GPs so that, if there are alternatives to deal with MSK, of which there is already a lot of evidence, they can refer people to a more appropriate or faster access route in the meantime. Those actions are being taken.
She is quite right that orthopaedics is a large part of the waiting list. However, diagnostics, access to faster treatment and using the independent sector where appropriate will particularly target orthopaedic waiting lists as part of our elective reform plan.
Dr Johnson
I am not opposed to the principle of GPs seeking advice or guidance; the issue is the compulsory nature of that and GPs not being able to refer.
Karin Smyth
The shadow Minister is tempting me to divert away from addressing the main point, but I will take her point on board. I am glad that the Conservatives do not oppose the principle of advice and guidance, because evidence suggests that it is a good route to patients having care closer to home and getting faster treatment. She knows this because it has been clarified, but if there is any doubt: there is no compulsion on GPs to do that.
The hon. Member for Winchester talked about his expertise and blowing his own trumpet with regard to antimicrobial resistance. He jests slightly about that expertise, but he raises a really important point about AMR that I am sure we will talk about more when we discuss new clause 32. He is absolutely right that it is an important public health issue that crosses many divides, and I look forward to discussing that later.
Dr Chambers
I thank all Members for their contributions to the discussion. The hon. Member for Lichfield made the good point that a committee of 70 people may not be that efficient. He should come to the Lib Dem parliamentary party meetings, which are incredibly efficient. We have incredibly insightful discussions, which is what makes us such an effective force, so I would not knock a committee of 70 people.
I appreciate the Minister’s acknowledgment of the important of cross-party work for public health. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 15
Impact of trade deals on the NHS
“(1) Any trade negotiation which would require NHS spending or funding to exceed £100 million must be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure.
(2) Before laying regulations under subsection (1) the Secretary of State must publish an impact assessment about how the trade negotiation will affect NHS frontline services and patients.”—(Dr Chambers.)
This new clause would require any trade negotiation which would require NHS spending or funding to exceed £100 million to be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure.
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss new clause 76—Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing—
“(1) The Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing may be ratified only if—
(a) a Minister of the Crown has laid before the House of Commons a copy of the Arrangement, and
(b) the Arrangement has been approved by a resolution of the House of Commons on a motion moved by a Minister of the Crown.
(2) Before tabling a motion under subsection (1)(b) the Secretary of State must publish and lay before the House of Commons an impact assessment on the potential effects on the health service of implementation of the Arrangement.”
This new clause would require the Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing to be brought before the House for a vote.
Dr Chambers
New clause 15 would require that the Secretary of State lay before Parliament any trade negotiation requiring NHS spending or funding exceeding £100 million, in the form of regulations subject to the affirmative procedure. New clause 76 would require that the arrangement between the United States and the United Kingdom on pharmaceutical pricing be laid before the House to be voted on.
The Institute for Fiscal Studies has indicated that, by 2036, the UK-US pharmaceuticals deal will have cost as much as £9 billion. That money could be transformative for the NHS. It could be put towards ending corridor care, as the Committee discussed earlier, or towards hiring thousands of ward staff, buying countless radiotherapy machines and starting to deliver high-quality care and help at home for the elderly and disabled.
To make matters worse, Trump’s ambassador hauled in the head of the National Institute for Health and Care Excellence—the expert independent body that considers value for money in the NHS—to rebuke him over his opposition to the deal. It is utterly outrageous that a British public servant has been dressed down by a foreign regime for putting the interests of British patients and the British taxpayer first. It is crazy that billions of pounds of NHS funding is being spent to placate Trump, at the expense of the patient wellbeing. We want to support the British life sciences sector. That should be a domestic matter for the UK Government to address holistically, through negotiations with the sector; it should not be dictated from Washington.
Hiking payments for medicine is the wrong approach for patients who badly need investment in frontline staff, hospitals and equipment. The lack of transparency over the full cost has already created great uncertainty in the sector, and it is astonishing that such a major decision will be made without the say of the British people via a vote in Parliament. The Government refused even to publish an assessment of the impact of the deal, which has raised suspicion and caused some to think that something is being hidden. Through the people who elected us, this House—not the White House—decides on matters of national importance. The Liberal Democrats have tabled these new clauses to allow the House to have a proper vote on the deal.
Dr Johnson
I will be relatively brief. New clause 15 would require the Secretary of State to lay before Parliament any trade negotiation requiring NHS spending or funding exceeding £100 million, in the form of regulations subject to the affirmative procedure. New clause 76 would require the arrangements between the United States and the United Kingdom on pharmaceutical pricing to be laid before the House to be voted on.
A key concern is costing. There have been various estimates of the additional cost of medicines. The former Secretary of State, the right hon. Member for Ilford North (Wes Streeting), said that he would not change or cut the NHS budget to pay for that increased cost. Will the Minister tell us the estimated extra cost of medicines, and where that money will come from, if not from the DHSC budget?
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairship, Ms Lewell. Like the shadow Minister, I will be relatively brief. [Interruption.] It was not clear whether that was a sound of appreciation or disappointment from the Minister. I will assume that she receives everything I say with the same noise and grace.
Yesterday, the Secretary of State appeared before the Health and Social Care Committee—on which my hon. Friend the Member for Isle of Wight East and I sit—and was questioned at some length by the Chair, the hon. Member for Oxford West and Abingdon (Layla Moran), about the UK-US trade deal. It was striking that the Secretary of State appeared unable to answer the basic question of whether an impact assessment could be presented to the Committee—under whatever terms of secrecy or confidentiality the Department wanted to place on it—to allow us to assess the costs, as the hon. Member for Winchester outlined, and, one would hope, the benefits.
The Secretary of State was very clear that there were benefits, but he was unable to outline what they were. He cited commercial confidentiality, which I do understand; there will be commercially confidential elements to the deal. What was really striking, however, was that even though the Select Committee was very happy to receive the information under whatever strictures he wanted to put on it, so that we could scrutinise it, it was not given. That is serious cause for concern.
I understand what the hon. Member for North Shropshire seeks to achieve through new clauses 15 and 76, but there are some problems in their drafting. There will be commercially confidential elements to the deal, so laying it before the House essentially completely unredacted, as new clause 15 would require, might pose real problems. Likewise, I assume that the intention of new clause 76 is to focus specifically on the UK-US trade deal as currently formulated.
Dr Prinsley
Much of the conversation around those trade deals relates to pharmaceuticals from the United States. Our patients should be able to access the best available treatments, whatever deals we cook up. We must support innovative research based in our own country, particularly clinical trials for new medicines. To do that, we need to support clinical academics—the doctors who work in universities and organise research. Does the hon. Gentleman acknowledge that the number of clinical academics fell under the previous Conservative Administration? Most clinical academics are now very senior, and we are not recruiting replacements effectively. We need to look after our home-grown pharmaceutical industry so that we do not need such trade deals.
Gregory Stafford
I certainly agree with the hon. Gentleman’s penultimate point: we need to support home-grown clinical academics and the life sciences industry in this country. As he has drawn me down that line, I declare that my wife works in the life sciences industry in the UK. I entirely agree with him on that point. However, if he is saying that a corollary is that we should not do pharmaceutical trade deals with other countries, I do not agree, because UK patients need the best medicines no matter where they come from. If that was not what he was saying and I am putting words into his mouth, I apologise, but that is how it sounded to me. I agree that we should support the home-grown, but obviously we need access to medicines from around the world.
That brings me to my concerns about new clause 76. I understand why the hon. Member for Winchester supports it, but the way it is written means that, for the lifetime of the Act, any trade deal with America would have to follow those strictures. Although I accept that he does not like the current deal or the incumbent in the White House, it seems odd that we are singling out in statute, and putting a stricture on, one country over every other. I still probably would not have voted for it, but the new clause might have been more acceptable had it referred to any trade deal with any country, or even a group of countries—I know he is a big fan of one particular group of countries. That might have made it difficult. It would be dangerous essentially for the Bill to put a stricture on a trade deal with one specific country—especially one that is probably our strongest ally. I think that sits very badly.
Sojan Joseph
Does the hon. Gentleman agree that the existing constitutional arrangements already provide mechanisms, ministerial accountability and parliamentary scrutiny? Singling out one country is a politicising measure, and it will have long-term consequences for our relationship.
Gregory Stafford
Yes, I agree entirely with the hon. Gentleman. It would be a very slippery slope to write that into legislation. I understand the motivation—as I often do—behind Liberal Democrat new clause 76, but I do not think its drafting is appropriate in this context, and I cannot support it.
Joe Robertson
As my hon. Friend the Member for Farnham and Bordon said, we on the Health and Social Care Committee heard from the Secretary of State yesterday. These new clauses were obviously drafted in advance, but the timing of their consideration is rather good.
We had the opportunity to ask the Secretary of State, who sits right at the top of the Department, some fairly basic questions about the deal that will apparently see the NHS pay 25% more for US drugs than it does currently. We asked, for example, how much it will cost. The Chair of the Select Committee, the hon. Member for Oxford West and Abingdon, skewered the Secretary of State within minutes. A short while later, once the Secretary of State had had the chance to reflect on her queries, I had the opportunity to ask some even more basic questions. I asked not what the figure was, but whether one even existed or whether any analysis had been done. We ended up going backwards.
We parliamentarians and the public still do not know the answers to some basic questions, even though a deal has been done. Do we know how much it will cost? Does a figure exist? Has an analysis been done? Are we talking about a figure or a bracket? On what basis was the deal agreed? We received absolutely no answers at all to those questions. To conclude, I posed a fairly obvious question: how on earth can we strike a deal to pay 25% more for drugs that we already get without knowing how much it will cost? No answer was given to that question either.
It is no wonder that these fundamental questions have effectively come in the middle of the Bill’s passage. This is not the place for them, but in the absence of basic answers, I can see why the hon. Member for Winchester and others have raised these issues. I will ask the same questions of the Minister. If her boss cannot answer them, perhaps she can, as the Department has had 24 hours to reflect. How much will the deal with the US cost? Are there—even if the Government do not want to disclose them—a figure and an impact assessment?
If the Government can confirm that a figure or bracket exists, why are they not willing to discuss them? If the Government can confirm that some sort of impact assessment has been done, when did it happen and why are they not disclosing it? Until we get those answers, so that people can see the fundamental considerations on which the Government base their decisions, this is a fairly unappealing way of going about securing investment for life sciences.
The Secretary of State talked about the benefits of this deal, and I am sure that there are benefits. I do not disagree with the principle of paying more for drugs if it has benefits for research and development—I understand and support that principle—but I want to be able to see what those intended benefits are, in some form of document or analysis. I do not want bare statements that say, “Research and development is good.” We all know that; I want to see the cost.
New clause 15 would also set a cost threshold of £100 million. The Government are not in a position to confirm whether the US deal would qualify under clause 15. It would at least force the Government’s hand. I suspect that the sum is far higher—into the billions—but we do not know. We are left to sit and speculate, despite the Secretary of State’s appearance before the Health and Social Care Committee. He must have expected that question to be asked. He was flanked by the permanent secretary of the Department and the chief executive of NHS England. By the way, he was a Treasury Minister prior to becoming the Secretary of State just two months ago. We had all the key people in the room to give some sort of indication about cost and benefit, yet none was forthcoming.
Although I cannot back the new clause, because I do not think statute is the right place to ask these questions, I completely understand why it was tabled. She will not accept the new clause, but could the Minister at least answer some of the questions that parliamentarians and the public are asking?
Karin Smyth
I am happy to talk about the impact of trade arrangements on NHS spending and how arrangements are scrutinised by Parliament. I am grateful to the Liberal Democrats for the new clauses.
Our relationship with industry, life sciences and the pharmaceutical sector, as my hon. Friend the Member for Bury St Edmunds and Stowmarket said, is crucial not only to our patients and constituents, but to growth in our country. Many hon. Members will have companies large and small in their constituencies—my hon. Friend the Member for Aylesbury has Lynam Pharma in hers. Important local companies are doing great work, innovating and bringing great people together to work on behalf of the life sciences sector and our country. They make us proud to be a leading country in this area, and I give credit to the Prime Minister for his leadership to put this country back in its rightful place on the international stage, addressing yet another part of our international reputation that was trashed by the Conservative party. [Interruption.] You started it.
On new clause 15, parliamentary scrutiny is crucial to ensure that trade deals negotiated by this Government are in the best interests of the UK. That is why the Government are committed to transparency and to enabling effective scrutiny of our trade agenda. Nowhere is scrutiny more important than in considering the potential impact of trade agreements on public services such as the NHS. The Government have a clear framework in place for scrutiny of the trade agreements that we have negotiated. This process strikes the right balance between ensuring that appropriate parliamentary accountability can take place and preserving our ability to negotiate agreements effectively. That is important to ensure that the UK can negotiate credibly with its partners and secure in trade deals positive outcomes for the public and British businesses, while upholding and protecting the role of Parliament.
Helen Morgan
The disquiet about the deal comes from the fact that the sums involved are huge—possibly £9 billion a year, or even more towards the back of the 10-year period—according to big companies in the sector. The Association of the British Pharmaceutical Industry was not involved in the negotiation of the deal; it was negotiated with the US. We fully support of the life sciences sector in this country, and there is a complex debate to be had about access to novel medicines for people with unusual and rare diseases, and about balancing that with everybody else’s access to volume services on the frontline, but that important discussion should be had by Parliament and the British people, not between a trade negotiator and Donald Trump’s White House. That is where our disquiet comes from, and it is why we tabled these new clauses.
Karin Smyth
I understand the intent of the hon. Member for North Shropshire and her commitment to parliamentary scrutiny, as well as that of her hon. Friend the Member for Oxford West and Abingdon. I hope that some of my points will address that.
New clause 15 duplicates existing processes and creates responsibilities for the Secretary of State for Health that would cut across our important procedures for scrutiny. No trade agreement can, by itself, change UK domestic law or require new public expenditure without the usual domestic processes being followed. Any changes to legislation necessary to implement a trade agreement would be subject to parliamentary scrutiny in the usual way. It is right that the Government be held to account, to ensure that trade deals deliver for the country. However, those processes are already in place and are working.
Joe Robertson
To strip this back further, can the Minister confirm whether a deal has been done?
Karin Smyth
I am not party to the negotiations. That is above my pay grade, like the conversation yesterday that the hon. Gentleman alluded to. I will get back to him on any outstanding questions, as the Department will to the Select Committee with other details.
Dave Robertson
To quote the Precision Health Technologies Accelerator at the University of Birmingham, very close to my Lichfield constituency, its leadership has been supportive of the removal of tariffs from pharmaceuticals, saying that the introduction of the tariffs could lead to
“supply chains collapsing and patients suffering.”
That is an enormous growth opportunity for the West Midlands combined authority, for Birmingham and for the wider region. There have been a lot of discussions, but I wanted to make sure that the views of organisations that will benefit are on the record, because this will be so beneficial for my region.
Karin Smyth
My hon. Friend clearly highlights the advantages for his constituents and the importance, particularly for that university and universities across the country, of such outward-facing arrangements, which benefit constituencies in many ways, not only through employment, but through the pharmaceuticals and medical devices, and so on, that help all our constituents.
New clause 76 specifically references the trade arrangement between the United States and the United Kingdom. That landmark partnership with the United States Government on pharmaceuticals pricing and tariffs is in the best interest of UK patients, supporting the NHS and the economy. As a result of the changes to the UK’s medicines pricing, NHS patients will get improved access to lifesaving treatments. New medicines have already been recommended under the updated approach, including a brain cancer drug available to patients as young as 12 and a last-resort treatment for a rare, aggressive stomach cancer—something that I think the entire House and the Committee would support.
Liz Twist
I want to emphasise a point that has already been made, which is the positive impact of the agreement for people with rare and undiagnosed conditions. As the Minister will know, I have worked with a number of those organisations, and this is certainly an opportunity for innovative treatments to be funded, as they might not have been before. I thank the Minister for that.
Karin Smyth
Again, this is an area of work that my hon. Friend has led on for many years, as I have seen, often when many others have not been around to support it. With so many organisations and charities lobbying on behalf of so many people who are desperate for rare diseases in particular to be highlighted—those diseases that affect a small number of people, many of them children—that work is crucial. Her work in leading in this place is exemplary. That is exactly where we aim to get by working with our partners in difficult circumstances. Trade deals and negotiations are necessarily difficult—otherwise, they would be easy—but the hard work yields results for people. As I have said, this Government have taken an outward approach to working with our partners and with industry.
We have already taken steps towards achieving our commitments, most notably increasing the NICE cost-effectiveness threshold. The Government previously updated Parliament in two ministerial statements, and of course MPs quite rightly have the option to continue to table parliamentary questions. Officials should be able to produce confidential advice for Ministers, to inform trade or other negotiations, and we must maintain that confidentiality in this case, as the impact assessment contains commercially sensitive assumptions. It is scenario-based and remains linked to live policy development. On that basis, I ask the hon. Member for Winchester to withdraw the new clause.
Dr Chambers
I thank the Minister for her comments. It is good to hear cross-party recognition of how important the life sciences sector is in the UK, to universities and businesses as knowledge transfer partnerships. This is a huge opportunity not only to improve the health of the nation and the treatments available, but to boost the economy.
We will withdraw new clause 15, but I thought the hon. Member for Isle of Wight East spoke extremely well about his concerns relating to the trade deal.
Joe Robertson
I think that the hon. Member has spoken very well, too, and I am grateful to him for airing this important subject through his new clause.
Dr Chambers
I appreciate that. Just to reiterate, I am talking specifically about the trade deal with the United States, not about every single trade deal. We completely accept that primary legislation is not necessarily the best way to scrutinise a trade deal, but given the lack of options at the moment, we must use every political mechanism available to create transparency.
Dr Johnson
This Government came to power saying that they would be more transparent, but they have not been. It took us months to get numbers out of the Government about the Chagos Islands deal.
Dr Chambers
I am grateful to the shadow Minister for that intervention.
Unless something changes significantly by the time we get to vote on new clause 76, which I understand will not be today, we will press it to a vote for transparency’s sake, but we will withdraw new clause 15. I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
New Clause 16
Duty to promote the health and wellbeing of carers
“After section 14Z44 of the NHS Act 2006 insert—
‘Duty to promote the health and wellbeing of carers
(1) Each integrated care board must exercise its functions with a view to improving and maintaining the physical health, mental health, and wellbeing of carers within its area.
(2) In exercising its duties under this section, an integrated care board must have regard to—
(a) reduction of health inequalities experienced by carers,
(b) prevention of deterioration in carers’ physical and/or mental health,
(c) involvement of carers in decisions relating to the care of persons for whom they provide care, and
(d) the need to ensure carers are able to access appropriate preventative and other health services and support.
(3) An integrated care board must take reasonable steps to ensure that NHS bodies and providers of NHS services within its area—
(a) consider the health and wellbeing needs of carers in care planning and discharge processes,
(b) involve carers appropriately in decisions relating to care and treatment, and
(c) provide carers with information about support available to them for their health and wellbeing.
(4) In preparing a Joint Forward Plan, an integrated care board must include—
(a) an assessment of the health and wellbeing needs of carers within its area,
(b) steps the integrated care board proposes to take to improve outcomes for carers, and
(c) measures for reducing inequalities experienced by carers.
(5) In this section, “carer” has the meaning given by section 10 of the Care Act 2014 and includes a young carer within the meaning of section 96 of the Children and Families Act 2014.’”—(Dr Chambers.)
This new clause would introduce a duty for integrated care boards to promote the health and wellbeing of carers.
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss the following:
New clause 17—Duty to identify and record unpaid carers—
“After section 14Z44 of the NHS Act 2006 insert—
‘Duty to identify and record unpaid carers
(1) An integrated care board must take reasonable steps to identify persons within its area who are unpaid carers.
(2) An integrated care board must make arrangements to ensure that NHS bodies and providers of NHS services within its area—
(a) maintain appropriate systems for recording whether a person is an unpaid carer,
(b) use consistent coding standards for the recording of unpaid carers in health records,
(c) review and update records relating to unpaid carers at appropriate intervals, and
(d) ensure that the identification and recording of unpaid carers forms part of—
(i) primary care registration processes,
(ii) hospital discharge procedures,
(iii) care planning processes, and
(iv) other relevant patient contact pathways.
(3) For the purposes of this section, “carer” has the meaning given by section 10 of the Care Act 2014 and includes a young carer within the meaning of section 96 of the Children and Families Act 2014.’”
This new clause would introduce a duty for integrated care boards to identify and record unpaid carers when they come into contact with NHS services.
New clause 18—National Respite Care Scheme—
“(1) Within six months of the passage of this Act, the Secretary of State must establish a National Respite Care Scheme.
(2) The scheme under subsection (1) must make provision for—
(a) a local authority carrying out a carer’s assessment under section 10 of the Care Act 2014 to be required to consider whether a carer is able to take sufficient breaks from their caring responsibilities.
(b) unpaid carers to receive support to take breaks from their caring responsibilities to—
(i) maintain their physical and mental health and emotional wellbeing,
(ii) participate in work, education, training or recreation, and
(iii) participate in family and community life.
(c) a carer to receive appropriate support if a local authority carrying out an assessment under subsection (2)(a) determines that a carer is unable to take sufficient breaks from caring.
(3) Under subsection (2), “support” may include—
(a) replacement care for the cared-for person;
(b) respite services;
(c) any other steps a local authority considers appropriate as support.
(4) The Secretary of State must provide sufficient support to local authorities to ensure the scheme under subsection (1) is delivered in every local authority.
(5) For the purposes of this section “unpaid carer” has the meaning given by section 10 of the Care Act 2014 and includes a young carer within the meaning of section 96 of the Children and Families Act 2014.”
This new clause would require the Secretary of State to establish a National Respite Care Scheme.
New clause 89—Duty of health bodies to provide information and advice to carers—
“(1) Within six months of the passage of this Act, the Secretary of State must make provision for an information and support service for unpaid carers.
(2) The service under subsection (1) must include—
(a) provision for an unpaid carer to access information regarding recommended care and treatment needs for the person for whom they are caring,
(b) information about services, support and assistance available from the National Health Service to assist unpaid carers in their caring role,
(c) information about the availability of support for unpaid carers provided by local authorities,
(d) information about support available to promote and maintain the health, wellbeing and resilience of unpaid carers,
(e) information about arrangements for obtaining advice, training, advocacy or peer support relevant to unpaid carers’ caring role, and
(f) any other provisions which the Secretary of State considers appropriate for supporting unpaid carers in relation to their delivery of care.
(3) In exercising the duty under subsection (1), the Secretary of State must prioritise proactive identification of unpaid carers and ensuring that information and advice is accessible, proportionate and appropriate to the needs of unpaid carers.
(4) In exercising the duty under subsection (1), the Secretary of State must have regard to an unpaid carer’s willingness and ability to provide care.
(5) The Secretary of State must take reasonable steps to ensure that unpaid carers are made aware of the information and advice available under this section.
(6) For the purposes of this section, ‘unpaid carer’ has the meaning given to ‘carer’ in section 10 of the Care Act 2014.”
This new clause would create a duty for the Secretary of State to provide certain information and advice to unpaid carers.
Dr Chambers
I will speak to new clauses 16, 17 and 18 together. They relate to the duty on integrated care boards to promote the health and wellbeing of carers. Certainly, as the Liberal Democrat spokesperson for mental health, and having been a carer myself—like many people in this room—I have a particular interest in the mental health of carers. Sometimes we forget that, as well as the patient, the carer also needs a huge amount of support, as what they do can be very draining.
Unpaid carers are essential to the sustainability of the NHS and social care system, but carers consistently experience poorer physical and mental health outcomes than non-carers, and frequently struggle to access support for their own health needs. There are approximately 4.7 million unpaid carers in England. They provide support valued at an estimated £152 billion annually—equivalent to the annual NHS budget.
Evidence consistently shows that unpaid carers experience worse health outcomes than non-carers. The GP patient survey 2025 showed that 72% of carers report a long-term condition or disability compared with 61% of non-carers. The Office for National Statistics reports that one in four adults providing unpaid care described being in “not good health”, compared with one in five adults who are not providing unpaid care. The probability of reporting being in “not good health” was higher for people providing more hours of unpaid care. Some 49% of unpaid carers reported at least one adverse health effect from providing that care. Low mental wellbeing was more common among unpaid carers, at about 20%, than among those not providing unpaid care, at 15%.
An academic study analysing GP patient survey data found that, for those caring for more than 50 hours a week, the health impact of being a carer is equivalent to losing 18 days of full health every year. A study has also found that carers cancel medical treatments and appointments because nobody is available to step into their caring role, and that, because of their caring responsibilities, carers cannot find appointments at times when they can attend.
A more targeted approach to support unpaid carers could help to prevent the onset of deteriorating carer health and wellbeing as a result of their caring roles. Although ICBs have broad duties relating to population health and inequalities, there is currently no explicit statutory duty requiring ICBs to improve the health and wellbeing of unpaid carers specifically.
Liz Twist
It is a pleasure to serve with you in the Chair, Ms Lewell. I listened with great interest to the hon. Member for Winchester talking about the new clauses; they have a great deal of similarity to new clause 89, in the name of my hon. Friend the Member for Shipley (Anna Dixon). We all know that it is absolutely vital to look after our carers. They do a huge amount of work to support us and make sure that people are kept at home and cared for.
New clause 89 covers a number of issues, and would create a duty on health bodies to provide information and advice to unpaid carers and task the Secretary of State with providing that service. It would ask first for information about medicine and medicine records, which we talked about a few days ago. Beyond that, it asks for information about services and support available from the NHS to help in their role as carers, and about support for their own needs and health, which are hugely important. It also asks for information about the support available to them and how to get more advice in their role.
I will not go over all the arguments again, but we heard about Carers UK’s “State of Caring” survey in 2025. Some 29% of carers say that they need more information and advice about caring, such as support with clinical tasks or managing someone’s condition. Many of them provide support with medication and administering it. Many also monitor blood pressure or sugar level, dress wounds and use equipment. In all these new clauses about carers, the discussion is about how we can best support carers in that role. They have a vital role, and I know that the Government recognise the important contribution they make to healthcare, so it is important that we consider the issue here.
Dr Johnson
This group of new clauses is about carers and how we look after them. They do so much work for so many people across the country by looking after their loved ones. Many of them are not necessarily in good health themselves, and some are even children. These new clauses have a positive intention: to try to improve carers’ lives and make sure that they are recognised.
I congratulate the hon. Member for Winchester on his success in keeping open his respite care centre. Perhaps he could share his notes with me, because the Reform county council in Lincolnshire is currently trying to close Swallow Lodge, a respite care centre that provides for people of working age who have severe disabilities. The council wants to close it, and the people there are devastated by that suggestion. We had a public meeting, which many people came to, and they had not been consulted at that point. I think that an assumption was made that they are not able to communicate, but many of them are able to do so with support. However, that communication had not happened.
It has caused fear for people. They are worried about where they will go instead and whether it will be suitable. What about the people they made friendships with at the centre? Many of them have elderly parents—in their 80s, in some cases. It is also economically short-sighted, because people may end up going into full-time care, which will ultimately cost the council more.
The council has now been persuaded to do a full consultation, which will happen over the next few months. If the hon. Member can share anything with me that was successful for him that could help me keep Swallow Lodge open against the Reform county council’s changes, I would be very grateful.
Sojan Joseph
As the chair of the APPG on adult social care, I pay tribute to unpaid carers for the enormous contribution they make to their families, their communities and wider society. I often have meetings with them, and as part of my job before I became an MP—I worked in the NHS—I had a lot of contact with carers. I have seen so many vulnerable patients benefit from the enormous amount of work that carers do. In some services, such as the mental health service, there is already provision for identifying carers, carers’ assessments and support for carers. Carers provide extraordinary support, often at great personal sacrifice.
Although the intention here is to make the wellbeing of carers a statutory duty, we need to be careful that we do not put any statutory responsibility for that on the NHS and create more administrative burden for it. I would appreciate it if the Minister would respond to that point, and if the Government would consider something to support carers, while not putting any more administrative burden on the NHS, where we are focusing on providing more support on the frontline.
New clauses 16 and 17 would impose new obligations on integrated care boards to promote carers’ wellbeing and to identify and record unpaid carers whenever they come into contact with NHS services. I want to make it clear that we should not create any more administrative burdens for NHS frontline services. Although identifying and supporting carers is important, the requirement would add to the administrative burden on NHS organisations at a time when they should be focusing on delivering frontline care.
We should be cautious about creating new statutory duties that divert resources and staff time away from patients. The proposal for a national respite care scheme is similarly well intentioned, but it risks imposing a centralised, one-size-fits-all model across a system that already makes local authorities and health boards responsible for assessing local needs and delivering support. Again, although we need more support for carers, we should be careful that we are not duplicating any of the services that are already available. Some charities also do a brilliant job of supporting carers. The provisions in these new clauses should be looked into, but we need to be cautious that we do not create more burdens for our existing systems.
Joe Robertson
I am grateful to the hon. Member for Winchester for introducing these new clauses and for the debate that that is allowing us to have. Unpaid carers are too often a silent and fundamentally unappreciated part of society, which the system could not cope without. They are family members who are thrown into the role of looking after their loved ones, which they did not expect to have to do. Most of them have no formal qualifications, but through love and family ties, they provide unpaid support, which in many cases has a negative effect on the financial wellbeing of the household and involves a huge amount of emotional toil.
The crisis in social care has lasted for decades under different Governments, who have struggled to tackle it, and it is putting increasing pressure on family carers. Many do not see themselves as a carer—they see themselves as a husband, wife, daughter, son or friend—but they provide millions of hours of care and support, year in and year out. My former role was at a national nursing charity that seeks to support the families of those living with dementia. I saw for myself how much wraparound care can achieve in relieving pressure and unnecessary suffering, not just for the person living with dementia—it does not have to be dementia, but that is what I have experience of—long-term frailty or conditions that require support, but for their family and carer. Very often, the biggest care need for the person living with dementia is the biggest need their family carer has; if we can sort the family carer’s biggest need, they can go on and do so much more for the person they love.
I thank the hon. Member for Winchester for allowing us to have this debate. I urge the Government, if they do not adopt these new clauses, to do all they can to relieve the pressure on unpaid carers up and down the country and to provide support for them.
Karin Smyth
Like the hon. Member for Isle of Wight East, I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. All Members are committed to ensuring that carers receive the care and support they need. The Government recognise that unpaid carers play a vital role in sustaining the health and wellbeing of millions of people across our country. I pay tribute to them, and recognise all the work they have contributed to. I also note the work done by my hon. Friend the Member for Ashford on the APPG with Members from across the House.
The hon. Member for Winchester highlighted the shocking impact on the physical and mental health of people who are caring, which we heard about in the evidence session. That is an important issue, and it is good that we can now talk more about the mental health of carers. As he rightly said, many of us are carers. It is not an easy thing to do.
I pay tribute to the hon. Member for Isle of Wight East for his comments about the importance of wraparound care to people who do not want to leave the one they care for. I recognise that respite care is important.
I wish the hon. Member for Sleaford and North Hykeham good luck in her campaign in her constituency with the Reform council.
Dr Johnson
I thank the Minister for her good wishes. The council has not just proposed closing Swallow Lodge; it has also recently closed the memory support service. I listened to what my hon. Friend the Member for Isle of Wight East said about services for people with dementia, and this is another area where people will suffer because of the closure of vital services.
Karin Smyth
When the hon. Lady gets back to her constituency, I am sure she will be campaigning heavily on behalf of her constituents.
We acknowledge the need to support carers’ health and wellbeing, but we do not think new clause 16 is necessary, because the existing legal framework already requires the system to support them. The new clause duplicates existing duties and risks adding complexity, rather than improving support in practice. Carers are explicitly referenced in the NHS constitution, which establishes the principles and values of the NHS in England and sets out the aim of improving the health and wellbeing of the population. The Secretary of State for Health, all NHS bodies, private and voluntary sector providers supplying NHS services, and local authorities in the exercise of their public health functions are required by law to take account of the constitution in their decisions and actions. Local authorities and NHS bodies also have a duty of co-operation in respect of their functions relating to carers.
Finally, under the Bill, the Secretary of State will take on NHS England’s role in promoting the involvement of each patient in decisions relating to their illness, care or treatment. That duty includes the involvement of carers and representatives.
Liz Twist
As the Minister says, many people in this room have had experience of being a carer for a family member. She said that there is already a legal framework, but carers are clearly saying that they need a bit more. How will the Government ensure that we provide not just words and legal documents, but help on the ground?
Karin Smyth
I was just moving on to talk about some of the work beyond the legislative framework.
Beyond the legislative framework, our focus is on delivering practical improvements because, as my hon. Friend says, that is absolutely what people want. We are committed to ensuring that carers have the support they need. Through measures in the 10-year health plan, we are already equipping and supporting carers by making them more visible, empowering their voices in care planning, joining up services and streamlining their care tasks by introducing a new My Carer section on the NHS app. We are also working with Ministers from the Department for Work and Pensions, the Department for Business and Trade and the Department for Education to consider how best to recognise and support unpaid carers. The Government are preparing a cross-Government action plan for unpaid carers, to be published this year.
Dr Prinsley
Will the Minister acknowledge that the uplift in the carer’s earnings allowance is a very significant measure that this Government did introduce?
Karin Smyth
I thank my hon. Friend. That is indeed one of the ways in which, working through the DWP and across Government, we have sought to bring in, as my hon. Friend the Member for Blaydon and Consett said, practical measures to make carers visible and to support them. That is exactly the sort of thing we wanted to do and have done, and it does start to recognise the work that people do.
Let me turn to new clause 17 and new clause 89, which my hon. Friend the Member for Blaydon and Consett talked about and which was tabled by my hon. Friend the Member for Shipley, whose expertise and commitment in this area are well known across the House. The new clauses look at the identification of, and provision of information to, unpaid carers. I agree on the importance of ensuring that carers are properly recorded and identified in the system and provided with relevant information and advice so that they can be better supported and involved in care decisions.
However, we do not believe that explicit requirements to identify and record particular patient and carer groups are appropriate for legislation. We have made clear commitments in the NHS 10-year health plan and are taking practical steps to improve identification, support carers and involve them in care planning. If we need to mandate compliance, that is best done by including requirements in national NHS contracts or in statutory guidance or directions, where we can provide more detail and directly address barriers.
Information about unpaid carers will be captured systematically to ensure that their responsibilities are recognised and supported, and developments such as the single patient record, which we have discussed in Committee, will make that easier in the future. That is a really important step forward.
We are also looking to support general practice in better identifying and recording which of their patients are unpaid carers, to help ensure that those carers can get the support they need in the community. NHS England recently published guidance to support that, and work is ongoing to ensure more consistent coding of unpaid carers by general practitioners.
We are also working to improve the quality of local authority data on unpaid carers. The Partners in Care and Health programme, launched with the Local Government Association, is working with local authorities to improve their data and address barriers to data sharing between local systems.
Dr Prinsley
Since I have been an MP, I have visited a number of schools in my constituency, and I have always been struck by the number of children who are carers. [Hon. Members: “Hear, hear.”] I think that is a very under-recognised group of people, whose lives are completely dominated by the fact that they are carers for their parents.
Karin Smyth
I thank my hon. Friend. I heard audible voices of approval for that point. I think that when any of us know or encounter children, whether it be in our own circle or when we visit schools in our constituency, we are very much struck by those who are at school and are themselves caring. I think most schools do a tremendous job where they recognise that. Often children, like adults, do not want to inform their school or local people that that is what they are doing—they are very proud—and perhaps the person they are caring for does not know how to do that. I have certainly seen in my constituency schools starting to recognise and support the needs of those children, in a way that is dignified and respecting of privacy.
I did allude to some of the work that we are doing across Government, including with the Department for Education, to recognise, and to find ways to support, those young people, many of whom want to support their loved ones. I think we have all seen great ways to support them. When we are addressing young children in classrooms, I am always conscious of the need to think about the circumstances in which we are talking to them. There are a lot of teenage carers as well. My hon. Friend the Member for Bury St Edmunds and Stowmarket is absolutely right to highlight that.
More broadly, apart from data sharing and addressing barriers, the My Carer section of the NHS app will allow people to securely prove that they are providing care. That will streamline the care responsibilities of carers significantly—again, that can be done without having to confront the situation in public, if that is what people want—while giving them a means to seek advice or reassurance directly from a range of professionals when they need it.
I am also not convinced that the challenge of providing effective support would be solved by an additional legal duty. The existing legal framework already requires the system to support carers, including through the provision of information and advice. As the Committee has discussed, practical steps are what is needed. Progress is being made locally through issuing practical toolkits to help hospitals implement their legal duties under the Health and Care Act 2022. This year, the Government will also commission the better care fund support programme, led by the Local Government Association, to work with the NHS and social care partners to strengthen their approach to involving unpaid carers in discharge planning.
New clause 18 would establish a national respite care scheme. The Government do not feel that that is necessary, as the legal framework already provides rights for carers to access support, including respite services. Under the Care Act 2014, where a carer appears to have support needs, whether those are current or in the future, local authorities are required to carry out a carer’s assessment. Where carers have eligible needs, local authorities have duties and powers to meet them. That establishes a framework where needs assessments and subsequent care planning focuses on the individual and their circumstances, rather than prescribing a particular service or solution. In other words, respite care is already one of the many forms of care and support that might be offered as part of the process, where it is appropriate to meet the needs of the individual carer.
Funding and mechanisms are in place to enable local areas to deliver support for carers. Under the better care fund framework, there is £9 billion for integrated care boards and local authorities to make joint plans and to pool budgets to deliver better, joined-up care. In developing their better care fund plans, ICBs and local authorities should consider how pooled funding can help the NHS and local authorities to meet duties on unpaid carers, including around short breaks and respite services.
The Government are also making available more than £4.6 billion of additional funding for adult social care in 2028-29, compared with 2025-26, to support the sector to make improvements. Local areas will determine how best to use the money to support carers, depending on local need and with reference to their statutory responsibilities.
For those reasons, I ask the hon. Member for Winchester to withdraw new clause 16, and hon. Members not to press new clauses 17, 18 and 89 to a vote.
Dr Chambers
I thank Committee members for their contributions. The hon. Member for Isle of Wight East spoke particularly well and emotively—I know that he worked for Dementia UK before entering Parliament. My mother was a carer for my father, who had dementia, and my sister and I gave her respite care, although probably not enough of it. I know that many Committee members will have been in a similar situation, as it is a common disease, and it is becoming increasingly common. I also thank the Minister for her comments and reassurance.
The hon. Member for Bury St Edmunds and Stowmarket made a point about children being carers. I sat on the Mental Health Bill Committee last year, and to give an example of how impactful such Committees can be, it is now a requirement, as a result of the Committee’s consideration, to identify whether mental health patients have children who are carers. That was not the case before, and we appreciated the Government engaging with us on that issue. It is often teenagers who care for adults with severe mental health issues, but they were not even identified before, so they could not be given the support they required. That has changed now, and it is fantastic to see that, through Committee scrutiny, we can make a tangible difference to people’s lives.
I will not press new clauses 16 and 17 to votes, but the Liberal Democrats do think that it would be sensible and impactful to establish a national respite care scheme, so I will press new clause 18 to a Division. On new clause 16, I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 18
National Respite Care Scheme
“(1) Within six months of the passage of this Act, the Secretary of State must establish a National Respite Care Scheme.
(2) The scheme under subsection (1) must make provision for—
(a) a local authority carrying out a carer’s assessment under section 10 of the Care Act 2014 to be required to consider whether a carer is able to take sufficient breaks from their caring responsibilities.
(b) unpaid carers to receive support to take breaks from their caring responsibilities to—
(i) maintain their physical and mental health and emotional wellbeing,
(ii) participate in work, education, training or recreation, and
(iii) participate in family and community life.
(c) a carer to receive appropriate support if a local authority carrying out an assessment under subsection (2)(a) determines that a carer is unable to take sufficient breaks from caring.
(3) Under subsection (2), ‘support’ may include—
(a) replacement care for the cared-for person;
(b) respite services;
(c) any other steps a local authority considers appropriate as support.
(4) The Secretary of State must provide sufficient support to local authorities to ensure the scheme under subsection (1) is delivered in every local authority.
(5) For the purposes of this section ‘unpaid carer’ has the meaning given by section 10 of the Care Act 2014 and includes a young carer within the meaning of section 96 of the Children and Families Act 2014.”—(Dr Chambers.)
This new clause would require the Secretary of State to establish a National Respite Care Scheme.
Brought up, and read the First time.
Question put, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss the following:
New clause 62—Family support duty following serious childhood diagnosis—
“(1) Where a child is diagnosed with cancer or another life-threatening condition, the responsible NHS provider must, within 14 days of diagnosis, ensure that the child’s family is offered appropriate information, support and coordination services.
(2) For the purposes of subsection (1), the responsible NHS provider must offer—
(a) access to a named family support coordinator;
(b) information regarding welfare benefits, financial support and relevant public services;
(c) information regarding employment rights and workplace support available to parents and carers;
(d) signposting to appropriate mental health and psychological support services;
(e) information regarding relevant local and national charities, support organisations and peer-support services;
(f) a written Family Support Plan setting out the support available to the family during treatment; and
(g) notification and information sharing in accordance with subsection (3).
(3) The responsible NHS provider must provide the child’s registered general practitioner and where different, the registered general practitioners of the child’s parents or primary carers, with a Family Support Summary.
(4) A Family Support Summary must include—
(a) the child’s diagnosis;
(b) the proposed treatment plan;
(c) the expected duration and intensity of treatment, where known;
(d) information regarding the potential impact of the diagnosis and treatment on parents, carers and siblings; and
(e) any recommendations regarding wellbeing support, monitoring or referral for the family unit.
(5) Following receipt of a Family Support Summary, the relevant general practice shall be encouraged to consider the wellbeing needs of parents, carers and siblings and, where appropriate, provide information, assessment, referral or signposting to suitable support services.
(6) NHS England must publish guidance for NHS providers on the discharge of duties under this section.
(7) In this section—
‘child’ means a person under the age of 16;
‘family’ includes parents, guardians, primary carers and siblings;
‘life-threatening condition’ means a condition designated as such by the Secretary of State in guidance.”
This new clause places a duty on NHS providers to offer practical information, coordination and support to families within 14 days of a child being diagnosed with cancer or another life-threatening condition.
New clause 63—Parent mental health and bereavement support duty—
“(1) Where a child is diagnosed with a life-threatening condition, the responsible NHS provider must ensure that the psychological wellbeing of parents, guardians, primary carers and siblings is considered as part of the child’s care pathway.
(2) Within 14 days of diagnosis, the responsible NHS provider must offer—
(a) a parental psychological wellbeing assessment;
(b) access to a designated family support practitioner, psychologist, counsellor or other appropriately qualified professional;
(c) information regarding the psychological impact of serious childhood illness, including trauma, anxiety, depression, stress and bereavement;
(d) a written Family Mental Health Support Plan;
(e) notification to the child’s registered general practitioner and, where different, the registered general practitioners of parents or primary carers.
(3) During active treatment, the responsible NHS provider must ensure that parents and primary carers are offered periodic psychological wellbeing reviews.
(4) The responsible NHS provider must offer an additional psychological wellbeing review following any—
(a) significant deterioration in the child’s condition,
(b) relapse,
(c) progression of disease,
(d) transition to palliative care, or
(e) other material change in prognosis.
(5) The responsible NHS provider must ensure that support under this section is offered proactively and must not be dependent upon a parent, guardian, carer or sibling requesting support, identifying their own need, or making a self-referral.
(6) Following the death of a child, the responsible NHS provider must—
(a) offer a bereavement wellbeing assessment to parents or primary carers;
(b) offer access to bereavement counselling, psychological support or equivalent specialist services;
(c) make proactive contact with the family within 14 days of the child’s death;
(d) offer further follow-up support at intervals specified in guidance issued by NHS England;
(e) ensure that referral pathways are available where significant psychological distress, trauma, anxiety, depression or post-traumatic stress symptoms are identified.
(7) The responsible NHS provider must ensure that information regarding available support services is provided to siblings and that age-appropriate emotional support pathways are available where required.
(8) NHS England must publish guidance regarding—
(a) parental psychological wellbeing assessments;
(b) family mental health support following serious childhood diagnosis;
(c) bereavement support following the death of a child;
(d) support for siblings affected by serious childhood illness;
(e) referral pathways into specialist mental health services;
(f) minimum standards for proactive family mental health support.
(9) NHS England must publish and lay before Parliament an annual report on compliance with this section.
(10) In this section—
‘child’ means a person under the age of 16;
‘family’ includes parents, guardians, primary carers and siblings;
‘life-threatening condition’ means a condition designated by the Secretary of State in regulations.
(11) The Secretary of State must, within three years of the commencement of this section, undertake a review of its operation and lay a report before Parliament.”
This new clause would establish a statutory duty on NHS providers to identify and support the psychological wellbeing of parents, carers and siblings following the diagnosis of a life threatening childhood condition. It would create a proactive, opt-out family mental health pathway from diagnosis through treatment and, where applicable, bereavement.
New clause 64—Review of uncertain imaging findings in high-risk childhood illness—
“(1) Where imaging undertaken in relation to a child with a high-risk cancer or other life threatening condition identifies findings that are—
(a) inconclusive,
(b) indeterminate, or
(c) suspicious,
the responsible NHS provider must ensure that the findings are reviewed by a consultant clinician responsible for the child's care.
(2) Following such review, the responsible NHS provider must ensure that the child’s parent, guardian or primary carer is informed—
(a) of the nature of the uncertainty identified;
(b) whether disease progression, relapse or recurrence can be confidently excluded;
(c) what further investigations or surveillance are being considered; and
(d) the risks and benefits associated with immediate further imaging, alternative imaging modalities, or continued observation.
(3) Where disease progression or relapse cannot be confidently excluded, the responsible NHS provider must consider whether additional imaging or investigation should be undertaken within 14 days or as soon as clinically practicable, whichever is sooner.
(4) The outcome of any discussion held under subsection (2), including the views expressed by the child's parent, guardian or primary carer, must be recorded in the child's medical records.
(5) NHS England must publish guidance on the operation of this section, including circumstances in which further imaging should be considered following uncertain or indeterminate findings.”
This new clause requires consultant review of uncertain imaging findings in children with designated high-risk conditions. The amendment also aims to ensure that parents are informed of the uncertainty, the available options and the risks and benefits of those options before a decision is made.
Dr Johnson
The hon. Member for Dewsbury and Batley (Iqbal Mohamed), who tabled new clause 25, asked me to speak to it, which I shall do briefly. This is a very serious issue. Critically ill children are infants, children and adolescents with life-threatening illness or injury, often requiring intensive, continuous care to survive conditions from leukaemia to meningococcal disease, traumatic brain injuries and major surgery such as spinal surgery. I should say that I am a consultant paediatrician, but I have worked in paediatric intensive care as a junior—now called a resident—doctor.
The new clause as drafted does not, I think, do what the hon. Member was aiming for. When I read it through, I think he is looking at cases such as the tragic one of little Charlie Gard, whom we all remember died of encephalomyopathic mitochondrial DNA depletion syndrome, known as MDDS. It is incredibly rare. That tragic case highlighted the potential for disputes between parents and doctors, which, thankfully, are unusual.
The new clause is headed, “Parents of critically ill children: communication and involvement in decision-making”. Of course parents should be involved in decision making about their children, but it is worth noting that the median time that children spend in ICU is two days and that, thankfully, most of them get better—very few do not. The new clause talks about teachers being involved, which in most cases is unnecessary and impractical; in many cases, a child may be admitted on a Friday and discharged from the ICU by the Monday. In the majority of cases, there is no practical reason for teachers to be involved.
I understand the desire for parents to be part of every meeting, but sometimes clinicians need to be able to talk frankly about cases. Sometimes they will have multidisciplinary meetings where they talk about a plethora of different cases, or they may compare one case with another in terms of what they have seen, the findings of scans and the like, so it is not possible to have parents in every single meeting, although it is of course desirable for them to be aware of the discussions.
Other parts of the new clause, including provision for parents to know about everything and to set out how communication and language needs may be met, seem reasonable. It mentions independent mediation where there is disagreement, which is a beneficial way to go about things, but we must not legislate so as to get in the way of urgent care, because most critically ill children in intensive care have urgent care needs that need dealing with now, not in a week’s time. Forming ethics committees to make decisions takes a long time, and that would get in the way of urgent care.
I think the hon. Member for Dewsbury and Batley is aiming for legislation that relates to chronically mechanically ventilated children with significant medical conditions, rather than children with an acute critical illness, but I said I would move the new clause and I have. I think he is trying to provide better care for some of the sickest children. That is a desirable aim and I know he cares deeply about it, but the new clause as drafted would not do what I think he aims for, and it could get in the way of paediatricians and others managing some of the sickest children in the country, so I will not press it to a vote.
Karin Smyth
I am grateful to the hon. Member for Dewsbury and Batley for tabling new clause 25, and grateful to the hon. Member for Sleaford and North Hykeham for her comments on it. It is a genuine pleasure to hear the expertise of clinicians such as her who work in the field of children’s health. She is obviously very passionate about that, and I thank her for bringing her expertise and commitment to looking after children, including critically ill children, to the Committee.
I recognise the profound impact that receiving a diagnosis of a life-threatening condition has on a child and their wider family. At such an overwhelming time in their lives, it is vital that families feel supported, informed and able to navigate the care and services available to them. We recognise that families can face huge variation in the support available and that they have to navigate complex systems at a particularly difficult time. I know that many hon. Members support many families in such circumstances in their constituencies. The Government are committed to ensuring that families have access to the support they need in the most straightforward way possible.
New clause 25 seeks to place a duty on the Secretary of State to issue guidance to integrated care boards on communications with parents of critically ill children and on parents’ involvement in decision making in respect of the treatment or care of their child. We heard from the Opposition spokesperson about some of the operational issues with some of its provisions, but there are no issues with its intent: of course parents should be involved and have good decision making at such a time.
Decisions about the care of a critically ill child can of course be distressing. We need to ensure that we get the process right from the beginning. That starts with good communication, sensitive handling and ensuring best practice across the system. Healthcare professionals should always act in the best interests of their patients; the views of parents are of course very important, but the child’s best interests are paramount, and we should not do anything that undermines that crucial principle. It is important that families and medical professionals communicate and, where possible, reach agreement on the care and treatment that is in the best interests of the child.
To support that, there are already many excellent examples of guidance and best practice across the health system. The Royal College of Paediatrics and Child Health is currently updating its framework for clinical practice on navigating decisions to provide, limit or withdraw treatment towards the end of a child’s life. That framework will include communication principles, legal and ethical principles, and clinical and practical considerations, including the role of clinical ethics services. It will also include guidance on navigating disagreements for professionals, children, young people and their families. An e-learning platform is available to staff working at all levels in children’s healthcare. The training programme provides professionals with a suite of resources to enhance knowledge, skills and confidence. It supports healthcare providers to recognise, manage and de-escalate conflict between families and healthcare providers where it occurs, and to signpost to both professional resources and resources for families. The actions I have outlined will continue to help and support the existing best practice.
Dr Johnson
The Minister is setting out the important guidance that can be provided to clinicians managing the care of children who are seriously unwell. I want to add for the record that I am a member of the Royal College of Paediatrics and Child Health, which is producing that guidance; I am grateful to her for setting out its importance. End-of-life-care decisions are very difficult. They need to be taken in conjunction with families but—the Minister is absolutely right—they must be made in the best interests of the child in all cases.
Karin Smyth
I am sure that the college will make best use of the hon. Member’s clinical expertise and her expertise as a legislator to get that guidance right. We work with royal colleges to ensure that we get the best clinical evidence into guidelines. I hope the actions I have outlined will continue to help and support the existing best practice, training and guidance on shared decision making and dispute resolution, so that it is embedded across the system.
There are a number of other important measures in this group that have not been mentioned. Let me just say that, alongside some of the things I have outlined, we want to progress system-wide reforms to improve the way children and young people, and their families, are supported across many conditions. We are working to bring forward a modern service framework for children and young people that will set out how we will improve quality for children and young people’s services in the longer term, as part of our 10-year health plan.
Dr Johnson
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 28
Appeals against health and social care provision in EHC plans
“(1) The Special Educational Needs and Disability Regulations 2014 (S.I. 2014/1530) are amended in accordance with subsections (2) and (3).
(2) After regulation 42, insert—
‘42A Other matters relating to EHC plans against which appeals may be brought
(1) In addition to the matters set out in section 51(2) of the Act, a child’s parent or a young person may appeal to the First-tier Tribunal against the matters set out in paragraph (2), subject to section 55 of the Act (mediation).
The matters are—
(a) a decision of a local authority, following an EHC needs assessment, that it is not necessary for health care provision or social care provision to be made for the child or young person in accordance with an EHC plan;
(b) where an EHC plan is maintained for the child or young person—
(i) the child’s or young person’s health care or social care needs as specified in the plan;
(ii) the health care provision or social care provision specified in the plan.’
(3) In regulation 43 (appeals), after paragraph (2) insert—
‘(3) When determining an appeal on the matters set out in regulation 42A(2)(a), the First-tier Tribunal has the power to order that—
(a) health care needs, or health care needs of a particular kind, which relate to the child or young person's special educational needs are specified in the EHC plan in accordance with regulation 12(1)(c);
(b) social care needs, or social care needs of a particular kind, which relate to the child or young person's special educational needs or to a disability are specified in the EHC plan in accordance with regulation 12(1)(d).
(4) When determining an appeal on the matters set out in regulation 42A(2)(b), the First-tier Tribunal has the power to order that—
(a) the health care needs specified in the EHC plan in accordance with regulation 12(1)(c) are amended;
(b) the social care needs specified in the EHC plan in accordance with regulation 12(1)(d) are amended;
(c) health care needs, or health care needs of a particular kind, which relate to the child or young person's special educational needs are specified in the EHC plan in accordance with regulation 12(1)(c) where those needs have not been specified in the plan; and
(d) social care needs, or social care needs of a particular kind, which relate to the child or young person's special educational needs or to a disability are specified in the EHC plan in accordance with regulation 12(1)(d) where those needs have not been specified in the plan.
(5) When determining an appeal on the matters set out in regulation 42A(2)(a), the First-tier Tribunal has the power to order that—
(a) health care provision, or health care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(g);
(b) social care provision, or social care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(h).
(6) When determining an appeal on the matters set out in regulation 42A(2)(b), the First-tier Tribunal has the power to order that—
(a) the health care provision specified in the EHC plan in accordance with regulation 12(1)(g) is amended;
(b) the social care provision specified in the EHC plan in accordance with regulation 12(1)(h) is amended;
(c) health care provision, or health care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(g) where that provision has not been specified in the EHC plan; and
(d) social care provision, or social care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(h) where that provision has not been specified in the EHC plan.
(7) When the First-tier Tribunal makes an order in respect of health care needs or health care provision, it must send a copy of the order to the responsible commissioning body.
(8) When sending a copy of an order, the First-tier Tribunal may also send a copy of the decision which disposes of any appeal brought under section 51(1) of the Act or under regulation 42A to the responsible commissioning body.
(9) The responsible commissioning body must respond within 5 weeks beginning with the date of the order to—
(a) the child's parent or the young person, and
(b) the local authority that maintains the EHC plan.
(10) The time limit specified in paragraph (9) does not apply where the First-tier Tribunal directs that a different time limit is to apply for the responsible commissioning body's response.
(11) A response under paragraph (9) must—
(a) be in writing,
(b) state what steps, if any, the responsible commissioning body has decided to take following its consideration of the order, and
(c) give reasons for any decision not to follow the order, or any part of it.
(12) The local authority must send a copy of the response received from the responsible commissioning body under paragraph (9)(b) to the Secretary of State within 1 week beginning with the date it was received.
(13) When the First-tier Tribunal makes an order in respect of social care needs or social care provision, the local authority must issue the amended EHC plan to the child's parent or the young person within 5 weeks beginning with the date of the order.
(14) The time limit specified in paragraph (13) does not apply where the First-tier Tribunal directs that a different time limit is to apply.
(15) The local authority must send a copy of the amended EHC plan under paragraph (13) to the Secretary of State within 1 week beginning with the date on which this is issued to the child's parent or the young person.’
(4) The Special Educational Needs and Disability (First-tier Tribunal Recommendations Power) Regulations 2017 (S.I. 2017/1306) are revoked.
(5) In consequence of the revocation made by subsection (3), the following 15 provisions of the Special Educational Needs and Disability Regulations 2014 are also revoked—
(a) regulation 10(3)(e);
(b) regulation 14(2)(e);
(c) regulation 201(11)(e);
(d) regulation 21(10)(e);
(e) regulation 22(5)(e);
(f) regulation 25(2)(e); and
(g) regulation 31(3)(e).”—(Dr Chambers.)
This new clause extends the powers of the First-tier Tribunal so that when it is determining an appeal it may order that Education, Health and Care plans must include health and social care needs and provision, rather than just making recommendations on these matters.
Brought up, and read the First time.
Dr Chambers
I beg to move, That the clause be read a Second time.
New clause 28, tabled in the name of the Chair of the Health and Social Care Committee, my hon. Friend the Member for Oxford West and Abingdon, extends the powers of the first-tier tribunal so that, when it determines an appeal, it may order that education, health and care plans must include health and social care needs and provision, rather than just making recommendations on those matters.
I am sure all Members are probably in a similar situation in that EHCPs, in their various forms, are one of the main reasons we get contacted by constituents; they certainly fill up my inbox. Following the Education Committee’s report, “Solving the SEND Crisis”, which identified significant gaps in accountability and engagement from the DHSC and health services in the special educational needs and disabilities—or SEND—system, the Health and Social Care Committee held a one-off evidence session to build on those findings, looking at the delivery of the health aspects of EHCPs.
The Health and Social Care Committee followed up a recommendation that the Education Committee had made that the powers of the SEND tribunal service should be extended to allow it to issue binding recommendations to health services, not just education providers. SEND tribunals are independent national tribunals that decide appeals against local authority decisions about the special educational needs of children and young people, including decisions made about an EHCP. Currently, they can make binding recommendations in relation to education provision, but not in relation to health and social care needs.
The Education Committee argued:
“This would ensure that when a failure to deliver a health provision specified in an EHC plan occurs, health bodies are legally obligated to take corrective action.”
When the Health and Social Care Committee raised that with witnesses in its evidence session, several were supportive of placing this duty in legislation, although they noted that it would require other reforms to workforce and commissioning arrangements to be successful. New clause 28 would provide a level playing field between education bodies and ICBs, so that ICBs are also under a legal obligation to comply with recommendations from SEND tribunals.
Dr Johnson
I should say that I am a member of the Education Committee. As the hon. Member for Winchester says, new clause 28 would extend the powers of the first-tier tribunal so that, when determining an appeal, it may order that EHCPs must include health and social care needs and provision, rather than just making recommendations on those matters.
It is clearly important that children with special educational needs get the support they need. We are all very aware, from our inboxes, that that does not always happen. I do not know whether putting this into legislation would make it happen, or whether it would need much more work than one clause, but clearly it is a very important aim and I support the principle of it. I would be grateful for the Minister’s comments on how she thinks this could work in practice and whether it is legislation or a more widespread plan that is required.
Gregory Stafford
I rise briefly to speak on this as well. I should note for the record that I am the vice-chair of the all-party parliamentary group on special educational needs and disabilities.
The hon. Member for Winchester, on behalf of the hon. Member for Oxford West and Abingdon, made the case very strongly. I am a member of the Health and Social Care Committee, and we took evidence as he described. The lack of a statutory obligation in the current EHCP process is a fundamental problem. We need to ensure that the health elements are put on the same footing as the social care ones. As I am sure is the case in every hon. and right. hon Member’s constituency inbox, the number of children who are receiving or require support with special educational needs and disabilities, and the frustrations with the process both locally and nationally, are rightly something that we, as parliamentarians and policymakers, need to get a grip on.
Karin Smyth
May I add to the comments of the hon. Member for Farnham and Bordon by paying tribute to the families in my constituency of Bristol South who are also struggling? The care of a child is obviously one of the most difficult and important things that a person can do. When that child is in distress and not supported by the system, it is a very hard place for a parent to be. As I think all hon. Members have said, that is an issue that arises a lot in our inboxes, our emails and our constituency surgeries, and it has been difficult to address. I commend the Education Secretary and her team of Ministers for bringing this work forward and starting to tackle the issue.
Dr Prinsley
My wife is an educational psychologist, so I have lived this, in a vicarious fashion, for the last 30 years or more. I understand how the system for special educational needs has evolved, particularly the role of the psychological services and how children are supported. As a result of a series of reforms, in particular during the years of austerity, the services provided by local authorities to schools—particularly the schools’ psychological services—became much more focused on psychologists providing reports to inform the distribution of resources, and much less focused on educational psychologists actually being in schools supporting children. I would like to see a change, such that educational psychologists and their expertise are back in schools, in classrooms, supporting teachers. Time and again when I visit schools, they say, “Let’s get educational psychology support back into schools.” I think that is something my wife would support.
Karin Smyth
I thank my hon. Friend for that. I put on record my thanks—our thanks—to his wife for her work in this area and for making him so aware of the issues, because he is absolutely right. This is a long-in-gestation issue that some of us have watched sadly get worse in our constituencies over recent years. Children only get one chance to come through this system, which is why people feel so passionately about it.
Sojan Joseph
I pay tribute to all the parents and schoolteachers who engaged with me last summer, following the White Paper and the SEND consultation. It has been a huge problem in Kent. Kent county council has been under Conservative administration for the last 25 years. In recent years, it was in special measures because of its SEND provision. Parents really struggled. My inbox is filled with these issues. We know that 98% of SEND provision tribunals rule in the parents’ favour. There has been a long wait. Does the Minister agree that, whether we accept the new clause or not, we need to look into how the NHS and local authorities can work together to make it easier for children, families and schools to get proper provision in place?
Karin Smyth
I thank my hon. Friend for his description of what has happened in Kent, which has been under Conservative administration for so long. He is absolutely right about the White Paper. The hard work that my right hon. Friend the Secretary of State and the ministerial team have done across the country, regardless of the local political administration, is exemplary. I will come on to talk about the tribunals.
The Government’s SEND reforms aim to transform outcomes for children and young people with SEND and their families, ensuring that the right support is available at the right time and preventing needs from escalating or reaching crisis in the first place. That is why the reforms aim to build a system that parents can trust with collective responsibility in local areas and strong partnership working across education, health and care. That is what parents expect us to be doing.
Liz Twist
I recently held consultation meetings on the proposed SEND reforms in Blaydon and Consett. The message from parents was clear in both places: they wanted greater integration of health into EHCPs. I welcome the Government’s commitment to asking ICBs to work more closely with local authorities to develop SEND reform plans and tackle this issue. Does the Minister agree that it is important for ICBs to take that on board?
Karin Smyth
I thank my hon. Friend for going to hear directly from her constituents. She is right: that message is fairly consistent. Last year, my hon. Friend the Member for Bristol East (Kerry McCarthy), my right hon. Friend the Member for Bristol North West (Darren Jones) and I played a pivotal role in bringing our ICB and local authorities together as local Members of Parliament. That was a result of our experience with parents and constituents. Members of Parliament from across the House—this is not a party political point—can bring parents together to highlight this issue and use parliamentary power to bring together organisations that sometimes do not listen or know the best way to communicate. Our role in that has been pivotal. The Secretary of State for Education has taken that learning forward across the country.
That is why we are taking the steps to deliver the programme. ICBs have been asked to work with local authorities to develop local SEND reform plans. Those plans will lay the foundation for long-term reform, enabling ongoing monitoring of progress, and draw on knowledge, skills and lived experience held locally. That builds on work that is under way to improve accountability and set expectations of joint working, which is what parents and families expected to happen, but was not happening. Each ICB is expected to have an executive lead on SEND. The NHS medium-term planning framework for the next three years made it clear that ICBs and providers must meet their statutory duties and support delivery of the reforms.
Ofsted and the Care Quality Commission will continue to check how local services, including health, work together for children and young people and hold them accountable. We will also update the SEND code of practice and publish new guidance so that local SEND partnerships have clearer expectations to work to. That is why we have not proposed changes to health and social care appeals to the SEND tribunal or made the decisions binding. This reflects the need for ICBs and NHS providers to retain the flexibility to plan services across their wider populations and prioritise support according to clinical and population need. This aligns with our commitment in the 10-year health plan to create a new NHS operating model where ICBs are the strategic commissioners of local healthcare services. It is worth noting that while tribunal decisions on health and care are non-binding, local authorities and ICBs are expected to follow them, and in most cases do. If they do not follow recommendations, they must send a response setting out the next steps they have decided to take and why.
There is no doubt that health and social care have crucial roles in SEND reforms, with shared ambitions across education, health and care for earlier intervention and support. I reassure the Committee that we are exploring further opportunities to strengthen accountability, as stated in the SEND consultation document. We are considering responses to the consultation, which closed on 18 May, and will set out our next steps in due course. For those reasons, I ask the hon. Member for Winchester to withdraw the new clause.
Dr Chambers
I thank everyone for their comments. I thank the Minister for her reassurances on the seriousness of this issue. Given that we are waiting for the response to the report, I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
Ordered, That further consideration be now adjourned.—(Emma Foody.)
Health Bill (Sixteenth sitting)
Thursday 16th July 2026
(1 week, 4 days ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 16 July 2026 - (16 Jul 2026)
The Committee divided: - Ayes: 2 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 4 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 4 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 3 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 5 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 3 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 3 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 5 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 5 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 5 / Noes: 9 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 9 - Question accordingly negatived.
The Chair
We resume line-by-line consideration of the Health Bill. The selection list for today’s sitting is available in the room. Proceedings must, so far as not previously concluded, be brought to a conclusion by 5 pm. Once again, I am happy to give a blanket dispensation for the removal of jackets.
New Clause 31
ECG screenings
“Within six months of the passage of this Act, the Secretary of State must conduct and publish a review into the use of ECG screenings to identify cardiac issues in persons over 14 years of age.”—(Dr Chambers.)
This new clause would require the Secretary of State to conduct and publish a review into the use of ECG screenings to identify cardiac issues in persons over 14 years of age.
Brought up, and read the First time.
Dr Danny Chambers (Winchester) (LD)
I beg to move, That the clause be read a Second time.
Twelve young people die every week from undiagnosed heart conditions. One of those was Clarissa Nicholls, who died just before her 21st birthday, while on a year abroad in France. Her mother and friends have campaigned tirelessly not only to provide electrocardiograms to young people, but to raise awareness about early detection of heart conditions. Finding a heart condition does not mean that exercise must stop or that life goes on hold; it just means that appropriate alterations can be made to keep a person safe, active and healthy.
Such a scheme has been rolled out in Italy and has been hugely successful. The new clause would push the Government to look seriously at having ECGs for young people as an early identifier for potentially fatal conditions, so that we do not lose up to 12 young people a week due just to a lack of testing.
Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I thank the hon. Member for his speech. I would like to know whether he is aware of any evidence that mass screening of young people with ECGs will actually improve matters.
The Chair
As that was a speech and not an intervention, we will take the Minister before the hon. Member for Winchester responds.
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairship, Dr Huq. The hon. Member for Winchester raises an important point. Cardiac issues are serious, and people too often lose their lives as a result of unidentified cardiac conditions. As we know, ECGs are used significantly across the whole of healthcare, from accident and emergency to new community diagnostic centres and beyond. They are important for investigating palpitations or unexpected syncope and for evaluating pacemaker function, and are an extremely useful diagnostic tool. However, as my hon. Friend the Member for Bury St Edmunds and Stowmarket suggested, there is no clear evidence that non-symptomatic population screening using standard ECGs would yield any useful health data or improve population outcomes.
Clearly, the loss of life—particularly a young life, as in the case of the constituent the hon. Member for Winchester mentioned, although we have all seen or, sadly, experienced such cases—is an awful tragedy for those concerned, but we need to rely on evidence. The UK National Screening Committee, which is an independent scientific advisory body, advises all four nations and is considering the issue. The committee launched a three-month public consultation on 8 June to look at the evidence on screening for sudden cardiac death. Its draft recommendation is against screening, because ECGs, as well as other tests, are an unreliable tool for identifying significant cardiac issues in asymptomatic individuals. ECGs are useful tools in the diagnosis of symptomatic patients, and the UK National Screening Committee is in the process of reviewing ECG use for asymptomatic individuals. For those reasons, I ask the hon. Member to withdraw the new clause.
Dr Chambers
I thank the Minister for her comments. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 32
Review on deaths related to antimicrobial resistant infection
“Within six months of the passage of this Act, the Secretary of State must conduct and publish a review into the number of yearly deaths in the UK which are related to antimicrobial resistant infection.”—(Dr Chambers.)
This new clause would require the Secretary of State to conduct and publish a review into the number of yearly deaths in the UK which are related to antimicrobial resistant infection.
Brought up, and read the First time.
Dr Chambers
I beg to move, That the clause be read a Second time.
The new clause would require the Secretary of State to conduct and publish a review into the yearly number of deaths in the UK related to antimicrobial-resistant infections. I declare an interest as the secretary of the all-party parliamentary group on antimicrobial resistance. AMR is a major threat to public health globally and domestically, and it is already contributing to an estimated 35,200 deaths every year in the UK.
AMR is a bit like a silent pandemic. It gets little media attention, but given the prediction that 39 million people worldwide will have died of AMR by 2040, it will eventually be pushed right up the political agenda. This is not simply a matter of people dying from infections that could not be treated; nearly all the advances in modern medicine over the last 50, 60 or 70 years would be null and void. It would be too risky for someone to have something like a hip replacement, because of the risk of getting an infection that could kill them; they would be better off living with a painful arthritic hip than taking the risk of dying from sepsis. It is the same with things like heart disease, while giving birth will once again become one of the most dangerous things a woman can do if we lose the impact and effectiveness of antibiotics.
The Government invested more than £560 million in AMR programmes between 2020 and 2024, so it is reasonable that Parliament should receive an annual assessment of AMR-related deaths to ensure that that significant public investment is delivering results, represents value for money and is targeted where it can have the greatest impact. We cannot effectively tackle what we do not measure, and an annual review of deaths linked to AMR would provide a clear, consistent picture of the scale of the problem and enable Parliament and the public to track whether policies are working.
Better data leads to better targeted interventions. We know that rapid diagnostic tests and different types of decontamination will be hugely important in tackling AMR, along with potential future technologies such as phage technology. Surveillance has already identified significant variations by age, deprivation and geography. Understanding where deaths are occurring, and in who, would help direct resources to the communities and services that are most affected.
AMR threatens the effectiveness of modern medicine, including surgery, cancer treatment and routine healthcare. An annual review of AMR-related deaths would ensure that this growing public health threat receives the attention and urgency it deserves. The reason I am determined to push it up the agenda is that the national cancer plan does not specifically mention AMR or infection, but it is the second biggest cause of death in cancer patients. At the moment, it is not pushed up the political agenda enough.
Karin Smyth
I commend the hon. Member for outlining this important issue before the Committee and for his work on the APPG.
AMR is recognised as a chronic risk in the Government’s national risk register. In 2022, it was estimated that 7,500 deaths per year can be directly attributed to AMR in the UK, with a further 35,000 deaths per year associated with AMR. It is a significant and growing issue that the Government take very seriously—I want to assure the hon. Member and the Committee of that. Through the delivery of the 2024 to 2029 UK AMR national action plan, the Government are already taking comprehensive action to tackle this threat and ultimately reduce the burden it places on individuals, families and the healthcare system. That is where that work is located.
I am not convinced that a review of the number of deaths at this point, while important, would add significantly to our understanding of the impact and burden of AMR or to the action being taken to address it, which we do take seriously. The Government will continue to work with APPGs and with information around this issue through the action plan. For that reason, I ask the hon. Member to withdraw the new clause.
Dr Chambers
I thank the Minister for her comments. We understand that the Government take this matter very seriously, but we are working on estimated numbers of deaths for something that will eventually be killing more people than covid. We really need some tangible figures, so I will press the new clause to a Division.
Question put, That the clause be read a Second time.
Helen Morgan (North Shropshire) (LD)
I beg to move, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss new clause 37—Powers for coroners and medical examiners to report suspected health system failings—
“(1) The Secretary of State must, by regulations, establish a standard mechanism for coroners and medical examiners to refer cases where they suspect failings in the provision of health care.
(2) A coroner or a medical examiner has a duty to report (a ‘duty to whistleblow’) using the mechanism established under subsection (1) if, in the course of their duties, they have reasonable grounds to suspect that a death or incident involved systemic failings in a health care setting.
(3) A referral under this section must be directed to any or all of the following bodies, as the coroner or medical examiner considers appropriate, based on the nature of the suspected failing—
(a) the chief officer of police for the relevant police area,
(b) the Care Quality Commission,
(c) the Department of Health and Social Care, and
(d) the Health Services Safety Investigations Body.
(4) Regulations under subsection (1) must specify—
(a) the information to be included in a referral,
(b) the timeframe within which a referral must be made following the formation of a suspicion, and
(c) guidance on the criteria for determining to which of the bodies listed in subsection (3) the referral must be directed.
(5) A disclosure made in fulfilment of the duty under subsection (2) is a protected disclosure for the purposes of Part 4A of the Employment Rights Act 1996 (protection for whistleblowing).
(6) The duties imposed by this section are in addition to, and do not affect, a senior coroner’s duty to make a report under paragraph 7 of Schedule 5 to the Coroners and Justice Act 2009 (reports on action to prevent other deaths).”
This new clause requires the Secretary of State to create a standardised framework for them to formally refer suspected health system failings (including systemic issues) directly to the police, the CQC, the Department of Health and Social Care, and the HSSIB, with a duty on coroners to participate. It provides legal protection for those making such referrals.
Helen Morgan
New clause 36 would introduce a mandatory individual duty for members of NHS trust and NHS foundation trust boards to escalate evidence of systemic medical malpractice to the Care Quality Commission, the Department of Health and Social Care and the Health Services Safety Investigations Body. It would also impose a collective duty on the board to formally refer the trust to regulators if staff raise concerns about malpractice.
New clause 37 would require the Secretary of State to create a standardised framework for coroners and medical examiners to formally refer suspected health system failings, including systemic issues, directly to the police, the CQC, the Department of Health and Social Care and HSSIB, with a duty on coroners to participate. It would provide legal protection for those making such referrals.
The new clauses were tabled in the light of the Ockenden review into failings at Nottingham university hospitals NHS trust, which came out a couple of weeks ago, and other reviews, including the review of Mid Staffordshire some time ago, which showed that hospital management failed to spot, and more importantly deal with, systemic issues. Staff were dismissed, failures were hidden from regulators, and patients and their families were not listened to. In the case of Nottingham, the board commissioned a number of independent reports into maternity services, and when it did not see an answer it liked, it just commissioned another one. We feel strongly that those issues should have been referred onwards as soon as they were known about. The new clauses would introduce a mandatory duty and create a standardised framework within which such concerns could be raised.
Coroners and medical examiners often spot trends or worrying failures in care that they think might hint at something systemic, but their main power is a regulation 28 order. When an order goes back to the hospital board, it investigates and reports back: “Everything is fine. We’ve dealt with the problem. There’s nothing to see here.” Coroners are often overworked and trying to get through huge court backlogs, so they do not have sufficient capacity to push back, even when they question the diligence of the internal review. We want to give them more powers and standardised routes to escalate concerns to the police, the CHC, the DHSC or the HSSIB , where they see fit. We need as many eyes on this as possible, because we have seen a defensive cover-up culture too many times.
We tabled similar amendments to the Hillsborough Bill to achieve the same outcome. We all know that the NHS is under strain and overworked, but trust management need to be more transparent, open and receptive to staff concerns. Although I do not intend to push the new clause to a vote, I am interested to hear from the Minister what the Government plan to do to ensure that concerns are acted on more quickly.
Karin Smyth
I thank the hon. Member for North Shropshire, who raises issues of patient safety diligently on behalf of her constituents and the wider system. I will take the time to answer some of the points about where the Government are. Obviously, we support prioritising patient safety, which along with service quality and experience is of the utmost importance.
On new clause 36, trusts are already subject to regulatory and contractual requirements to report medical malpractice, which is why we do not think the new clause is necessary. For example, CQC regulations on safe care and treatment and on good governance are central to trust accountability for systemic malpractice. They require trusts to have effective systems to identify patterns of harm, manage risks and deliver system-wide improvements.
Trusts are required to identify and report incidents leading to significant harm through the Learn from Patient Safety Events service, ensuring that the CQC is informed and enabling NHS England to identify trends and support learning and improvement. This information can be shared with and accessed by HSSIB and could in the future be shared with and accessed by the investigations arm of the CQC.
The CQC regulation on duty of candour reinforces transparency through truthful accounts of what has happened when something goes wrong, including where harm reflects systemic issues. Under the patient safety incident response framework, trusts must undertake patient safety learning investigations into certain incidents to support learning and improvement.
In parallel, the NHS provider licence requires NHS trust boards to maintain clear accountability for quality of care and reporting of safety information through effective governance systems. Where failures of governance occur, NHS England has the powers to intervene. Those powers will transfer to the Secretary of State as part of the Bill.
The new clause would clearly duplicate current processes. Together, the existing mechanisms already help trusts to identify and address systemic issues locally, while enabling national aggregation to support system-wide learning.
New clause 37 seeks to require the creation of a standardised framework for coroners and medical examiners to report health system failings. I take the opportunity to reassure the hon. Member for North Shropshire that regulations already require medical examiners to report serious concerns identified in respect of clinical governance, patient safety or public health surveillance, in accordance with local reporting arrangements. Existing regulations also require coroners, in the context of an investigation, to issue a report to a person, organisation, local authority, or Government Department or agency where the coroner believes they may have power to take relevant action to prevent future deaths.
In September 2024, the Department of Health and Social Care introduced death certification reforms, putting in place regulations to provide greater safeguards for the public by ensuring independent scrutiny by medical examiners of all deaths not investigated by a coroner. These reforms, as set out in the Medical Certificate of Cause of Death Regulations 2024, which require an independent review to be carried out for all deaths in England, introduce a system whereby all deaths are subject to either a medical examiner’s independent scrutiny or a coroner’s investigation.
Should the medical examiner detect concerns about care, they will refer such cases to established clinical governance review processes and bodies and notify the coroner or, if necessary, the police. The Notification of Deaths Regulations 2019 require all doctors, including medical examiners, to refer a death to a coroner if they believe that deficiency of care while undergoing treatment contributed to the death, making the death unnatural. Under the Coroners and Justice Act 2009, a coroner has a statutory duty to report issues to the appropriate bodies where they believe that action can be taken to mitigate or prevent the risk of future deaths, and both the report and responses to it are published by the chief coroner.
When incidents and errors occur resulting in death or serious injury, it is important that we learn any lessons. The Government are committed to ensuring that the prevention of future deaths reports are taken seriously and lead to meaningful action. The Department is working across Government and with the chief coroner to identify ways to strengthen oversight and ensure that the right organisations are consistently notified of concerns, respond to them in a timely manner and drive appropriate action.
Under the Medical Act 1983, the General Medical Council ensures that all doctors, including medical examiners, report suspected health system failings by speaking up. That is a mandatory professional obligation linked to a doctor’s licence to practise, embedding this whistleblowing requirement into the GMC’s core regulatory and fitness to practise frameworks. The GMC also enforces a professional duty of candour requiring all doctors to be open and honest with patients and official bodies when things go wrong and actively report adverse incidents so that systematic lessons can be learned.
In summary, both new clauses duplicate requirements that already exist. Regulations, systems and processes are already in place to report suspected health system failings to the appropriate bodies. For that reason, I ask the hon. Member for North Shropshire to withdraw the new clause.
Helen Morgan
I thank the Minister for outlining the existing statutory framework. I agree that it ought to be sufficient, but there are high-profile instances where it has not been, so I look forward to hearing more from her on Report about how the cultural change will be implemented so that further legislation is not necessary. I beg to ask leave to withdraw the new clause.
Clause, by leave, withdrawn.
New Clause 38
Single sex facilities
“The Secretary of State is required to ensure that there are single sex—
(a) changing rooms for NHS staff
(b) toilets and washing facilities for NHS staff
(c) wards for NHS patients
(d) toilets and washing facilities for NHS patients.”—(Dr Caroline Johnson.)
This new clause creates a requirement for the Secretary of State to ensure certain single sex facilities are made available for NHS staff and patients.
Brought up, and read the First time.
Dr Johnson
I beg to move, That the clause be read a Second time.
This is a very straightforward new clause. The Secretary of State would be required to ensure that there are single-sex changing rooms, toilets and washing facilities for NHS staff and single-sex wards, toilets and washing facilities for NHS patients.
The UK Supreme Court unanimously ruled that a woman is defined by biological sex in 2025, and the Minister herself said:
“We are completely committed to single-sex spaces.”
However, it appears that the Minister for Women and Equalities did not get that memo. Despite having apparently been sat on her desk since September, the new draft code from the Equality and Human Rights Commission was not laid before Parliament until 21 May. One week before that guidance was published, a female NHS England employee in Leeds won her claims of indirect sex discrimination and harassment over a policy allowing transgender colleagues to use toilets and changing rooms that correspond to their gender identity rather than their biological sex. On 28 June, after the draft code was laid, it was reported that West London NHS trust had told patients that they could use single-sex facilities based on gender identity.
It has taken the current Health Secretary some time, but I understand that he has changed his mind on the issue and come to the same conclusion as others: that a woman is, in fact, a woman and that toilets and changing facilities must be protected. Will the Minister follow his lead and protect single-sex spaces in NHS trusts? The Supreme Court has ruled that a woman is defined by her biological sex. My party knows that. The Minister claims her party knows that too. It is time for her to show it by pulling the levers that only she can to ensure that patients and staff are protected right across our health service.
Karin Smyth
I am grateful to the hon. Member for bringing this discussion before the Committee. She is right that, following the For Women Scotland case at the Supreme Court in April 2025 and the recent laying of the Equality and Human Rights Commission’s updated code of practice on 21 May, ensuring the provision of single-sex facilities for patients and staff is a prominent issue. The Government welcomed the clarity provided by the Supreme Court judgment. The EHRC code of practice sets out how service providers may lawfully apply sex-based distinctions following the Supreme Court judgment. That guidance is applicable to services, public functions and associations and includes, but is not limited to, the services provided in the NHS.
Following that, NHS England drafted the revised guidance, “Privacy, dignity and safety in hospital accommodation”, which will align with the legal position and the EHRC code of practice and replace existing guidance. I know that many colleagues are impatient to see the existing guidance replaced following the Supreme Court ruling. It was important to wait for the EHRC code of practice to be published so that it could be considered in any guidance. The code of practice was published on 21 May. Following the publication, NHS England reviewed the guidance to ensure that it was in line with the code. The code was subject to a 40-day laying period before Parliament, which ended on 9 July. The Government expect the code to come into force in early August. Guidance for the NHS will be published shortly afterwards.
NHS England is also developing guidance on staff facilities, including changing rooms, toilets and washing facilities that should be used by trusts and ICBs. The provision of physical single-sex facilities for NHS staff is for NHS organisations to individually manage in line with their legal obligations. There is already legislation covering this issue, particularly the Workplace (Health, Safety and Welfare) Regulations 1992. Organisations should already be conducting assessments of their own estates and the needs of their workforce to decide what changes they need to make to comply with all legislative requirements.
On mixed-sex accommodation and breaches, there is a long-standing policy of same-sex accommodation. Individuals should not have to share sleeping accommodation with patients of the opposite sex unless appropriate. In practice, the proposed amendment does not allow scope for mixed-sex accommodation where clinically appropriate—for example, intensive care unit facilities or where it is necessary for patient safety. For those reasons, I ask the hon. Member for Sleaford and North Hykeham to withdraw the new clause.
Question put, That the clause be read a Second time.
Dr Johnson
I beg to move, That the clause be read a Second time.
New clause 40 would require the Secretary of State to publish a report detailing the business case for the use of public-private partnerships for neighbourhood health centres. This goes back to the use of the private finance initiative in the past, particularly during the last Labour Government when Ministers were attracted by the prospect of off-balance sheet financing. Although the idea looked good on paper, it proved a disaster in practice. Before the 2008 financial crisis, private finance initiative interest rates were 2.5% to 4.4% higher than public sector borrowing rates. After the crisis, PFI projects increased their rates by 20% to 30%. In the interests of time, I will not rehash the story I told earlier in Committee about the problems with simple things such as putting a whiteboard up, but PFI did create operational problems, too.
The previous Government rightly called time on PFI and announced in the 2018 Budget that it would not be used for future projects, which is why this Government’s plans are so peculiar. Labour Ministers have taken a trip to the graveyard of bad ideas, resurrected PFI and adorned it in new clothes: it is now PPP. The Government have tried to reassure the public that it is not a rehash of PFI, but the facts suggest otherwise. The funding of neighbourhood health centres is to be 80% through PPP. The Minister told the BBC we will be working with the private sector, particularly around construction and maintenance of many of the new centres. How is PPP different from PFI?
The Minister has previously told this House that the new scheme will draw on lessons learnt in the past, so could she please say what those lessons are? If they have been learnt, why did 53 academics write a letter urging the Government to abandon the proposal? Why did dozens of Labour MPs sign an early-day motion expressing grave concerns? And why have the Treasury Committee, the Public Accounts Committee, the National Audit Office, the Institute for Public Policy Research and the Institute of Economic Affairs all cast doubt over the value of money for such schemes?
No matter how Ministers dress things up, I am concerned. The Government need to publish a business case for the proposal to show how it will work in practice and demonstrate they have learnt lessons from the past. If they have, Members have no good reason to object to the amendment. It only asks Ministers to show their workings-out in full view of the House openly and transparently.
Karin Smyth
Well, what was a disaster was the Tories’ management of the capital estate pre-1997 and post-2010, if the hon. Member for Sleaford and North Hykeham wants to talk about disasters on capital planning. I could talk about this for a very long time, but I know the Committee is keen to move forward, and I addressed some of these issues in debate on a previous amendment. I am very proud of, for example, Southmead hospital in Bristol, which is one of the finest examples of a hospital in the country and was built under a PFI scheme. I received treatment there a couple of years ago, in facilities that are good for staff to work and patients to be treated in. It replaced a hospital that was falling down and in shocking condition, despite the best efforts of staff. We can see similar examples across the country.
Under the Tories’ management, and for some of the early PFI schemes under the last Labour Government, contracts were poorly negotiated. They had issues with, for example, management of inflation. We have learned lessons from that. The hon. Member for Sleaford and North Hykeham talked about some contracts, including one where, I think, her whiteboard was not working. We know what the lessons are to be learned from that, and we are doing exactly what a good Government do when they take charge—change it.
In the 14 years that the Conservatives were in power, they could have started negotiating these contracts differently at any point, but they chose not to. They chose to let the estate atrophy and fall down. That is bad for patients and the public. That is why I was proud last week to launch the Government’s capital plan, building for the future, looking forward and giving nine years of certainty for estates across all our constituencies.
Dr Prinsley
I agree with everything that the Minister has to say—what a surprise—but particularly the fact that when the new Government came in, they did something about these 40 “new” hospitals that were not full hospitals. The people of Bury St Edmunds were delighted to learn that their RAAC-affected hospital, which is tumbling down, will be one of the first to be reconstructed. We look forward to that and are grateful for the decisions made by the Government.
Karin Smyth
I thank my hon. Friend for that. Across the east of England, where we now have so many Labour MPs, everyone has been trying to rectify the mismanagement that local people have seen, particularly of the capital estate. I will not detain the Committee on the capital estate—one of my favourite subjects—for very long.
The hon. Member for Sleaford and North Hykeham is aware that the decision on neighbourhood health centres was announced in the autumn. The decision-making process was supported by a business case to examine the feasibility of developing a new model, learning the lessons of the past on public-private partnerships specifically to build neighbourhood health centres as part of our 10-year plan. That informed the decision to proceed. The business case was a strategic outline case, the purpose of which was to scope and identify the preferred way forward for a new potential model, in line with the Treasury’s five case model. We are now working with the National Infrastructure and Service Transformation Authority to develop this further, and we expect a further round of market engagement in the autumn.
I recognise the interest in making the business case available to both Houses, but that must be balanced with the need to develop an effective policy. Publication while policy development is ongoing would limit full, candid and proper deliberation. Civil servants and subject experts need to be able to engage in frank discussion of policy options to expose their merits, demerits and possible implications. Their candour in doing so would be affected by their assessment of whether the content of such discussions would be disclosed.
We are committed to building neighbourhood health centres across the country. That is what patients and the public deserve. We will obviously be mindful of public money and subject to the usual processes of the House, including the Public Accounts Committee. We will learn those lessons. We are in full discussion with NISTA. For those reasons, we are committed to developing good estate across our country. That is what our constituents deserve. I therefore ask the hon. Member for Sleaford and North Hykeham to withdraw her new clause.
Dr Johnson
For the record, I am a member of the Royal College of Paediatrics and Child Health and work as a consultant paediatrician at North West Anglia NHS foundation trust, which will have a new hospital. I would like to press the new clause to a vote.
Question put, That the clause be read a Second time.
Dr Johnson
I beg to move, That the clause be read a Second time.
This new clause asks the Government to use private providers to help get waiting lists down. We are told that waiting lists are falling, but the Government’s own figures show that waiting lists are higher than they were last month, and if we look at the group of people who are waiting for admission for a procedure or operation, they are higher than they were last month, last year or indeed at the general election in 2024. There were 76,250 women waiting for gynaecological treatment at the end of July ’24, when this Labour Government took office; that rose by more than 6,000 patients to 82,623 as of May 2026. Private providers have capacity that may be able to help with that.
The deployment of private providers is about using all the resources and capacity on offer across the country to get waiting lists down. The NHS uses private providers to perform some surgeries and scans, mental health support, GPs and dentistry, but it is a sensible measure to ensure that all hands are on deck when it comes to treating patients. I look forward to hearing how the Minister can use private providers to get more patients seen more quickly as opposed to wiping them from waiting lists at record rates.
Karin Smyth
Again, I am grateful to the hon. Member for Sleaford and North Hykeham for bringing this discussion before the Committee. This new clause would require the Secretary of State to make regulations about how the NHS uses private provision to support access to treatment and reduce lists. I understand the point that she is making, but I assure her that this is an unnecessary new clause.
ICBs already can and do use private healthcare providers to offer patients treatment in their area and boost capacity to reduce lists. Our approach is pragmatic, not ideological: in the 10-year health plan, the Government committed to continuing to use private sector capacity where it is available; that is not because we favour the private sector but because we are committed to using capacity wherever it is available. Our priority is treating patients in a timely manner, not favouring one form of provider over another. Under existing legislation, patients must be offered a choice of provider for their first outpatient appointment, where the duty of choice applies. If a person’s needs are not met by local services or waiting times are high, they can use that choice to see an appropriately qualified provider.
However, we must resist the temptation to apply a one-size-fits-all approach here. ICBs are responsible for the financial sustainability, planning and strategic commissioning of services for their local populations, so they are best placed to decide how private premises should be used to meet a population’s needs. For example, high waiting times, which we obviously inherited from the Conservatives, for a particular specialty may result not from a lack of capacity but from increased demand from GP referrals. The ICB must have the flexibility to improve how advice and guidance—referral support, for instance—is working for GPs, rather than being required to wastefully spend NHS funds on increasing capacity with the private sector.
Sojan Joseph (Ashford) (Lab)
If this is put on the statute book, will it not mean that the private sector can have more and more hospitals, when we should be using them only if the NHS does not have the capacity? The private sector should be the last resort rather than a first choice.
Karin Smyth
I am slightly confused, as I suspect other Committee members are, by the Opposition’s approach to the private sector, having had a discussion in relation to the previous new clause about not using the private sector and boosting work and employment opportunities in our country. They do have a slightly odd view with regard to this. As I said, our view is very pragmatic: it is to support the treatment of patients to get waiting lists down. That is what our constituents deserve. Where capacity can be used, we want to make sure that that choice is available.
Dr Prinsley
I am confused by the Opposition referring in their new clause to a requirement to “make regulations” in this respect, as the private sector is already widely used to reduce waiting lists where appropriate. However, we must also be aware of the problem we have with overuse of private facilities. That can have an effect on the provision of NHS services, because the number of available staff is limited. I think particularly of ophthalmology services, as we have created a situation in which the overprovision of private services has disabled the provision of ophthalmology services.
Karin Smyth
That is why I was clear in outlining that ICBs have a duty to make sure that they are financially sustainable and that their planning and strategic commissioning meets the needs of their local population. They need to balance those requirements.
Under the new clause, there is a risk that the Secretary of State, by setting blanket requirements, would contravene the level playing field provisions in clause 10 of the Bill. For those reasons, I ask the hon. Member for Sleaford and North Hykeham to withdraw the new clause.
Dr Johnson
The previous use of private providers was to remove debt from the Government’s balance sheet. That is not the same as providing guidance and regulations on how to increase capacity and use the spare capacity of private providers to reduce waiting lists, which are currently rising. In response to the point made by the hon. Member for Bury St Edmunds and Stowmarket, the workforce plan is important. Despite that plan being “imminent” for several weeks now, it has not been published. I will press the new clause to a vote.
Question put, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss the following:
New clause 75—Transition strategy for the abolition of NHS England—
“(1) The Secretary of State must, before the abolition of NHS England takes effect, prepare and lay before Parliament a report setting out a transition strategy for the abolition of NHS England (the ‘strategy’).
(2) The strategy must—
(a) identify and map critical functions and areas of expertise currently exercised by NHS England, including clinical, operational, analytical and patient engagement capabilities;
(b) assess the risk of loss of knowledge, skills and organisational capacity arising from the abolition of NHS England;
(c) set out the steps the Secretary of State proposes to take to ensure the retention and effective transfer of such functions, expertise, knowledge and skills; and
(d) assess the likely impact of the transition on the delivery of key health programmes and services, including cancer services.
(3) The Secretary of State must, at intervals of not more than 12 months, lay before Parliament a report on the implementation of the transition strategy.
(4) A report under subsection (3) must include—
(a) progress on workforce retention;
(b) arrangements for the transfer of knowledge, expertise and institutional capability; and
(c) any identified gaps in capability and the steps being taken to address them.”
This new clause would require the Secretary of State to prepare and lay before Parliament a formal transition strategy before the abolition of NHS England, setting out how critical functions and expertise will be identified, retained and transferred. It would also require the Secretary of State to report to Parliament at least annually on the implementation of that strategy.
Amendment 37, in clause 71, page 48, line 28, at end insert—
“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the conditions in subsection (3B) are met.
(3B) The conditions are that—
(a) the Secretary of State has published a document setting out the operating model for the exercise of functions by the Department of Health and Social Care following the abolition of NHS England (the ‘operating model document’); and
(b) the Secretary of State has published a plan for the management of personnel affected by the abolition of NHS England and the transfer of its functions to the Department of Health and Social Care (the ‘workforce transition plan’).
(3C) The operating model document must include—
(a) a description of how each of the functions exercised by NHS England is to be exercised following its abolition;
(b) the governance and accountability arrangements for the exercise of those functions;
(c) the organisational structure of the Department of Health and Social Care as it will operate following the abolition; and
(d) the proposed timetable for the transition.
(3D) The workforce transition plan must include—
(a) an assessment of the number of personnel whose employment is affected by the abolition of NHS England;
(b) the arrangements for the transfer, redeployment or redundancy of affected personnel; and
(c) proposals for consultation with recognised trade unions and staff representative bodies in connection with the abolition.
(3E) Regulations to commence section (1) are to be made by statutory instrument and may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.
(3F) Before laying a draft instrument under subsection (3E), the Secretary of State must allow a period of at least 60 days beginning with the date of publication of the operating model document and the workforce transition plan (whichever is the later) before the draft instrument is laid.
(3G) A period during which Parliament is dissolved, prorogued or adjourned for more than four days are not to count towards the 60-day period in subsection (3F).”
This amendment would prevent the abolition of NHS England before the production of an operating model for the merged DHSC/NHSE and associated plan to manage personnel.
Amendment 38, in clause 71, page 48, line 28, at end insert—
“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the condition in subsection (3B) has been met.
(3B) The condition is that the Secretary of State has published an impact assessment in respect of the abolition of NHS England that complies with subsection (3C) (a ‘qualifying impact assessment’).
(3C) A qualifying impact assessment must include—
(a) a quantified estimate, expressed in monetary terms, of the total transition costs of abolishing NHS England, including in particular—
(i) redundancy costs;
(ii) the costs of integrating data, digital and information technology systems;
(iii) the costs of reorganising and rehousing staff and functions; and
(iv) productivity losses during the transition period;
(b) a quantified estimate, expressed in monetary terms, of the ongoing annual costs of the restructured Department of Health and Social Care following the abolition of NHS England, including any costs falling on integrated care boards as a result of the transfer of functions to them;
(c) a quantified estimate, expressed in monetary terms, of the estimated annual savings arising from the abolition, including savings from the elimination of duplicated corporate functions and reduced administrative costs;
(d) a quantified estimate, expressed in monetary terms, of the net present value of the abolition, being the difference between the total costs under paragraphs (a) and (b) and the total benefits under paragraph (c) over a period of not less than ten years;
(e) a statement of the key assumptions underlying the estimates in paragraphs (a) to (d) and an assessment of the sensitivity of those estimates to changes in those assumptions;
(f) an assessment of the risks to the delivery of the anticipated benefits, including the risk of disruption to NHS functions during the transition period; and
(g) a statement of the methodology used to produce the estimates, including any data sources relied upon.
(3D) Before publishing a qualifying impact assessment, the Secretary of State must submit it for independent scrutiny to the Regulatory Policy Committee (or any successor body) and must publish the Committee's opinion on the assessment alongside it.
(3E) The Secretary of State must lay the qualifying impact assessment and the Committee's opinion before both Houses of Parliament.
(3F) Regulations to commence section (1) are to be made by statutory instrument and may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.
(3G) A draft instrument under subsection (3F) may not be laid unless at least 60 sitting days have elapsed since the qualifying impact assessment was laid under subsection (3E).”
This amendment requires the Secretary of State to publish, and submit to independent scrutiny, an impact assessment on the abolition of NHS England, containing quantified cost and benefit figures, before making regulations to abolish the body.
Amendment 39, in clause 71, page 48, line 28, at end insert—
“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the condition in subsection (3B) is met.
(3B) The condition is that the Secretary of State has published a plan setting out how health services provided by or under arrangements made by NHS bodies are to work alongside and be integrated with the social care system in England (the ‘health and social care integration plan’).
(3C) Before preparing the health and social care integration plan, the Secretary of State must have regard to—
(a) the recommendations made by the Independent Commission on Adult Social Care chaired by Baroness Casey of Blackstock (or any successor body undertaking that Commission’s work) in any report published by the Commission before the plan is laid; and
(b) the need to reflect any such recommendations in the content of the plan so far as they are relevant to the interface between health services and adult social care.
(3D) The health and social care integration plan must include—
(a) a description of the structural and operational arrangements for joint working between NHS bodies and local authority social care services following the abolition of NHS England;
(b) proposals for how the transfer of NHS England’s functions to the Secretary of State will affect the coordination of health and social care commissioning, including in particular the commissioning of services for people with complex needs spanning health and social care;
(c) arrangements for reducing delayed discharges from hospital attributable to the absence of suitable social care provision;
(d) proposals for how the funding flows between the NHS and the social care system, including NHS Continuing Healthcare, will be managed following the abolition;
(e) the workforce implications for the health and social care sectors arising from the abolition and the steps to be taken to address them; and
(f) a timetable for implementing the arrangements described in the plan.
(3E) The Secretary of State must lay the health and social care integration plan before both Houses of Parliament.
(3F) Regulations to commence section (1) are to be made by statutory instrument and may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.
(3G) A draft instrument under subsection (3F) may not be laid before either House of Parliament until at least 60 sitting days have elapsed since the health and social care integration plan was laid under subsection (3E).
(3H) In this section—
‘NHS body’ has the same meaning as in the National Health Service Act 2006;
‘social care system’ means the system for the provision of care and support under the Care Act 2014 and services provided by local authorities in the exercise of their functions relating to adult social care.”
This amendment requires the Secretary of State to publish and lay before Parliament a plan setting out how health services will work alongside the social care system following the abolition of NHS England before using their powers for its abolition. The plan must address joint commissioning, funding flows (including NHS Continuing Healthcare), delayed hospital discharges, and workforce.
Dr Johnson
New clause 46 would require the Secretary of State to publish the number of staff in the Department of Health and Social Care and the number of people made redundant following the abolition of NHS England. New clause 75 would require the Secretary of State to prepare and lay before Parliament a formal transition strategy. Amendment 37 would prevent the abolition of NHS England before the production of an operating model. Amendment 38 would require the Secretary of State to publish and submit to independent scrutiny an impact assessment on the abolition of NHS England containing quantified cost and benefit figures before making regulations to abolish it.
Amendment 39 would require the Secretary of State to publish and lay before Parliament a plan setting out how health services will work alongside the social care system following the abolition of NHS England before using the powers in the Bill for abolition. The plan must address joint commissioning, funding flows, delayed hospital discharges and the workforce. The problem is essentially that Ministers marched off into a battle without a plan and continue to fight without one.
In this Committee, we have heard consistently about the number of times that things have not been thoroughly planned out and properly considered, particularly in relation to social care. I know that Members on all sides of the House are concerned about how social care will interact with the health service under the proposed new regime. In March 2025, Ministers and officials were going to work to determine what was needed, and in March 2026, they were still progressing to develop the design—12 months later, there was a change in tense but still no proper plan.
When putting the Bill before the House, the Government published an impact assessment, but where there should be numbers quantifying how much this is all going to cost us, there is simply “N/A”. How is that any way to conduct a reorganisation? That is why I tabled amendments 37, 38 and 39. They would apply the brakes until the operating model had been established by requiring the full publication of a proper impact assessment, a detailed plan of how the health service will work alongside social care, and the publication of redundancy figures. They would ensure that the Government have worked out what they are going to do before they get on and start doing it.
Karin Smyth
The Government of course recognise the importance of clarity and assurance as we undertake this significant transformation, including on how functions, governance and the workforce will operate in the future. That is essential for ensuring that our staff and other stakeholders understand the new role of the Department.
On new clause 46, we recognise the importance of transparency around departmental workforce numbers and the impact of abolishing NHS England. The Government remain committed to significantly reducing headcount across NHS England and the Department of Health and Social Care, but I put on record my thanks to all the staff and talented professionals working in both organisations; this is a difficult time for them. However, this new clause is not necessary. Workforce information is already published both monthly and through the Department’s annual report and accounts, alongside wider Government transparency publications. Placing a further reporting requirement in legislation would risk duplicating existing transparency data, so it is unnecessary to include it in the Bill.
On amendment 37, I reassure the Committee that we will consult on the proposed structure for the new Department of Health and Social Care, and that is also required under existing employment law. The structure will clearly explain what every part of the new Department will do and set out every post we think we need. The target operating model is an internal document that sets out the proposed purpose, role, governance and organisational structure of the future Department. It will be shared internally, following engagement with staff and stakeholders, including trade unions. The chair of NHS England, Dr Penny Dash, has committed to sharing it with the Health and Social Care Committee once it is finalised.
The target operating model will be used to guide detailed organisational design and will iterate over time. The proposed design of the new organisation will be subject to consultation. The target operating model does not implement changes that remain subject to parliamentary approval through this Bill.
On workforce transition, we will follow TUPE-like principles whether TUPE or any other transfer mechanism applies, in line with the Cabinet Office statement of practice on staff transfers in the public sector. That means that recognised trade unions will be formally consulted and engaged with on measures related to the transfer. No changes to contractual terms and conditions will be made without proper consultation and engagement.
We are committed to maintaining an ongoing dialogue with trade unions and staff throughout this period of change, and we are updating them as often as possible. Where appropriate, we are also committed to working with staff networks on the changes, particularly on how we can best support staff. Given those commitments, I hope that the hon. Member for Sleaford and North Hykeham agrees that placing further requirements in the Bill would be disproportionate.
On amendment 38, we agree that it is important to be transparent about the costs and benefits of this programme. The Department has been open about the initial estimate of around £1 billion of savings per year, and we published an impact assessment alongside the Bill. The detailed timing and scale of costs and savings from the programme depend on factors such as the take-up of voluntary exit and redundancy schemes, which are under way. We will continue to refine our assessment of costs and savings as the programme progresses and as we move towards the abolition of NHS England. We will continue to be open about those figures.
The savings will support continued investment in frontline services. The timescales set out in the amendment would risk delaying the abolition of NHS England and, as a result, would delay the transfer of savings to frontline services and the stability and certainty we need for our staff.
On amendment 39, the Government are committed to supporting the integration of health and social care so that people experience more joined-up, person-centred care. Key planning frameworks, including for the better care fund and for neighbourhood health, already stress the critical importance of strong join-up and integration. We expect those frameworks to continue to guide the health and care system following the abolition of NHS England. Most importantly of all, we are committed to developing neighbourhood health approaches as an essential part of reforming the health and care system. That approach will deliver more integrated services across health, local government and wider partners, including the voluntary and community sector.
The Bill simplifies existing complex legal frameworks to make collaboration easier and emphasises the role of health and wellbeing boards as a focal point for that collaboration. However, partnership and collaboration take many forms depending on local circumstances, and they cannot simply be prescribed through a centrally developed plan. Instead, we should encourage areas to develop effective, productive relationships in the interests of the people they serve. We have discussed that in this Committee, and hon. Members from all parties have a key role to play there.
Turning to new clause 75, we absolutely recognise the need to ensure that critical functions, expertise and organisational capability are identified, retained and effectively transferred during this period of change. That is essential to maintaining continuity of services and supporting the delivery of key health programmes, including vital services such as cancer care.
I reassure the Committee that that work is already well under way. We are carefully mapping all areas of current activity across NHS England, assessing what capabilities we need to deliver them in future and putting processes in place to support the retention and transfer of expertise. This includes the phased approach we are taking to workforce changes, alongside a robust and consistently applied process for voluntary redundancies and voluntary exits, to minimise disruption and protect critical skills. We are also committed to ongoing monitoring and oversight through the transition, and as part of our programme of governance, there is ongoing consideration of skill retention, knowledge transfer and organisational capability, and we will take action where gaps are identified.
As drafted, the new clause would introduce a new statutory requirement to produce and lay before Parliament a formal transition strategy before the abolition of NHS England and the implementation of transfer schemes, alongside new ongoing reporting obligations. While well-intentioned, it would add another unnecessary step into what is already a complex and carefully sequenced programme. It would reduce the flexibility needed to adapt workforce organisational decisions as the transformation progresses. For those reasons, the Government believe that the objectives of the new clause are already being delivered through existing programme arrangements, without the need to place further requirements in the Bill.
Dr Johnson
I listened carefully to what the Minister said, but I do not know where the Government have transparently published all these numbers and calculations. A lot of parliamentary questions have been asked on the detail of this transition, so I think it is important that the detail is published so we can see it, and that the detail is planned, before the abolition process takes place. I therefore want to press the new clause to a vote.
Question put, That the clause be read a Second time.
Dr Johnson
I beg to move, That the clause be read a Second time.
The new clause would require the Secretary of State to publish a plan for securing the provision of universal fracture liaison services across England. As we get older, our bone density naturally decreases, increasing the risk of bone fractures and possibly osteoporosis, which affects 3.5 million people across the UK.
Fracture liaison services identify people aged 50 or over who have broken a bone, and they provide treatment to reduce the risk of further debilitating fractures. Of those over 50, one in two women and one in five men will break a bone because of osteoporosis. Heartbreakingly, 2,000 people die each year from preventable fractures. When the former Secretary of State, the right hon. Member for Ilford North (Wes Streeting), claimed that delivering universal fracture liaison services would be one of his first priorities if elected to Government, many people hoped to see this happen, but it has not.
The previous Conservative Government began rolling out fracture liaison services, and it is an indicator of just how little progress the current Government have made that 97% of today’s fracture liaison services were delivered by the Conservatives. What have the Labour Government been doing? What is more, one in two NHS trusts, following freedom of information requests, tell me that they have no fracture liaison service at all, which is quite literally an accident waiting to happen. I am very grateful to the Royal Osteoporosis Society for its campaigning on this issue. By its calculations, at the current rate of delivery, it will take 38 years for the Government to deliver universal fracture liaison services, which is obviously far too slow.
We have tabled the new clause because the Government need a plan. The former puppeteer of this Government, Morgan McSweeney, made it clear that Labour did not have a plan for government. The new clause would require the Secretary of State to deliver a plan within 90 days, not just to secure the provision of universal fracture liaison services but to deliver on his predecessor’s very clear and very deliberate promise to do so.
The Minister in the other place was asked whether an implementation plan for fracture liaison services was needed. The answer was, effectively, no. What is the view of the Minister before us in Committee? There are so many critical questions in this area that have no answers and that a plan would and should address. What are the Minister’s annual milestones for achieving universal access to fracture liaison services by 2030? How will the Minister’s plans to cut ICB budgets by 50% impact that key promise? An important question on the promise is whether the Minister’s plans to merge ICBs mean that fewer services will now be delivered. How will that impact patients? What extra workforce, diagnostic and NHS estates capacity is required to deliver it?
Yet again, as so often with this Government, we are left with a headline-grabbing promise with no plan behind it. The consequence is that more than 40,000 people are predicted to die from hip fractures that could have been prevented through timely national implementation.
Dr Prinsley
I am listening carefully to what the hon. Member, who is a medical colleague of mine, has to say. Although I think that a fracture liaison service is an excellent idea, there are many, many aspects of medical care that require careful attention, such as the management of people with hearing loss—my own field—or the assessment of people with chronic renal failure. Does the shadow Minister believe that all aspects of each individual disease category require some sort of primary legislation?
Dr Johnson
Not necessarily, no, but this one does, because the Government clearly made a promise before the election. The former Secretary of State was clear that it would be one of his first acts—that is what he said—and it has not happened, so in this case we need to hold the Government to account. It is our job to hold them to account on their promises, and I am afraid that they are failing on this one.
To sum up, the Government need to get their act together, because otherwise more and more vulnerable people will come to unnecessary and potentially fatal harm. I look forward to hearing the Minister’s plans to accelerate the delivery of the Government’s promise—and fast.
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship, Dr Huq. I welcome the Minister back from her son’s graduation —I hope it went well.
I rise to state my support for new clause 47, which would require the Secretary of State to publish a clear roll-out plan for fracture liaison services across England and report annually to Parliament on progress towards universal coverage by 2030. It is not about creating a new target, because the target already exists: both this Government and the previous Government committed to achieving 100% fracture liaison service coverage by 2030. The question before us, as proposed by the shadow Minister, is simple: how will that promise be delivered, and how will Parliament know whether meaningful progress is being made?
Fracture liaison services are one of the most evidence-based interventions in osteoporosis care. They systematically identify people aged over 50 who suffer a fragility fracture; assess their bone health; initiate treatment where appropriate; and monitor patients to reduce the risk of subsequent fractures. Given that around half of patients who sustain a hip fracture have previously broken another bone, those services represent a vital opportunity to intervene before a life-changing injury occurs. The human cost is considerable. Osteoporosis affects millions of people, particularly older women, and fragility fractures can result in a loss of independence, reduced mobility, social isolation and significant pressure on health and social care services. The National Institute for Health and Care Excellence estimates that around 180,000 fractures each year in England and Wales are attributable to osteoporosis.
There is also a compelling economic case: the Royal Osteoporosis Society estimates that investing around £30 million in fracture liaison services could prevent approximately 74,000 fractures over five years, including 31,000 hip fractures, saving the NHS around £665 million and freeing up some 750,000 bed days. Few preventive interventions offer that combination of better patient outcomes and substantial savings for the NHS.
The Government frequently point to their commitment to universal coverage by 2030, but as the shadow Minister pointed out, progress has been achingly slow. When the Secretary of State appeared before the Health and Social Care Committee last week, I questioned him on that issue directly. While he confirmed that the Department remains committed to meeting that 2030 target, which was first established by the previous Conservative Government, no plan—or indication of when a plan would come—was given. A commitment alone is not a delivery plan.
There are also growing concerns that the Government have overstated the progress that has already been made. The Royal Osteoporosis Society has confirmed that more than 97% of the fracture liaison services counted by the current Government were already in place before the change of Government. So, rather than that representing any significant expansion in national coverage, this Government have gone slow. I think it is therefore very reasonable—to answer the question from the hon. Member for Bury St Edmunds and Stowmarket—for Parliament to be entitled to ask what additional progress has actually been made since the commitment was reaffirmed.
New clause 47 would also require the Secretary of State to publish an assessment of access in every integrated care board area. It would also require annual milestones, because, at present, there is no publicly available timetable showing where the services will be established, or which areas will be prioritised or progressed between now and 2030.
Crucially, the new clause would require the Government to set out how integrated care boards will actually be supported. Ministers rightly point out that fracture liaison services are commissioned locally by integrated care boards, but if the responsibility for delivery rests locally while responsibility for national targets rests with central Government, there clearly needs to be a well-thought-through national framework explaining how those boards will be supported through funding, guidance, workforce planning and accountability.
This is, therefore, a straightforward request for transparency, accountability and, most importantly, delivery. If Ministers are committed to achieving this by 2030, they should have absolutely no objection to publishing a plan that shows how they intend to get there. For those reasons, I support the new clause.
Karin Smyth
I will partly agree with the Opposition to start off with: they are absolutely right that osteoporosis is a really important issue, particularly for older women. The hon. Member for Farnham and Bordon outlined some of the economic case, but crucially, it is a strong health issue. I worked and campaigned on this issue in opposition myself, because it predominantly affects older women. It also very much fits into our 10-year health plan regarding prevention. That is why we have also, for example, increased access to DEXA—dual-energy X-ray absorptiometry—scanners.
It is rather disappointing, though, for a subject on which there is obviously so much agreement to be used as a political back-and-forth here today. Let me be clear. I think some of the comments show why some of this has got a bit confused, including for people who genuinely care about this rather than just wanting to make it a political issue. Again, it is entirely the Opposition’s job to oppose the Government, and I do not have any problem with that, but there is a serious issue here about how this is monitored.
We are absolutely committed to having coverage across the country by 2030, as the Secretary of State has recently said. That is why we are rolling out more DEXA scanners and so on, but with the clustering of ICBs, 92% of the country is now covered across those clusters.
Karin Smyth
That is why it is important that we look at what is actually happening on the ground and how we are moving forward. We are committed to supporting this cohort, and particularly those patients for whom this condition is largely preventable. Care closer to home, based around our 10-year plan, is absolutely the right way to go about that.
Karin Smyth
I was going to outline the points, but I am happy to give way if the hon. Lady wants.
Dr Johnson
Can the Minister be clear on the point about ICBs? There is a concern that, where there are perhaps three ICBs, one of which has a service and two of which do not, and they merge together, the Government then say, “Aha! This ICB area now has coverage,” but that is for part of it, not all of it. What is important for a universal service is that it is available to all.
Karin Smyth
Again, the hon. Lady has intervened, but that is exactly my point. There is a danger here of the Conservative party focusing on a target or number and totally missing the point, which is to have good, locally available services accessible to this predominantly female and predominantly older population through our 10-year health plan. If one counts the new clustered ICBs in that target, 92% of areas are covered.
We want to get to the heart of this issue. Integrated care boards are the commissioners of local health services and remain best placed to make decisions according to local need. Commissioning these services at a local rather than national level—which is the entire thrust of our 10-year health plan, and indeed this Bill—means that ICBs are best placed to commission holistic, integrated care that wraps around the patient’s need, where the patient is.
We have been very clear in our 10-year health plan, and indeed in this Bill, that we are not expecting patients to fit in with models of care that have been devised over a period of time and in hospitals that are largely located far from their homes. We are looking at a close-to-home service and building models of care around peoples’ needs. A legislative requirement for a national implementation plan would cut across that responsibility, undermining local ability to tailor services to patient needs and causing confusion for delivery. That is why we do not think the new clause is necessary.
The renewed women’s health strategy sets an expectation that ICBs prioritise community-based models when commissioning new fracture prevention services. The Department will continue to work closely with NHS England and ICBs to explore a range of options that provide better quality, and better access to, important preventive services. I therefore ask the shadow Minister to withdraw the motion.
Dr Johnson
I am afraid I am not reassured at all. The Minister seems to be saying that the ICBs will do it—the same ICBs where she is cutting their budgets, making them change the board and making them merge with each other all at the same time. The target is behind schedule and it is important that we hold the Government to account on it. Therefore, I will press new clause 47 to a vote.
Question put, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss the following:
New clause 53—Cancer treatment: waiting times—
“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision for every patient to have access to cancer treatment within 62 days following referral.
(2) The Secretary of State must establish a scheme to support NHS hospital trusts in meeting the requirement under subsection (1).
(3) As part of the scheme, the Secretary of State must expand the capacity of the Medicines and Healthcare products Regulatory Agency.
(4) The Secretary of State must make an annual statement to Parliament on progress on meeting the requirement under subsection (1).
(5) Any statement made under subsection (4) should be made as close as reasonably practicable to 4 February.”
This new clause gives patients a right to start cancer treatment within 62 days of referral and requires the Secretary of State to establish a scheme to deliver this. It also requires the Secretary of State to update the House on progress against the target on/around the time of World Cancer Day.
New clause 54—Cancer Survival Research—
“(1) Within 12 months beginning on the day on which this Act is passed, the Secretary of State must by regulations establish a Cancer Survival Research Programme.
(2) Regulations under this section must—
(a) require government co-ordination and funding for research into cancers with a five-year survival rate below 20%, and
(b) establish a fellowship programme for foreign academics in cancer research.
(3) Any programme established under paragraph 2(b) must make provision to waive visa fees for entry into the UK for participating academics.
(4) Regulations under this section are subject to the affirmative procedure.”
This new clause would require the Secretary of State to introduce regulations requiring the government to coordinate research into cancers with the lowest survival rate.
New clause 65—National framework on radiotherapy treatment
“(1) Within six months of the passage of this Act, Secretary of State must publish and maintain a national framework for improving access to radiotherapy services in England.
(2) The framework must include minimum standards, established by the Secretary of State, against which—
(a) integrated care boards must measure and report their investment in, and delivery of, radiotherapy services, and
(b) the Secretary of State must assess the performance of integrated care boards.
(3) The minimum standards under subsection (2) must include standards regarding—
(a) waiting times for radiotherapy (including time to definitive treatment),
(b) patient travel times to radiotherapy services,
(c) the number of cancer patients receiving radiotherapy and the quality of such radiotherapy,
(d) the age, capability and replacement needs of radiotherapy equipment,
(e) access to modern radiotherapy techniques and technologies,
(f) access to treatments recommended by the National Institute for Health and Care Excellence,
(g) radiotherapy treatment capacity against current and projected population needs,
(h) variation in access to radiotherapy services between integrated care board areas,
(i) workforce capacity to deliver radiotherapy treatment,
(j) the level of investment in radiotherapy services and the extent to which such investment reflects clinical need.
(4) For the purposes of subsection (3)(d) the Secretary of State must set a maximum proportion of linear accelerators that are more than 10 years old or otherwise beyond the recommended replacement age.
(5) Each integrated care board must publish an annual report on its performance against the minimum standards in the framework.
(6) Where an integrated care board fails to meet at least one of minimum standards it must publish a remedial action plan setting out the steps it will take to achieve compliance.
(7) Before publishing or revising the framework, the Secretary of State must consult all persons with clinical, technical, operational and patient expertise in radiotherapy the Secretary of State considers appropriate.
(8) The Secretary of State must lay before Parliament, at least once in each financial year, a report on the implementation of the framework.”
New clause 100—Single patient record: review of flagging for early cancer diagnosis—
“(1) Within 12 months of the day on which this Act is passed, the Secretary of State must lay before both Houses of Parliament a report on the feasibility of using patient records held by the health service to indicate, to a person providing health care to a patient, cases in which a patient has presented symptoms on more than one occasion which may indicate the presence of cancer.
(2) The report under subsection (1) must consider—
(a) the potential for such indication to support early diagnosis of cancer in patients aged under 50 years of age, and
(b) any implications of such an indication requirement for clinical responsibility and patient safety.
(3) In preparing the report the Secretary of State must consult—
(a) NICE, and
(b) any other persons as the Secretary of State considers appropriate.”
This new clause would require the Secretary of State to report on the feasibility of using patient records held by the health service to indicate, to a person providing health care to a patient, cases in which a patient has presented symptoms on more than one occasion which may indicate the presence of cancer.
Dr Johnson
New clause 48 would require the Secretary of State to
“publish and maintain a national framework for improving access to radiotherapy services in England.”
One in four people can expect to need radiotherapy in their lives. That is a lot of people who will need consultation, assessment, pre-treatment planning and treatment delivery. Data published a few years ago showed that Scotland, Wales and Northern Ireland have more linear accelerator machines per million people than in England. Can the Minister confirm whether that is still the case? Last year, Radiotherapy UK had research indicating that more than 60,000 cancer patients are not getting the radiotherapy they need and I know particular areas of the country are struggling. Can the Minister provide an update on the roll-out of the new LINAC machines at 28 hospitals, which she spoke about in May 2025?
We were also told that by March 2027, up to 27,500 additional treatments will be delivered. Can the Minister share some information on how that will be achieved? The Labour Government have now been in power for two years. They have raised taxes by more than £60 billion and they do not have much to show for it. They have not produced a workforce plan. They have said that one will be imminent; can the Minister confirm whether it will be published today before we break for the recess? Is the intention to publish it during the recess or will we have to wait until the autumn?
There is a 31% shortfall in clinical radiologists. New clause 48 essentially requires the publication and maintenance of
“a national framework for improving access to radiotherapy services”.
This Government have essentially shown that if a requirement is not in legislation, plans just get delayed, diminished and disowned, but patients cannot afford to wait any longer.
Helen Morgan
I rise to speak to new clauses 53 and 54, tabled in the name of my hon. Friend the Member for Epsom and Ewell (Helen Maguire), and new clause 65, tabled by my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron).
New clause 53 would give patients a right to start cancer treatment within 62 days of referral and require the Secretary of State to establish a scheme to deliver that. It would also require the Secretary of State to update the House on progress against the target on or around the time of World Cancer Day. New clause 54 would require the Secretary of State to introduce regulations requiring the Government to co-ordinate research into cancers with the lowest survival rate.
Karin Smyth
This is an important debate, as many of them are today. I understand that waiting for a cancer diagnosis, as I have had to do myself, is very stressful. The national cancer plan sets out how the Government will change that experience for patients and their families. Crucially, the plan is driven by evidence and shaped by the voices of more than 11,000 patients, charities and professionals who responded to our call for evidence.
The plan covers the entirety of the pathway, from referral and diagnosis to treatment and ongoing care, as well as prevention and research and innovation, and tackles the key issues raised in the new clauses. Delivery of the plan will be monitored by the national cancer board, with an independent co-chair reporting to the Department.
On new clauses 48 and 65, let me be clear that improving access to high-quality radiotherapy services is a priority for the Government, and one that we are already delivering. In May last year we announced the roll-out of new linear accelerator machines, we have committed to meeting all cancer waiting time targets by the end of this Parliament, and timely access to radiotherapy is central to the 31-day and 62-day treatment standards. We will go further by reviewing the targets, once they have been met, to consider whether they should be strengthened. That will include considering what data is needed to support improved performance. A separate statutory framework would duplicate the established performance regime.
We are well aware that radiotherapy performance is below that of other treatment types, as the hon. Member for North Shropshire outlined. We are also aware of the serious variation between different parts of the country. We have at our disposal the Getting It Right First Time programme and national interventions to address those issues at a local level. The national cancer plan also tackles unwarranted variation through robust national data and oversight from the national cancer board, while ensuring that service configuration remains clinically led.
We have committed to improving the productivity of radiotherapy services, including by using artificial intelligence to streamline treatment. We will make a £70 million investment in state-of-the-art radiotherapy machines by 2027 through a managed national replacement programme. Imposing fixed legislative limits on the age profile of equipment would reduce the flexibility required to manage that programme effectively. Additionally, the NHS is already under a clear statutory duty to fund NICE-recommended interventions, supported by national commissioning guidance. Additional minimum standards would duplicate those safeguards without improving outcomes.
New clause 48 also suggests metrics to track radiotherapy performance. I assure the hon. Member for North Shropshire that high-quality and detailed data already helps us to understand emerging issues and to monitor performance. The National Disease Registration Service in NHS England collects diagnosis, treatment and outcome data on cancer patients in England. It routinely reports incidence, prevalence, survival, routes to diagnosis and treatment data on all cancers. NHS England also publishes monthly radiotherapy performance data.
On workforce capacity, we are already seeing increases in key roles, including clinical oncology doctors and radiologists, and the Getting It Right First Time review of radiotherapy services will report later this year. The new clauses risk duplicating efforts already in train to improve the oversight of radiotherapy services, workforce, data quality and coverage, and would create additional bureaucracy and divert resources away from patient care.
I turn to new clause 53. Improving performance against cancer waiting standards is a priority for this Government. We have made year-on-year progress with cancer waiting times, but we know that there is some way to go. Cancer incidence is about 15% higher than when the 62-day standard was last met, in late 2015. There are more than 200 distinct cancer types, and each is complex. The cancer waiting time targets, including the 62-day referral-to-treatment target, are not set at 100% for several reasons, including patient choice, clinical guidelines and the complexity of diagnosis and treatment planning. That means that not every patient can or should be treated within the waiting time standard. We therefore do not think the new clause is appropriate.
Change, including improvements to the cancer pathway and to tackle variation in performance, cannot be delivered overnight. The national cancer plan sets out the concrete actions that we are taking to get there. We have already demonstrated our commitment to transforming diagnostic services by investing £2.3 billion in diagnostic capacity. That will support us in achieving the 62-day standard through faster diagnosis. We recognise that the provision of cancer services, including treatment, varies across the country. The national cancer plan addresses how to tackle that variation.
To accelerate breakthroughs in cancer treatments, we will explore innovative procurement methods. That will aim to stimulate the development of new diagnostic tests, targeted therapies and more effective treatment for rare cancers, ensuring that the NHS remains at the forefront of medical innovation.
We believe that new clause 54, in the name of the hon. Member for North Shropshire, is unnecessary because the Department already has the National Institute for Health and Care Research and the national cancer plan underpinning its cancer research strategy. The Department invests about £1.8 billion each year on research through the NIHR. Cancer is a major area of its spending, at £141.6 million in 2024-25, reflecting the fact that it is a high priority. The NIHR does not usually ringfence funds for research in specific conditions; it welcomes funding applications for research into any aspect of human health and care, including cancer. Research is funded through open and fair competition and peer review to ensure that the highest-quality proposals most likely to deliver real impact for patients are funded without imposing financial targets or limits.
The national cancer plan is the first plan to have a dedicated chapter on rare cancers, which is important to many hon. Members across the House, including my hon. Friend the Member for Blaydon and Consett, who has done great work. The plan includes a commitment to make progress on rare cancers as one of six key research priorities to tackle stubbornly low survival rates. Our aim is to be in the top quartile across 28 countries for survival of 14 rare and less common cancers. Through the NIHR, the Department is the largest funder of clinical academic training. The NIHR plays a key role in attracting training and supporting the best clinical academic researchers, providing comprehensive research career pathways for clinicians across all career stages, from undergraduate level through to professional appointments.
New clause 100 would require the Department to publish a report on the feasibility of using data in patient records to flag symptoms. I understand the concerns behind it. We fully support using the single patient record and other data to improve cancer care and diagnosis, but we have largely covered the issues raised by the new clause in the cancer plan. We understand that there are concerns in some areas. The Government have introduced Jess’s rule, which instructs GPs to rethink a diagnosis if a patient presents with the same symptoms. That followed a campaign on behalf of the family of Jessica Brady, who tragically died after symptoms of her cancer were not recognised. The single patient record will give clinicians timely access to a single trusted record, which is why it is such an important part of the Bill. We envisage that the Bill, together with the cancer plan, will enable more personalised insight into cancer risk, for example, through the NHS app. For those reasons, we do not think the new clause is necessary.
Dr Johnson
If I heard the Minister correctly, she said that the ICBs would provide NICE-approved treatment, which they have to do within 90 days at the moment. At an earlier sitting, we debated an amendment tabled by the Minister that would enable the Secretary of State to delay the provision of NICE-approved treatment, which was agreed to. I am not quite sure how that is congruous, but in either case we would like to press new clause 48 to a vote.
Question put, That the clause be read a Second time.
Dr Johnson
I beg to move, That the clause be read a Second time.
I will be brief, because we have a lot to get through. The new clause would require the Government to produce a modern service framework for respiratory disease within 18 months and, in essence, to make a plan for providing and improving treatment for those with respiratory disease. The previous Government had a major conditions strategy, which looked at the six major causes of ill health, one of which was respiratory disease. This Government paused that when they came into office to consider their own plans, but have not responded with a plan for respiratory disease in any detail. The new clause would require them to do so.
Karin Smyth
I am grateful to the hon. Member for bringing another important disease to the attention of the Committee. I agree that modern service frameworks are important tools for improving patient care. They sit at the heart of our 10-year health plan, enabling a step change in both service quality and delivery. That is why we are prioritising making rapid progress on them. The first two MSFs, on sepsis and cardiovascular disease, will be published shortly, and a further four are in development. Given the momentum, it is clear that primary legislation is not needed to drive the development of MSFs; instead, we have established a robust, expert-led process.
Liz Twist (Blaydon and Consett) (Lab)
I should declare that I am an officer of the all-party parliamentary group for respiratory health. Clearly, a modern service framework is important, certainly for a constituency such as mine in the north-east that has a lot of respiratory health problems, but as the Minister said, we need action rather than legislative change.
Karin Smyth
Like my hon. Friend’s constituency, my constituency of Bristol South has a large tobacco industry legacy, and it is crucial to address respiratory disease in a way that looks at the whole person.
Dr Prinsley
Does the Minister agree that the single most effective thing that we have done for public health since we were elected is to get the Tobacco and Vapes Act 2026 passed? The gradual abolition of cigarette smoking will save more lives than anything else we could conceivably do in politics.
Karin Smyth
My hon. Friend tempts me to go down the path that we went down in another Committee. I recognise that the Tobacco and Vapes Bill took a long time to come through Parliament, despite having been started by the Conservatives under the right hon. Member for Richmond and Northallerton (Rishi Sunak). It faced a lot of opposition, but we are absolutely clear that that is the single most beneficial piece of work. The hon. Member for Sleaford and North Hykeham asked me about the future, in terms of vape shops and so on, and I have corresponded back to her on that issue.
Instead of what is proposed in new clause 49, we have established a robust, expert-led process. The national quality board will assess all proposals for new MSFs against a clear set of criteria, ensuring that we prioritise those areas where an MSF will deliver the greatest impact for patients. Alongside developing the first wave of MSFs, we are further strengthening the process, including by setting out a clear and consistent approach for assessing future proposals. Embedding an MSF in respiratory health in primary legislation would risk limiting that flexibility, rather than strengthening our ability to improve care, as my hon. Friends the Members for Blaydon and Consett and for Bury St Edmunds and Stowmarket have outlined, by taking the action that is so necessary to help and support people with respiratory disease.
Dr Johnson
The Minister talks about momentum, but as I understand it, there is a severe mental illness MSF, for which timelines are to be published in due course; a sepsis MSF that was expected in the spring but is now anticipated in the summer; a frailty and dementia MSF expected sometime this year; a palliative care MSF that was published in June as an interim update, but will not be complete until the autumn; and a cardiovascular MSF. I do not see very much momentum there, given that the Government have been in office for two years.
Karin Smyth
It is a lot faster than the 14 years in which it was not done under the Conservatives.
Dr Johnson
Actually, there were plans, changes and improvements in respiratory care. One of the more obvious ones for lung cancer was the start of the lung cancer screening programme. I do not think the Government have the momentum and vigour that is required. Of course, they have also paused the long-term conditions strategy, which was already written and would have delivered. This is important, and we will press new clause 49 to a vote.
Question put, That the clause be read a Second time.
Dr Johnson
I beg to move, That the clause be read a Second time.
The new clause would require the Secretary of State to produce a delivery plan for the transformative technology commitments in the 10-year plan. The 10-year plan took a lot of people a year to write, and there is plenty of ambition in it, but so far the delivery is rather suspect. The Government are right to say that technology can be game-changing, but it is one thing to ask civil servants and special advisers to draw up a grand plan and a nice brochure, and another to actually deliver on those ambitions. The Labour party came into government without a plan, and we are about to have a new Prime Minister but we do not know what his plan is, or even if he has one, either.
We have seen IT outages take down health systems, hospitals fail to communicate critical information after patients are discharged, and warm weather take down MRI scanners and radiotherapy machines. The new clause would require the Secretary of State to produce a delivery plan for the transformative technology commitments in the 10-year health plan, and would provide a clear road map for data quality and interoperability, artificial intelligence, genomics and predictive analytics, wearables, and robotics. Let us be clear: the Opposition support introducing new technology to make the NHS more efficient and improve patient care, but we need clarity from the Government on how they will do that.
Ordered, That the debate be now adjourned.—(Emma Foody.)
Health Bill (Seventeenth sitting)
Thursday 16th July 2026
(1 week, 4 days ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 16 July 2026 - (16 Jul 2026)
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The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairship, Ms Lewell. As the shadow Minister, the hon. Member for Sleaford and North Hykeham, said before the break, technology is a game changer. It is a key enabler of our 10-year health plan and a modern NHS. This new clause follows the plan’s five big bets, the transformative technologies key to NHS improvement: data to deliver impact; AI to drive patient power and productivity; genomics and predictive analytics for pre-emptive personalised care; wearables to make care real-time; and robotics to support precision. To require those diverse areas to be subject to a cohort of plans to be laid before Parliament, and to make them subject to perpetual monitoring by Parliament, would be to legislate for micromanagement. One of the priorities of tech delivery is that it needs to be agile. The new clause would inhibit that.
Parliament does not usually have a role in overseeing delivery plans for specific elements of NHS technology. Adding in new reporting structures is unnecessary bureaucracy that would slow down delivery of the technologies and their impact on patients. In some areas, we already have arrangements in place to underpin delivery, via legislation approved by Parliament. The Health and Care Act 2022, the Data (Use and Access) Act 2025 and related legislation have established a framework for mandatory information standards, which can set the technical and data requirements to ensure interoperability. Along with our 10-year plan, our ambition to be the most artificial intelligence-enabled healthcare system in the world by 2035 and our commitment to an AI road map, that means that the new clause is unnecessary. I therefore ask the hon. Member to withdraw the motion.
Question put, That the clause be read a Second time.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I beg to move, That the clause be read a Second time.
The new clause is a probing amendment. The aim is to press the Government to explain why the Bill does not include provisions to implement statutory regulation of NHS management, as they had said they would, and to commit to a timetable for bringing the regulations they promised into force.
I am an NHS consultant paediatrician and am regulated as such by the General Medical Council. The GMC regulates doctors, the Nursing and Midwifery Council regulates nurses and midwives, and different bodies represent other professionals in the health service—but not managers. The Government said that there would be such a register. I know that there are many excellent managers—the Minister was one—but as in every profession, bad apples need to be identified and managed appropriately.
The Times has reported that senior bosses at Leeds teaching hospital NHS trust asked consultants and nurses to work in ways that lie outside the national service recommendations. We have also heard from Donna Ockenden that of the 66 former senior staff members in Nottingham she approached, only 35 agreed to be interviewed. The former Secretary of State for Health and Social Care, the right hon. Member for Ilford North (Wes Streeting), has said that he finds it
“unconscionable that people who worked for the NHS would deny them”—
the families—
“an honest account of what went wrong”.
Establishing a register would be the first step in ensuring that bad apples can be held to account. Those who bully staff, cover up problems, endanger patients or misappropriate funds should not be allowed to fail upwards. The NHS benefits from having outside experience, including from the private sector and the armed forces, so I am looking not for full occupational licensing, but simply for a register of those who are not suitable to be appointed. We should not see managers going from one trust to another and another after they fail at the first. I should finish by declaring that I worked at Nottingham University hospitals NHS trust during late 2012 and early 2013.
Karin Smyth
May I put on record my thanks to all the excellent managers in the NHS? I am not sure whether I raised the bar, as the hon. Lady said, but it was a great career and one that I enjoyed very much. It is a difficult job, and we want to support managers in future. We cannot deliver our 10-year health plan without them. That is one of the reasons why we have already established a leadership college to support their development, as we committed to doing.
Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
Does the Minister agree that managers in the NHS sometimes get a very bad press from the medical profession? I believe that to be wholly unjustified.
Karin Smyth
I thank my hon. Friend and the shadow Minister for their comments about NHS managers. I agree that they often get a bad press, and often from politicians as well. We cannot run the health service without both clinically and non-clinically trained managers, so we need to ensure that they have the right support to do their difficult job. My experience is that when the partnership with clinicians works well, it is really powerful. I have certainly learned a lot from working with some fantastic clinicians in my career.
We are absolutely committed to introducing a statutory barring system. We will do that by introducing secondary legislation within this Parliament to enable the Health and Care Professions Council to operate that barring system. We intend to do so as part of the planned secondary legislation to modernise the framework that governs the Health and Care Professions Council.
Changes to this legislation are subject to a statutory three-month consultation period, in addition to which this legislation will be novel and complex. It will require extensive stakeholder engagement to ensure that we develop a barring system that is proportionate and operates efficiently alongside existing frameworks, codes of practice and other regulation governing the work of NHS senior leaders. For those reasons, a 12-month timeline to bring forward the section 60 order is unfeasible. The new clause also sets out prescriptive duties on the content of the section 60 order; we would not wish to pre-empt the outcome of detailed policy development and consultation.
I welcome the support of the hon. Member for Sleaford and North Hykeham for the broad programme of initiatives to professionalise and increase the accountability of managers and leaders in the NHS. Although we do not agree that it would be proportionate to set a requirement in primary legislation to lay before Parliament a timetable to which those measures will be delivered, officials in the Department of Health and Social Care and in NHS England are already working in partnership with organisations across the health sector and will set out more on the individual timelines in due course. For those reasons, I ask the hon. Member to withdraw her new clause.
Dr Johnson
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 52
Access to dental provision: Dental deserts
“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must establish a scheme to improve access to dental provision (‘the Scheme’).
(2) The purpose of the scheme is to end dental deserts.
(3) A dental desert is defined as any local authority area with fewer than ten active dental practices per 100,000 people.
(4) The scheme must make provision to support integrated care boards to—
(a) guarantee emergency access to an NHS dentist,
(b) provide free dental checks up for—
(i) children,
(ii) mothers within one year of having given birth,
(iii) pregnant women, and
(iv) low-income households, and
(c) guarantee dental appointments for persons commencing—
(i) surgery,
(ii) chemotherapy, or
(iii) transplant procedures.
(5) The Secretary of State must, before publishing the scheme, issue a reformed dental contract.
(6) The Secretary of State must, within six months of the establishment of the scheme, publish a dental workforce plan to support delivery of the scheme.”—(Helen Morgan.)
This new clause would establish a scheme to support integrated care boards to end dental deserts.
Brought up, and read the First time.
Question put, That the clause be read a Second time.
Helen Morgan (North Shropshire) (LD)
I beg to move, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss the following:
New clause 58—Inquiry into women’s health outcomes—
“(1) The Secretary of State must, within six months beginning on the day on which this Act is passed, commission an independent inquiry into women’s health provision and outcomes in England.
(2) Any inquiry established under subsection (1) must consider—
(a) the causes of—
(i) poorer health outcomes, and
(ii) disparities in patient safety
for women,
(b) the effectiveness of existing commissioning arrangements in meeting the needs of women, and
(c) recommendations to assist the Secretary of State in discharging the duty to reduce inequalities in health outcomes under section 1C of the National Health Service Act 2006.
(3) The Secretary of State must lay a report on the findings of the inquiry before Parliament within the period of 12 months beginning with the day on which this Act is passed.”
This new clause would establish an inquiry into the poorer health outcomes faced by women.
New clause 104—Implementation of the Women’s Health Strategy—
“(1) The Secretary of State must, within 90 days of the date on which this Act receives Royal Assent, publish a women's health implementation plan (the ‘implementation plan’) setting out how the commitments in the document entitled ‘The Renewed Women's Health Strategy for England’ published on 15 April 2026 (or any successor document) will be delivered.
(2) The implementation plan must include, in particular—
(a) a timetable for delivering simpler access to long-acting reversible contraception (LARC);
(b) a trajectory for reducing the gynaecology waiting list and for reducing average diagnosis times for endometriosis;
(c) a plan for establishing the regional specialist centres for group-based women's health pathways, including contraception, heavy periods, uro-gynaecology and menopause; and
(d) measurable targets and milestones for each commitment in the strategy, including a baseline and timetable for delivery.
(3) The Secretary of State must lay the implementation plan before Parliament on the day it is published.
(4) In preparing the implementation plan, the Secretary of State must consult—
(a) the Royal College of Obstetricians and Gynaecologists,
(b) the Faculty of Sexual and Reproductive Healthcare, and
(c) patient organisations representing women affected by the conditions addressed by the strategy.”
This new clause would require the Secretary of State to publish a women's health implementation plan setting out how the commitments in the document entitled “The Renewed Women’s Health Strategy for England” will be delivered.
Helen Morgan
New clause 57 would ensure that the average waiting time for diagnosis and treatment for elective conditions for women’s health issues does not exceed the average waiting time for wider NHS elective treatment. New clause 58 would establish an inquiry into the poorer health outcomes that women face.
In communities up and down the country, we have seen the devastating toll taken by the various and sustained failures to invest in and deliver better women’s health. Vital services remain understaffed and underfunded, while women and girls are going without the care they need. In 2022, we welcomed the first women’s health strategy, which promised to
“listen more carefully to women, close gaps in care, improve research and tackle inequalities.”
Those were all vital goals, but three years on, the problems remain stubbornly in place: long waits for gynaecology treatment, patchy access to services, women reporting that they are not listened to, pain not taken seriously and conditions diagnosed too late.
Medical misogyny is a perverse and unacceptable norm in the health sector. Women are not offered pain relief when they need it. The side effects of treatment and drugs on women in particular are far too often overlooked and under-researched. More research is needed to improve medical and reproductive products for women. In addition, about half a million women are waiting for gynaecology treatment across the country.
We just cannot keep failing women in this way. The current average wait for a diagnosis of endometriosis is nine years and four months. Tackling NHS waiting times, including for gynaecological services, must be a top priority for the Government. More needs to be done to tackle the backlogs. Waits for health conditions specific to women should not be so much longer than those for general health conditions.
The former Secretary of State recognised that the NHS
“has a problem with basic, everyday sexism and an appalling culture of medical misogyny.”
We welcome that acknowledgment, but we believe that the Department of Health and Social Care should ask the same questions of itself.
As I say, new clause 57 would ensure that the average waiting time for diagnosis and treatment for elective conditions for women’s health issues does not exceed the average waiting time for wider NHS elective treatment. It would be a meaningful step towards parity and equality. As we know, in the NHS what gets measured gets done.
The Government’s new women’s health strategy is welcome—it has more urgency and has the laudable goals of tackling medical misogyny, of faster diagnosis of conditions such as endometriosis, and of better pain management—but in comparison with the men’s health strategy that was released last year, it lacks teeth. Its goals are laudable, but it lacks a named academic network, a formal National Institute for Health and Care Research-aligned research mandate, a committed stakeholder governance group, a named condition-specific research investment at a comparable scale to that in the men’s health strategy and a formal accountability architecture with named organisations, governance structures and public reporting obligations.
This time, we need to back the strategy with real investment in the services that impact women, which have been stretched to breaking point. New clause 58 would introduce an inquiry into the poor health outcomes faced by women. We hope that such an inquiry would achieve the same goal and shed a light on women’s health issues, which seem to get so little focus at the moment.
Dr Johnson
I rise to discuss new clause 104, which stands in my name. The Labour Government’s general election manifesto made a bold pledge:
“Never again will women’s health be neglected.”
The Government have been in power for two years, and I am not convinced that they are doing all they can for women’s health. The latest NHS statistics show that waiting lists are rising under this Government. The trend is particularly acute for gynaecology services. More women are awaiting admission to hospital for gynaecology treatment or procedures than in July 2024. How does that square with the Government’s ambition to improve and prioritise women’s health?
We talked this morning about fracture liaison services, which is another treatment that would predominantly have benefited women if the Government had kept their promise and rolled it out as they said they would. The previous Conservative Government commissioned the Hughes report. The Labour Government have repeatedly pledged to address the issue at the earliest opportunity, but when will the Minister respond to the women who have been waiting so long? The Government published their renewed women’s health strategy in April, but where are the timelines, steps and milestones to deliver and implement improvements to women’s health? Where is the plan to reduce gynaecology waiting lists? Where is the timetable for delivering on long-acting reversible contraceptives, for example?
I have no doubt that the Minister has a desire to improve outcomes for women and improve their care, but I am concerned about the actual delivery, which has been a theme throughout the day. I tabled new clause 104 because this Labour Government have made promises to women that they need to keep, and that they need a plan for how they will keep them. My new clause would ensure that they have a plan to deliver, rather than just making promises in glossy brochures.
Karin Smyth
Hon. Members have brought to the Committee a really important discussion about women’s health. I am very happy to have that discussion, because the Government are committed to prioritising women’s health. That is why I am so proud that we published a renewed women’s health strategy earlier this year.
I say in response to the Liberal Democrat spokeswoman, the hon. Member for North Shropshire, that we renewed the strategy partly because—to be absolutely fair to the Conservative party—we agreed with much of what it put in place under its women’s health strategy. We did not see the need to start it from scratch, so to speak. There had not been a men’s health strategy, so they are very different propositions.
Much of the direction had been covered, but the implementation had not. On the point made by the hon. Member for Sleaford and North Hykeham, we wanted to go further and faster and acknowledge some things, as the former Secretary of State did, about medical misogyny, as well as the need to renew that strategy.
I fully agree with new clause 57 that women should get equal access to high-quality elective care. We are committed to tackling the long waits for services primarily affecting women; I am acutely aware that women can wait disproportionately longer for a wide range of treatments, although none solely impacts women more than gynaecology services. The Government recognise that injustice. That is why we have implemented measures to improve gynaecology services and women’s access to care, including piloting gynaecology pathways in community diagnostic centres for patients with post-menopausal bleeding, increasing the relative funding available to incentivise providers to take on more gynaecology procedures, and using surgical hubs to help endometriosis patients to get quicker treatment. Those measures have helped to improve 18-week referral-to-treatment times for gynaecology by 5.1 percentage points over the past year.
We will go further over the course of this Parliament, including by launching NHS Online clinical services from 2027. That will initially prioritise nine conditions, including women’s health conditions such as severe menopause symptoms and menstrual problems that may be a sign of endometriosis or fibroids. Patients will have the choice of getting the specialist care they need from home, and we will provide additional appointments to reduce waiting times.
More broadly, we have committed to returning to the NHS constitutional standard by March 2029 so that 92% of patients wait no longer than 18 weeks from referral to consultant-led treatment across all patient groups and specialties. Delivering against this standard would also require the waiting times for a diagnostic test to improve significantly. We recognise that, which is why in the medium-term planning framework, the NHS target is to ensure that by March 2029 no more than 1% of patients are waiting more than six weeks for a diagnostic test.
On new clause 58, we acknowledge that women’s health has been neglected and that women deserve better. We acknowledge that there have been longstanding failings in women’s health outcomes, experiences and access to care. That is why we published the renewed women’s health strategy, making it clear that women’s voices and choices are central in healthcare. We will transform NHS performance in the services that matter most to women, support all women to live healthy, prosperous lives, and create an approach to research and development that works for and empowers women.
Reducing inequalities is hardwired throughout the strategy. Actions are targeted by deprivation, ethnicity and unmet need, with a focus on marginalised women, community-based services, neighbourhood health models, and transparent data. The renewed women’s health strategy marks a decisive shift from identifying problems to delivering change. By listening to women’s voices, improving performance where it matters most, and tackling the drivers of poor health and inequality, we will ensure that women and girls receive the care, respect and outcomes they deserve. As a result, we do not think that conducting an independent inquiry into women’s health provisions and outcomes in England at this time would add value. Instead, now is the time to deliver the change that we all know and agree is absolutely needed.
I recognise the intention behind new clause 104, but I do not believe that it is necessary to publish an implementation plan. The action summary tables in the renewed women’s health strategy clearly highlight the responsible delivery organisation and the planned timeframe for all 117 actions. Some actions are already under way or funded for this year; others will be delivered over the next two to five years, and more fundamental reforms will be phased in over the next decade, aligned with the 10-year health plan.
Progress in the renewed strategy will be judged against three overarching outcomes: reversing the decline in healthy life expectancy since the 2010s, raising healthy life expectancy in the poorest regions to at least 61 years, and reducing the time women spend in poor health, particularly where inequalities are greatest—something I see very starkly in my Bristol South constituency. We will also be transparent on progress through a new women’s health data dashboard, publishing neighbourhood-level data on performance, access, outcomes and experience.
This Government have already undertaken extensive engagement to inform the development of the strategy. We had nearly 100,000 responses to the 2022 women’s health strategy call for evidence, more than 400 submissions from individuals and organisations with expertise in women’s health, and analysis from the Change NHS engagement exercise, where roundtables brought together women with lived experience, clinicians, academics and expert organisations. I was part of some of those roundtables and it was very instructive. I thank them for the work they did to get us to this point. We will continue to engage and to listen to women through the new women’s voices partnership and through patient-reported experience and outcome measures, which will help to shape and improve services.
Creating a new statutory duty to publish an implementation plan risks diverting attention and resources away from delivering the actions in the renewed strategy, which should now be our priority. It is for those reasons that I ask hon. Members not to press their new clauses.
Helen Morgan
I am suddenly cast back to 31 years ago, when I was choosing my subjects for the final year of my history degree. One of the early modern history papers was provocatively entitled “Women and other deviants”. It was called that to draw attention to the fact that, despite making up 50% of the population, women are often treated as a minority group. I sincerely hope that we are not still in that situation, but women’s issues clearly still need addressing. I will take the Minister at her word, but I will keep pressing her on this issue as we go through the course of this Parliament. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 66
Puberty blockers
‘(1) Within three months of the passage of this Act the Secretary of State must make regulations which ensure that puberty blockers may not be prescribed, dispensed or supplied to persons under 18 years of age for the purposes of treatment related to gender dysphoria, gender incongruence or a combination of both, in the United Kingdom.
(2) These regulations must ensure that such drugs cannot be given out or used as part of clinical trials for the treatment of gender dysphoria, gender incongruence or a combination of both, unless that trial has specifically been approved by a resolution of both Houses of Parliament.
(3) For the purposes of this section, puberty blockers means—
(a) a “gonadotrophin-releasing hormone (‘GnRH’) analogue” which means a medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin, and
(b) any other drug which has the effect of suppressing or delaying puberty that the Secretary of State may by regulation appoint.’—(Dr Caroline Johnson.)
This new clause would create a requirement for the Secretary of State to make regulations which prevent puberty blockers from being prescribed to persons under 18 years of age for the purposes of treatment related to gender incongruence, or clinical trials related to gender incongruence unless specifically approved by Parliament.
Brought up, and read the First time.
Dr Johnson
I beg to move, That the clause be read a Second time.
New clause 66 relates to the prescription of puberty blocker drugs, also known as GnRH agonists. A first rule of medicine is “Primum non nocere”—first do no harm. That is what this clause seeks: to make sure that harm does not come unnecessarily to children. It is required because the Government are sponsoring a £10.6 million trial to put 226 physically healthy children on puberty-blocking drugs. That is being done despite the fact that the Health Secretary claims he feels “uncomfortable and uneasy” at the prospect.
There are lots of questions that need to be answered. The minimum age for this trial is 11 years old for girls and 12 years old for boys, despite the Medicines and Healthcare products Regulatory Agency having recommended a much older group. When my hon. Friend the Member for Fylde (Mr Snowden) asked why in a written question, the Minister gave a holding answer. Is that because the Government do not know or because they do not want to say?
I am not convinced that the trial will produce the answers the Government want. Apparently, they are asking the question of whether puberty blockers benefit children who have questions over their gender and who will later go on to have a trans identity in adulthood. The challenge is that we do not know which of the children who have challenges with their gender during puberty will go on to have such an identity in adulthood, so we are essentially doing a trial on a large number of children to see whether puberty blockers are beneficial for a small group, or, as it was described by the Secretary of State,
“a very small subset of a very small group”.—[Official Report, 22 June 2026; Vol. 788, c. 56.]
The Government have data that they could use in a data linkage study to try to narrow that field down, but for some reason they are choosing to do this trial before that. I do not understand why; perhaps the Minister can explain.
I do not want to detain the Committee too long on this issue—I could talk for some time—because we have had Opposition day debates in the House on it, but we have seen unease from both sides of the House. The Minister will be aware that there was a vote on the trial at the end of the recent Opposition day debate, and there were a large number of abstentions, as well as three votes against, from her party, as well as many votes against from ours. Puberty blockers carry risks that may or may not be reversible: there are concerns about bone density, cognitive damage and fertility loss, all for children who should be enjoying their childhood.
The new clause would prevent a trial from taking place without votes in the Houses of Parliament. I appreciate that we would not normally seek to have votes in the Houses of Parliament on a clinical trial, because it would slow clinical trials down, but I think this topic in particular has unfortunately become so polarised that it is very difficult to see how it can be processed properly.
Ultimately, the Government have responsibility for what goes on in this country. If the Government want to pay for the trial, then it is the Government’s trial, and the Government should bring it before the House for us to decide as parliamentarians whether it is the right thing to do. I think it is absolutely not. I think we are putting children at risk of permanent harm. We do not know that these children are going to benefit. We do not even know if they are in the pool of children who would, in the long term, have a trans identity, and the Government are not even waiting to see whether they can find out using the data linkage study. It is wrong, and we need to do what we can to try to prevent it.
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship, Ms Lewell. I had written a 25-page speech for this debate, but to the disappointment of my researcher—and probably the delight of this Committee—I do not intend to read out all 25 pages. [Interruption.] There are cries of “Shame!” from my own side, but I accept that there are a number of amendments and new clauses to get through. My stated objection to the puberty blocker trial is also well known and on the record, so I do not wish to detain the Committee for too long.
I want to pick out five areas where I think there are problems. They are why I support new clause 66, tabled by my hon. Friend the Member for Sleaford and North Hykeham. My first point can be summarised as: “Don’t repeat a mistake to find out whether it was a mistake.” Thousands of children have already received puberty blockers through the former Tavistock pathway, and my view is that, before exposing a whole new cohort, the Government should complete the long-promised data linkage study to establish what happened to those children. That is probably the core argument.
Secondly, if the Government rightly say that the drugs present an unacceptable safety risk, how can it be ethical to give them to children in a trial? It must still be an unacceptable safety risk, whether it is for the general population of those who wish for it or for the people in the trial. The Government banned routine prescribing because of the safety concerns, yet propose administering the same medicines in a research setting. That is a complete contradiction of the ban.
Thirdly, clinical equipoise does not exist in the evidence if the evidence already points to significant risk and uncertain benefit. The Cass review concluded that the evidence base for puberty blockers is weak and that concerns remain over bone health, fertility and neurodevelopment. A trial should not proceed unless there is genuine uncertainty that justifies exposing children to those risks.
Fourthly, children should not bear the burden of answering questions that the NHS should have answered itself. The failure to collect the robust, long-term evidence from previous patients, including through the data linkage trial, should not be remedied by recruiting another generation of vulnerable children. Ethical research requires exhausting the existing evidence first. Finally, even the medicines regulator—the MHRA—had sufficient concerns to halt the trial. The MHRA intervened to pause the pathways trial over safety and wellbeing concerns, reinforcing the idea that the scientific and ethical questions remain unresolved. A pause should lead to a complete reassessment, not simply restarting as soon as possible.
Dr Johnson
Does it concern my hon. Friend that the person who raised the concerns about the trial then recused himself from further involvement in it?
Gregory Stafford
It did. If memory serves, that question was raised—although I cannot say more because it was in private. I do have concerns that the professor who was in charge and raised those concerns at the MHRA was recused. I cannot discuss the details of that, but it could show that there was a bias in the selection of the people who were pushing the trial forward. I am not saying that there was bias, but I think that, on an issue of such importance, the perception of bias is almost as bad. We need to be very careful about that.
Either way, I think the trial is wrong for the five reasons I have outlined. The key reason is the moral and ethical issue, and my hon. Friend the Member for Isle of Wight East raised it in both the Health and Social Care Committee and the Chamber: it is clearly morally wrong to experiment on children just for the sake of experimenting. The fact that there is no evidence does not mean that we should put children through a trial to see whether the evidence exists.
Karin Smyth
Usually, I say that I am grateful that a discussion has been brought before the Committee and that I am happy to have it, but it is unusual to have a discussion on a clinical trial in a political environment. I stand to be corrected, but I do not think that there has ever been a clinical trial subject to a parliamentary vote. There has been an Opposition day debate about this, in which many issues were rightly aired, so we will not spend much time discussing it this afternoon.
The safety and wellbeing of children and young people is paramount. Children’s healthcare must always be led by evidence and expert scientific and clinical advice. We all know that that was not the case in some of the instances at the Tavistock over time, in the late 2010s. We pay tribute, as we have done several times, to the then right hon. Member for Bromsgrove when he was Secretary of State for Health—in 2022, he finally took action on that particular service and what went on there, commissioning Dr Hilary Cass’s review, which we supported on a cross-party basis, for the health, safety and wellbeing of children. Hilary Cass’s interim review in 2022—which bears reading, for those who have not read it recently—found the evidence for the service model and the clinical base to be woefully lacking. In the 2010s, that was allowed to continue for a long time, but fortunately started to be stopped in 2022.
Ever since, we have had cross-party agreement in support of Dr Cass’s review. She found that the evidence on the use of puberty-supressing hormones for children and young people for treatment of gender incongruence is “remarkably weak”. Based on the available evidence, NHS England introduced a new clinical policy in March 2024 that means that puberty-suppressing hormones are no longer available routinely in the NHS for children and young people with gender incongruence. In December 2024, for non-NHS prescriptions, the Government introduced an indefinite ban on the sale and supply of puberty-suppressing hormones to children and young people for the purpose of gender dysphoria or incongruence. That followed independent advice from the Commission on Human Medicines.
Clinical practice should be based on evidence. When evidence is lacking, clinical research takes place to improve the evidence base. That is why, to properly understand the impact of puberty-suppressing hormones to treat gender incongruence, the Cass review recommended a clinical trial. In line with the Cass review’s recommendation, a trial has been developed and has now secured updated study approvals from the MHRA and the Health Research Authority.
This country has a well-deserved international reputation for academic and scientific excellence, with robust independent regulatory processes in place to properly scrutinise and assure the scientific rigour and ethics of publicly funded clinical trials. That helps to ensure that individuals receive evidence-based care, based on the highest quality research, regardless of their clinical diagnosis. I therefore disagree with the view of the hon. Member for Sleaford and North Hykeham that, uniquely, clinical trials for those types of medicines must be subject to the scrutiny and approval of both Houses.
Dr Johnson
A couple of points. Does the Minister recognise that the cancel culture associated with much of the work in this area, and in looking after those vulnerable groups of children, means that the tendency among those who get involved is to have a particular view? How has she worked to ensure no bias among those on the committee involved in producing the trial? Does she recognise that by choosing a cohort of children—226 of them—to do this experiment on, she is selecting a group of children of whom most will have a gender incongruence that will get better by itself? There are two effects of that. First, these children will have unnecessary treatment. Secondly, even if there were in theory a benefit to the small group of children who would have persisted in a trans identity, that would affect the reliability of the results; therefore, whatever the results, people would think them unreliable.
Karin Smyth
I think that was yet another addition to the hon. Lady’s speech. Initially, she asked whether I recognised the cancel culture in this area. I have already alluded to, absolutely, recognising that what occurred in the 2010s at the Tavistock and around was not acceptable. Under the stewardship of the Conservative party of the NHS and so on, it took until 2022 to start rectifying that situation in order to give good treatment to children and young people. She is herself a clinician, so I am somewhat surprised at her. Noting what I set out, I am surprised that she does not recognise that a clinical trial has never—I stand to be corrected—been subject to a vote in Parliament, whereby politicians who are not experts have a say; but we can come back to that.
Karin Smyth
I am going to move on.
Noting what I have set out, having such a vote would set an uncomfortable precedent that would be likely to significantly compromise the value and reputation of UK research, as well as creating an inequity unique to individuals with gender incongruence or gender dysphoria. For those reasons, I ask the hon. Lady to withdraw the new clause.
Dr Johnson
I am not aware of any clinical trial that has provided potentially extremely harmful medication to children who have a self-limiting issue and who are physically healthy, to change their physically healthy bodies by changing puberty or anything else to a physiologically abnormal state from a physiologically normal one. These are children going through normal, physically healthy puberty. Their normal puberty is being stopped. I think the trial is badly designed, and I wish to press the new clause to a vote.
Question put, That the clause be read a Second time.
Helen Morgan
I beg to move, That the clause be read a Second time.
I thank my hon. Friend the Member for Guildford (Zöe Franklin) for tabling the new clause. She has asked me to speak about dental deserts in Surrey and East Hampshire, the area that she lives in and represents. The new clause places a duty on the Secretary of State to ensure that there is adequate provision of NHS dental appointments in Surrey and East Hampshire, and allows us to raise once again the shocking state of dentistry in this country.
As we have discussed on many occasions, more than 5 million children did not see a dentist at all in 2025—that is a stark reminder of what we mean when we talk about dental deserts. We have heard that DIY dentistry has become normalised, which is pretty horrifying. People are using pliers to extract teeth and superglue to reattach crowns, or attempting to fill cavities with household adhesives. Beyond those obviously shocking Victorian scenes, DIY dentistry is very risky and has, tragically, led to deaths from sepsis. That is all because people cannot get an NHS dental appointment and cannot afford a private one.
The last Conservative Government pushed dentistry to the brink, and children and parents in particular are paying the price of that neglect. That is a national shame—one that we must fix. As I mentioned, my hon. Friend the Member for Guildford tabled the new clause to highlight the issues in her part of the country. Surrey and East Hampshire is not the worst place in the country for access to NHS dentistry, but it does face serious issues. Some pockets of the population have been left unable to get an NHS dental appointment.
The action taken so far by the Labour Government has not been good enough, but the fault for this dire situation lies solely at the door of the Conservatives. Their years of neglect have left our dentistry in a shocking condition. Healthwatch—once again showing why it is so important—has classified large parts of Hampshire as dental deserts. Equally, a Healthwatch report into dentistry in Surrey told us of ever-so-familiar themes: people cannot find a dentist accepting NHS patients, information about dentists accepting NHS patients is not up to date, and there are financial barriers to receiving dental care. Clearly, much more needs to be done for the people of Surrey and East Hampshire. I commend the new clause to the Committee.
Gregory Stafford
Unlike that of the hon. Member for Guildford, my constituency covers both Surrey and East Hampshire, so I welcome the focus that new clause 72 places on our local area. Constituents regularly raise with me their concerns about seeing an NHS dentist. As I have announced a number of times in this Committee—although I have not checked today, so may not be true any more—there is not a single dentist in my constituency taking on adult or child NHS patients at the moment.
For many people, the challenge is not simply one of convenience; it is about being able to access timely care when they need it. Good oral health is an essential part of overall health, and we cannot allow dentistry to become an afterthought in our healthcare system. The ability see a dentist for routine check-ups, preventive care and urgent treatment helps to reduce pressure elsewhere in the NHS by dealing with problems before they become more serious.
The new clause rightly highlights the need both for urgent appointments and for improved access to routine NHS dental care. Prevention is at the heart of a sustainable healthcare system, and regular access to dental services plays an important role in achieving that. I welcome the accountability that the new clause seeks to introduce. In places where there are persistent challenges in accessing services—so-called dental deserts—local communities deserve transparency about what action is being taken and why improvements have not yet been delivered. As I have mentioned before, the spanking new dental surgery in Haslemere hospital has sat entirely unused since it was built, and, as far as I am aware, there are no plans to use it. That seems like a shocking waste of money and, more importantly, a shocking waste of a dental surgery that could be treating patients in Haslemere and the wider area.
The hon. Member for North Shropshire always wants to place the blame with the Conservatives, and does not seem to feel the need to challenge the Government, but I gently remind her that there was a Liberal Democrat Minister in the Department of Health and Social Care for five years, and apparently they did absolutely nothing to raise this issue.
Although this issue is particularly important for Surrey and East Hampshire, it reflects a wider challenge facing communities across the country. Residents should not have to struggle to find an NHS dentist, and ensuring that provision is adequate must remain a priority. I hope the Government take that on board.
Karin Smyth
Welcome to another rerun of the 2010s —happier times for the Opposition. Sometimes they do not remember what happened, and I have to remind them—and every now and then, they remind us. This is a really important issue, not only for the hon. Member for Guildford, who tabled new clause 72, and the hon. Member for North Shropshire, who moved it, but for all our constituencies. It has been a huge priority for this Government.
The Secretary of State will continue to have a duty to promote a comprehensive health service in England. In addition, clause 4 provides for an amended duty for the Secretary of State to reduce inequalities in access to services across England. However, we also recognise that practical action is needed to secure access to urgent and routine NHS dentistry care. As the Committee has discussed, that is why the Government have prioritised a number of improvements over the past two years.
Last year, ICBs commissioned additional urgent dental care appointments, and there is now an urgent care safety net across the country. In April 2026, we introduced a requirement for NHS dental practices across England to deliver a set proportion of their contract as urgent care. Supported by increased payments for dentists delivering that care, that made it easier for patients to get prompt support through the NHS. We are committed to reforming the NHS dental contract by the end of this Parliament—something that could have been done at any point in the past 14 years. As a first step, the package of reforms we introduced earlier this year will address some of the pressing issues that dentists and dental teams have been experiencing. Those reforms will help to prioritise those with the greatest need, supporting a shift away from clinically unnecessary check-ups.
The Government are already making progress on improving access to NHS dentistry across England, including in Surrey and East Hampshire. I hope that hon. Members can see how legislating for one area in particular conflicts with the Secretary of State’s duties to promote a comprehensive health service for England as a whole, and risks creating health inequalities in other regions. For that reason, I ask that the hon. Member for North Shropshire withdraw the new clause.
Helen Morgan
My hon. Friend the Member for Guildford has specifically requested that I press the new clause to a vote because she feels so strongly about the issues in her area.
Question put, That the clause be read a Second time.
Helen Morgan
I beg to move, That the clause be read a Second time.
The new clause would place a duty on the Secretary of State
“to publish a strategy to combat anti-vaccine and medical disinformation”.
We increasingly see the impact of anti-vax and medical disinformation. Lower vaccination rates have been recognised as a growing threat to public health this year, and in February the NHS launched a new vaccination campaign following concerns about the declining uptake of measles, mumps and rubella vaccinations.
Disinformation, including anti-vax conspiracy theories, is dangerous and leads to increased levels of preventable illness. The leader of Reform UK has platformed prominent anti-vaccine conspiracy theories at his conferences, and Reform UK needs to be held accountable for its role in this. It is amplifying and importing the conspiracy theories and outright dangerous views of the US President and Robert F. Kennedy. The leader of Reform UK has refused to condemn Donald Trump’s medical conspiracy theories, including unfounded claims about autism and paracetamol. Those views have had a very real effect in the US, undermining and hollowing out important scientific and medical institutions to the detriment of the nation’s health.
Dr Prinsley
Does the hon. Member agree that the invention of vaccination by Jenner centuries ago is the single most important medical invention we have had in this country?
Helen Morgan
I absolutely agree. My mother and grandmother both had polio, which nobody would expect to experience in this day and age. That same grandmother’s sister died of diphtheria, and her father had smallpox. That was all just over 100 years ago, so it was not too long ago that people were experiencing what we now consider to be antiquated and unthinkable diseases.
The vaccination programmes that have been brought in over the past century have undoubtedly been game-changing for public health, not least for people growing up with working-class backgrounds, as my family would have been. That is why it is so important to deal with the disinformation that allows unscientific and dangerous anti-vax views to be communicated convincingly to the wider community.
Sojan Joseph (Ashford) (Lab)
I agree with the hon. Member that people with power, especially those with political platforms, have used it to spread misinformation about vaccination. Some medical professionals working in our hospitals and the NHS—doctors and nurses—are also against vaccines. Can the hon. Member explain how we can tackle that issue?
Helen Morgan
It is really important not to blame people who have seen convincing information online or have been given convincing information by people who ought to know better—including at political party conferences. We need to battle the source of that information and ensure that accurate, factual information is available and communicated to everyone in an accessible way by people they trust. That is key to all this. As I have said before, ostracising or ridiculing people who have been given information in a very convincing way is not the way to resolve this problem. We need to tackle it in an understanding way by communicating the facts sympathetically and accessibly.
It is important to note that concerns about vaccinations are not exclusive to a single group of voters. There is significant vaccine hesitancy across some ethnic minority communities and in hard-to-reach places across the country. We must do more to support doctors, nurses and the NHS to fight fiction with facts, or the long-term health of the country will suffer. That is what new clause 77 seeks to do. There is some great local work being done, but there needs to be a joined-up strategy to combat all aspects of disinformation, because a nice social media video telling people to get their jab will not beat it.
Now that Reform UK has a greater presence in our local government, NHS leaders will have to handle more and more difficult conversations with anti-vax and conspiracy theorist councillors, and they deserve support to engage with those people effectively and constructively. The proposed strategy would provide just that. It would have to consider
“support for medical professionals to build trust and engage with persons who are anti-vaccine…investment in public messaging to combat medical disinformation, including engagement with trusted online influencers…outreach campaigns focused on communities that are sceptical about vaccinations…introducing criminal liability for those, including online influencers and politicians, who profit from medical disinformation, and…a new verification requirement for any social media account claiming to be a medical professional.”
We must do more systematically to protect the NHS and our nation’s health from the growing threats of medical misinformation. We urge the Government to give this issue the focus it needs, and we hope that they consider this new clause one way to do that.
Karin Smyth
The hon. Member has brought up an important topic. The Government absolutely recognise that inaccurate information can undermine confidence in vaccines, which are so important. We are already taking a multi-pronged approach to addressing that through national communications, support for healthcare professionals and the ongoing monitoring of emerging narratives.
The evidence is clear that, although it is a risk, misinformation is not a primary cause for people not to take up the offer of vaccinations. Rather, practical barriers such as access to services, socioeconomic factors and levels of awareness play a more significant role. We are already acting to reduce those barriers, with targeted action to improve access, strengthen communications and support frontline staff. A new statutory strategy focused solely on disinformation would risk narrowing our approach when a broader, evidence-led response is required.
For those reasons, we do not consider the new clause to be the right approach. I recognise much of what the hon. Member says about access to information, but we want to maintain a wider approach. On that basis, I respectfully ask her to withdraw the new clause.
Helen Morgan
I thank the Minister for her response. I think it is important that we keep an eye on the power of medical misinformation or disinformation, and expand that consideration to things such as therapy chatbots. It is not just an online problem, but an AI problem—it is not just malign influences that cause the problem. I beg to ask to leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 81
Minimum service levels
“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must, by regulations, make provision for minimum service levels to operate in the NHS during periods of strike action.
(2) Regulations under subsection (1) may repeal or otherwise amend provisions in the Employment Rights Act 2025, insofar as is necessary for the purposes of this section.
(3) Regulations under subsection (1) must include provision for minimum levels of service by categories of NHS workforce staff, including all Agenda for Change staff but not doctors.
(4) Regulations under subsection (1) may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.
(5) When minimum service levels are in operation under this section, the NHS must set minimum standards of acceptable service to be provided by the NHS during periods of strike action, including mitigating any effect on appointments, medical procedures, acute services, midwifery, surgical procedures, and any other matters that the Secretary of State deems appropriate.
(6) With one year beginning on the day on which regulations are made under subsection (1), and within each period of a year thereafter, the Secretary of State must lay before Parliament a report on compliance with minimum service levels, including reasons for any failure by operators to secure the required thresholds, and actions the NHS is taking to improve performance to meet the minimum service levels.”—(Dr Caroline Johnson.)
This new clause would require the Secretary of State to make regulations which create minimum service levels to operate in the NHS during periods of strike action.
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss new clause 82—Strike action—
“(1) It is an offence for medical practitioners to undertake strike action.
(2) The Secretary of State may repeal or otherwise amend provisions in the Employment Rights Act 2025, insofar as is necessary for the purposes of this section.”
This new clause would make it illegal for doctors to go on strike.
Dr Johnson
New clauses 81 and 82 stand in my name. As a doctor, I felt deeply uncomfortable with the morality of going on strike, with doctors leaving their patients to suffer in order to get more money for themselves. That is one of the reasons why the previous Government introduced minimum service legislation to ban strikes in essential services. We are clear that we would not allow doctors to go on strike, just as the police and the military cannot. These are key services and key people for the functioning of our country.
Unfortunately, on 6 August, one month after entering office, this Government announced that they would repeal the minimum service legislation, leaving the safety of patients at the behest of union barons. Despite resident doctors having a 28.9% pay rise, we have seen damaging strike action across the NHS: the Minister wrote that the strike action has cost £1 billion since July 2024. The latest round of strikes in April 2026 led to the cancellation of almost 50,000 appointments, on this Government’s watch. Those are all patients who are waiting.
Dr Prinsley
I am interested in what the hon. Member has to say about strike action. I was involved in trying to get the resident doctors’ strike stopped, but was unsuccessful for many months. I think she is talking about the principle of whether people involved in medical care should ever go on strike. If she were to apply the proposed measure to medical practitioners, would she introduce the same rule for nurses?
Dr Johnson
If the hon. Gentleman reads new clauses 81 and 82 together, he will see that one of them would require doctors not to go on strike, because they are involved in the clinical decision making across the piece, while the other would make provision for staff across the NHS to be on minimum service level provision. That is something that I maintained under the previous Government as well: I do not think that doctors should go on strike, in the same way that the police and the military do not go on strike.
Medical professionals are key to the functioning of a hospital in a way that means they should not go on strike. Other staff within the hospital provide an extremely valuable and important service, but often several individuals provide that service, so it might be possible to say, “We can have three here rather than five today and still deliver most of the service.” Fundamentally, I do not think that it is morally right for doctors to go on strike, because in effect they are saying to people, “We know you’ve been waiting for your knee replacement for a year and we know your knee hurts, but we’re not going to do your knee replacement today, because we’re going to go on strike for more cash.” I just do not think that that is right. [Interruption.] I will take an intervention from my hon. Friend the Member for Farnham and Bordon.
Gregory Stafford
My hon. Friend has just sat down. I was not sure whether she had finished her speech or was willing to take an intervention.
Dr Prinsley
This is, obviously, a very interesting discussion. I agree—I actually do—that medical practitioners should not go on strike, but the question is whether that should be the law. I would apply the same question to nurses, a point that the hon. Lady has not answered.
Dr Johnson
For generations, it has not needed to be the law: doctors did not go on strike, because they recognised what would happen to patients if they did. Now that we know that doctors will go on strike, the landscape has changed. Consultants—I should say that I am an NHS consultant—have just balloted to go on strike, which will be fundamentally unsafe. The Government have a duty to keep people safe; first and foremost, that is the Government’s job. Doctors going on strike is fundamentally unsafe and should not happen. I agree with the hon. Member for Bury St Edmunds and Stowmarket that morally it should not need to be the law, but I think the evidence suggests that it does.
New clause 82 would make it
“an offence for medical practitioners to undertake strike action”,
and would provide for the Secretary of State to repeal any necessary clauses of other employment regulations in order to do so. New clause 81 concerns the minimum service levels provided across the NHS. There are staff who provide an important and valuable service but whose jobs may not be clinical; for example, services may be able to run with slightly fewer porters if they want to go on strike.
I hope that no member of NHS staff would want to go on strike. I hope they would want to make sure that patients were getting care, and I hope they would recognise that, in a universal service, they are essentially causing harm to the patients around them, who are their friends, their neighbours, the people who live on their street and the people who would look after them. However, the evidence suggests that that is happening, so I am afraid that these new clauses are necessary. We need to put a minimum number of staff in place to support the doctors, and doctors should be at work to make sure that patients are safe.
Gregory Stafford
Hopefully, this is a pleasure postponed. I rise to support new clauses 81 and 82, tabled by my hon. Friend the Member for Sleaford and North Hykeham. As legislators, we have a moral duty to ensure that patients are protected during times of disruption in the NHS. Nobody disputes the fact that NHS staff work incredibly hard. They absolutely do. The dedication shown by doctors, nurses, paramedics, midwives and all those who keep our health service running deserves enormous respect. Having worked in healthcare for pretty much all my career, including for professional organisations such as the Royal College of Occupational Therapists, I know at first hand how hard they work.
Equally, we need to recognise that the NHS is not an ordinary service. Working for it is not like being a shop assistant, a bin collector or a tax inspector; in its importance to the health and safety of this nation, it is more akin to being a police officer or a member of our armed forces. It is an essential public service. When people are at their most vulnerable, whether that is because they are waiting for an operation, procedure or intervention or because they are in the process of having those interventions, they must have confidence that the care they rely on will still be there.
The right to strike has to come with responsibilities. In the NHS, the consequences of industrial action are real: cancelled operations, delayed treatments, missed appointments and increased pressure on emergency services. When I raised some of these issues with Sir Jim Mackey when he appeared before the Health and Social Care Committee, he could not tell me, hand on heart, that people have not died because of these strikes. I suspect that they probably have. For patients awaiting cancer treatment, for someone requiring urgent surgery or for families relying on maternity services, the impact can be deeply serious and potentially even deadly.
There is a moral obligation, both on NHS doctors and on us as legislators, to ensure that we have a universal, 24-hour, seven-day-a-week service that is free at the point of use that patients can and should expect to rely on. I therefore support new clause 81’s minimum service requirements and new clause 2’s the removal of clinicians’ ability to strike. We must ensure that our NHS staff are supported, protected, paid appropriately and given the resources they need to do their job, but the corollary is that they should remain on the job to serve our constituents.
Karin Smyth
There have been interesting discussions on these new clauses. I recognise that the intention behind them is to reduce the impact on patients and NHS budgets when doctors take industrial action. That is an objective that we all support, but I do not agree that the new clauses are the best way to achieve it.
I respect the shadow Minister’s professional background and the strong moral case she set out to explain why she does not feel it is appropriate. For a long time, as she says, doctors did not go on strike, but something changed in the industrial relations landscape roughly 10 years ago to start that process, that change of culture and that frustration that led doctors to strike. I listened with interest to the former Health and Social Care Secretary, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), reflecting on this issue recently—we’re all subject to podcasts these days, aren’t we? He spoke about those relationships at the time, and I think we should learn from that; it is very helpful to have those recollections. But something changed, and this has been the result.
I pay tribute to my hon. Friend the Member for Bury St Edmunds and Stowmarket and many others of his vintage, if I can say that—
Karin Smyth
Indeed. They wanted to work with resident doctors to talk through a way to make progress without resorting to strike action, because that is a sign of failure in any system.
On new clause 81, we are committed to reforming trade union legislation to bring it into the 21st century. We want to create an industrial relations framework that is fit for a modern economy, and workplaces that work for everyone. That is why the Employment Rights Act 2025 repealed the Strikes (Minimum Service Level) Act 2023. The previous legislation created a hostile environment, which was not conducive to good partnership working with trade unions or to settling disputes.
On new clause 82, although strikes are hugely disruptive, a ban on a doctor’s right to strike is not the answer.
Dave Robertson (Lichfield) (Lab)
As I am sure the Minister knows, I have been a trade unionist since I started my teaching career some years ago. I have been involved in a number of industrial actions over that time, as a teacher and member of a trade union and as a trade union staffer. The driving force behind a significant majority of those industrial actions was not pay; it was often the safety of staff, the safety of sites, bullying managers or the inability to deliver an environment in which members felt they could deliver their best. Does the Minister agree that the ability to take industrial action is not always about money-grubbing or about pay? It is often about health and safety and about delivering the very best workplaces for our workers.
Karin Smyth
I thank my hon. Friend for bringing his experience to bear on this matter. I absolutely agree. New clause 82 stems from that resident doctors dispute. One of the first things that we did was to agree the 10-point plan with regard to the management in trusts. I have said before how truly shocking the working conditions are in many trusts not just for resident doctors, but for other doctors and professionals. There is no ability to take a break, have a rest or get away. Some of the equipment that they are dealing with is also shocking, as are the levels of the estate. Those are some of the many things that have driven and continue to drive poor industrial relations, along with the fact that there is no one to speak up for them.
Dr Johnson
The Minister says that if doctors want to go on strike, that is a failure of the system. The consultants have just balloted to go on strike. What failure in the system does she think has caused that?
Karin Smyth
I think I said that it is a failure of representatives on both the management side and the union side to agree a solution. That is what I meant by a failure of the system. Ultimately, strike action, as my hon. Friend the Member for Lichfield would attest, is a sign of the failure of good, conducive relationships and partnership working. That is why we never want to see it.
Dr Johnson
I understand the Minister’s interest in the balance between trade unions and patient safety. My personal view is that we should focus on patient safety. I am aware—anecdotally, to be fair—of examples of individual clinicians who were asked during previous strikes to come off the picket line to help and did not. I am also aware of many instances in which clinicians did, so it works both ways, but ultimately the Government’s job is to protect patients and put patient safety first. I will therefore press the new clauses to a vote.
Question put, That the clause be read a Second time.
Dr Johnson
I beg to move, That the clause be read a Second time.
In their final months in office, the last Labour Government introduced the Equality Act 2010. That consolidated several pieces of anti-discrimination legislation, which was welcome, but it also introduced a new public sector equality duty, requiring public authorities to have “due regard” to preventing unlawful discrimination and fostering equality of opportunity between groups. The public sector equality duty also requires authorities
“to…encourage persons who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such persons is disproportionately low.”
Unfortunately, that has become a vehicle for social engineering. It was designed, I believe, to improve equality of opportunity, but it is being used to gerrymander equality of outcome instead. That can mean discrimination—against different groups of people, but discrimination nevertheless.
That is clinically objectionable, because it means that health and social care staff may be recruited for reasons other than their clinical abilities, which are what we need and are most important. We have parts of the health service spending their time working on cultural learning classes and pushing paper around, rather than on patient care.
We must get the health service back to basic healthcare, ensuring that it delivers the very best healthcare, free at the point of use, to all individuals based on their clinical need, not their ability to pay. We need to focus on clinical need and the best possible staff, not on trying to gerrymander some sort of social engineering.
Karin Smyth
With new clause 83, I think the hon. Member for Sleaford and North Hykeham would like to exempt organisations that receive public funding to provide health and social care services from the public sector equality duty. I do not agree with the intent of this measure.
The duty under the Equality Act 2010 was designed to ensure that public authorities
“have due regard to the need to…eliminate discrimination…advance equality of opportunity”
and
“foster good relations”
in the exercise of their functions. That includes when designing and delivering services. It is not an unnecessary addition but part of good service design and delivery.
The duty is not there to dictate a particular outcome or set of priorities for the decision maker; it is there to help decision makers understand and take account of the consequences of their choices. It ensures that issues of discrimination, equality of opportunity and good relations between different groups of people are not overlooked during complex decision making. That is why it is important for publicly funded providers of health and social care to have due regard to the duty.
The public sector equality duty should always be applied in a proportionate way. It should not create an administrative burden. If a provider of health and social care is taking a decision that has little or no consequence to equality outcomes, it needs only to note that. It is for that reason that I ask the hon. Member to withdraw her new clause.
Dr Johnson
I wish to press new clause 83 to a vote.
Question put, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss new clause 98—Response to the Hughes Report: options for redress for those harmed by valproate and pelvic mesh—
“The Secretary of State must, within 30 days of the day on which this Act is passed, publish the government’s response to the Hughes Report.”
This new clause would require the Secretary of State to publish the government’s response to the Hughes Report within 30 days of this Act being passed.
Dr Johnson
The Minister will remember the evidence given earlier in Committee by my right hon. Friend the Member for Godalming and Ash, in our first sitting. As our longest-serving Health Secretary, my right hon. Friend focused much of his tenure on patient safety, and yet, as he made clear:
“We are the world champion at doing inquiries and reports. Unfortunately we are also the world champion at allowing those reports to gather dust without anything actually happening.”—[Official Report, Health Public Bill Committee, 16 June 2026; c. 30, Q52.]
One clear example of that so far is the Hughes report. Twenty-nine months ago, Professor Henrietta Hughes published a report outlining redress for thousands of victims of the pelvic mesh and sodium valproate scandal. Time and time again, I and other hon. and right hon. Members have asked this Government when they plan to respond. Every time, the answer is, “Soon”, “At the earliest opportunity”, or, “We’re working on it”, but warm words are not enough to secure patient safety. Can the Minister confirm when she intends to publish the Government response to the Hughes report?
Many patient safety recommendations prompt questions about the effectiveness of the Care Quality Commission, the national care regulator. The former Health Secretary claimed that it was not fit for purpose, and yet the Government have decided to bring HSSIB—Health Services Safety Investigations Body—within the CQC, as well as to add other measures, including events management. We need urgent steps taken to revive the CQC to ensure that it is fit for purpose to uphold patient safety.
I will keep my remarks brief, because we have a lot to get through, but the Government need to respond to the Hughes report. Too many people, predominantly women, but men also, are waiting for the answers. They want to know what the Government are going to do. This Government have been in office for more than two years, with the report published shortly before that. Those people need an answer. In future, new clause 85 would mean that that delay cannot happen again, because the Government would have to respond to any future reports on patient safety issues within a set timeframe of six months, to ensure that we cannot have situations where people are waiting far too long for the answers that they need and deserve.
Gregory Stafford
I declare that I am a member of the all-party parliamentary group on patient safety. Patient safety cannot be something that is discussed only after a tragedy has occurred. It requires a culture of accountability, transparency, and most importantly, action. That is why the new clause is such a sensible and important amendment to the Bill. It would not dictate the outcome of every review or every recommendation, but it would require the Government to respond properly. The new clause would create a straightforward expectation that when experts have identified changes that could improve patient safety, Ministers cannot simply leave those recommendations unanswered. The new clause pushes that forward, as recommended by my right hon. Friend the Member for Godalming and Ash. There must be a clear process and a clear timeline.
Such a process and principle are closely connected with new clause 98 and the Government response to the Hughes report on those harmed by sodium valproate and pelvic mesh. Those are deeply serious issues involving people who have suffered life-changing consequences and have spent years seeking recognition and redress. Last week, I think, at the Health and Social Care Committee, I questioned the current Secretary of State on this matter, and his answer was equivocating, dissembling and, I am afraid to say, frankly unacceptable to those patients who have suffered from both those. He could not even tell me whether the response would be published by the end of the recess—we probably have two hours until recess, so unless the Minister is going to tell me otherwise, I suspect it is not coming before the recess.
It seems shocking—perhaps even a slap in the face to those victims—that the Secretary of State could not even give an answer on that issue. However, they received some positive news on Tuesday evening, when the right hon. Member for Makerfield (Andy Burnham)—presumably the incoming Prime Minister—raised this issue in the House during the debate on the remaining stages of the Public Office (Accountability) Bill. I hope the Minister has had the chance to speak to the right hon. Member—unlike the rest of us—so that she understands his priorities and when redress is coming. If her new boss has given his stamp of approval, Labour MPs on the Committee should have no problem supporting these Opposition new clauses.
Karin Smyth
I am grateful to the hon. Member for Sleaford and North Hykeham for bringing this discussion before the Committee again today. The safety recommendations are an important mechanism for improving services and securing better outcomes for patients. We support the aim of bringing greater clarity to the recommendations landscape, and we are already taking forward work in this area.
The Dash review of patient safety across the health and care landscape found that a very high number of recommendations have been made to the NHS that often lack any cost-benefit analysis, which is why the 10-year health plan committed to giving specific responsibility for reviewing, analysing and taking forward recommendations to the national quality board. In line with the Dash review, work is progressing on a recommendations hub that will sit within the Department.
The hub will include a repository to hold all national-level recommendations relevant to care quality, including safety, effectiveness and patient experience. It will provide an efficient system for co-ordinating, prioritising and overseeing recommendations made by the national quality board. The hub will record responsibility for implementing prioritised recommendations and, once fully operational, strengthen transparency and accountability for how they are taken forward, which is something I think we all welcome. This new approach will enable the NHS to focus on the actions most likely to enhance patient outcomes.
Where reviews or reports commissioned by the Secretary of State make recommendations to local bodies, those recommendations will remain subject to local governance arrangements within the overall co-ordination retained by the Department. Our existing plans meet the intention behind new clause 85; in fact, they go further by prioritising national-level recommendations for the NHS in a proportionate way, without being bound to specific timescales. They will provide the greater clarity that the new clause seeks without the need for legislation.
On the specific question, I am sorry to disappoint the many campaigners on this issue and Opposition Members by saying that we will not be announcing anything in the next two hours, but the point has been well made. I responded to a Westminster Hall debate myself, and the Minister responsible for patient safety has previously responded to the commissioner and made public the work that the Government are doing. Due to the cross-Government nature of the work, we cannot give exact timelines.
We have heard the calls for clarity, speed and decisive action, and we have committed to setting this out at the earliest opportunity. I have not had a chance to speak directly with my right hon. Friend the Member for Makerfield about this issue, but I am sure many conversations on many subjects will be coming our way soon. As both my right hon. Friend and the Prime Minister made clear during Tuesday night’s debate on the Hillsborough law, redress and patient trust are important aspects of rebuilding the confidence of the public and those who have been wronged in all parts of the state. We are committed to getting this out as soon as is credibly possible. For that reason, I ask the hon. Member for Sleaford and North Hykeham to withdraw her new clause.
Dr Johnson
The new clauses ask the Government to respond to recommendations on patient safety, and to say within six months whether they will implement them. As I said, we have been waiting several years for the Hughes report response. All new clause 98 would require is that the Secretary of State must, within 30 days of the Bill’s passage, publish the Government’s response to the report. That, in itself, is not immediately soon; it is 30 days after the Bill is passed, and it is still yet to go through the Lords and return to the Commons. The new clause would effectively provide a backstop or legal end date—it is still too far away—after which the Government cannot go any further. I will be very disappointed if the Government are not prepared to do that, so I would like to press the new clause to a vote. These people have waited long enough.
Question put, That the clause be read a Second time.
Dr Johnson
I beg to move, That the clause be read a Second time.
Advice and guidance services were an improvement. Previously, if a general practitioner wanted to refer someone to hospital, a consultant would triage the referral. Sometimes, the referral was not needed, so a message would be written to the GP saying, “I wonder if you’ve tried this” or “Could you give more information, please?” Improving that process was the advice and guidance service, which in many ways is beneficial.
I am, however, concerned by the suggestion earlier in the year that advice and guidance will become a compulsory feature, and that only after advice and guidance has been received will there be potential for referral. Instead of a GP being able to refer to a consultant and a consultant being able to accept that referral, advice and guidance will have to be sought first. That will cause a delay in patient pathways and flow. It may mean that the date on which the person is added to the waiting list for an appointment is a couple of days later. That may slow things down and improve the figures, but I cannot see any clinical benefit from mandating it.
There is also a concern that there would be what is called a diversion rate of at least 25% by March 2027 for at least 10 high-volume specialties. I am concerned about that. If someone gets to the point of being given a hospital appointment, that is because the clinician who saw them in primary care used their clinical judgment to decide that the patient needed that appointment, and the consultant triaging the referral used their clinical judgment to decide that the patient needed to be seen.
Dr Prinsley
I wonder whether the hon. Member’s experience mirrors mine. Many years ago, it seemed to be easy for general practitioners to ring me up. I often received telephone calls from general practitioners asking for advice about patients. As time went on, general practitioners became busier and busier and seemed to have less time to telephone consultants. When I started my consultant career, I spoke often to general practitioners, and by the time I got elected to Parliament and had to stop, I found that was a very unusual thing. Has her experience been similar?
Dr Johnson
I think we are all getting busier. As such, it is harder for clinicians in primary care to phone the consultant and speak to them, because both are busy and potentially seeing patients. I am not criticising the ability to have an advice and guidance service, because it is helpful. We do the same with specialists in tertiary centres, for example. One might send them a message asking a question. Advice and guidance is a good principle. My concern is that it would remove the ability for consultants to refer directly, introducing an unnecessary delay in the system. Are we questioning the judgment of clinicians? Why do we want to reduce the number of patients who get put on the list by a quarter?
I recognise, as I am sure the hon. Member for Bury St Edmunds and Stowmarket does, that sometimes referrals could be better directed. There is a mechanism already for doing that, but new clause 86 reflects the fact that general practitioners should still be able to refer patients using their clinical judgment to a consultant. That may be someone who the patient has chosen to see or who the GP believes is right for the patient’s condition.
Dr Prinsley
The other important fact is that more and more hospital referrals were not coming from general practitioners at all, but from other people working in the general practice such as nurses and physician associates, who are less confident in forming a clinical judgment.
Dr Johnson
If they are, they can use the advice and guidance service. The point is that when a general practitioner wants to refer his or her patient to a consultant on the basis of their clinical need, they should be able to. That is the purpose of the new clause.
Karin Smyth
As someone who previously set up a referral management service, I feel the need to join in this interesting clinical discussion while everybody else watches us for the next hour and a half, but I am not going to do that.
Some interesting points have been raised. To add my two pennies’ worth to the point made by my hon. Friend the Member for Bury St Edmunds and Stowmarket, the change in practice is partly due to increased specialism among consultants, which makes it harder to refer. When we set up a referral management service in Bristol, two issues were the pressure on general practice and the use of locums, who were perhaps working temporarily in the area and did not know the full range of available community services. That was some 12 years ago, so greater support on advice and guidance is long overdue as we roll this out.
At the end of the day, the aim is to support patients getting the right clinical care in the right place as fast as possible. We want patients to have timely assessment of their care needs and clear next steps in the right settings. GP referrals and support for GPs in making those referrals is crucial.
The advice and guidance model, which allows GPs to seek rapid specialist input into a patient’s care without an initial face-to-face appointment, and the single point of access model, which will be rolled out in October, support GPs and hospital specialists to work together and make the best treatment plans for patients while reducing unnecessary referrals and increasing waiting lists.
Trusts and integrated care boards must ensure that local GPs, GP leaders, local medical committees and interface groups are involved in the design and ongoing refinement of elective single point of access pathways. In my experience, that is important because we gain their expertise and there is more buy-in to making the pathways a routine part of their work. Advice and guidance is already a routine part of much GP practice. GPs continue to be able to make clinical decisions to refer for specialist care where that is in the patient’s best interests. Advice and guidance and the single point of access do not alter the clinical threshold for a referral, and a GP’s clinical decision to refer remains unchanged. All requests for advice and guidance will receive a response from a named consultant with clear accountability and oversight.
We are clear that GPs should continue to make a clinical decision to refer to specialist care where that is in the patient’s best interests. The model is intended to support decision making, not override it. To be clear to the hon. Member for Sleaford and North Hykeham, the intention was never to mandate. There is a difference, which I think was made clear in subsequent guidance on the system. The diversion rate, as she calls it, is an estimate of the potential of patients who are not referred to the right place in the first place. It is not compulsory. What the new clause proposes already exists and does not need to be set out in primary legislation. For those reasons, I ask her to withdraw it.
Dr Johnson
If the hon. Lady is correct, she will not be perturbed by the new clause, which simply says that general practitioners must be able to directly refer patients to consultants when clinical need requires it. I would like to press the new clause to a vote.
Question put, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss new clause 113—Prioritising British citizens for the UK foundation programme (No. 2)—
“(1) The Medical Training (Prioritisation) Act 2026 is amended as follows.
(2) In section 4, after subsection (4) insert—
‘(4A) A person is within this subsection if they—
(a) are a British citizen,
(b) have indefinite leave to remain under the Immigration Act 1971, or
(c) have settled status under the EU Settlement Scheme, and
(d) hold a primary medical qualification from an international branch campus of a higher education institution in the United Kingdom.’”
This new clause amends the Medical Training (Prioritisation) Act 2026 so that British citizens, people with indefinite leave to remain, or settled status who have studied at international branch campuses of UK higher education institutions can be prioritised for foundation programme training places.
Dr Johnson
New clause 87 would amend the Medical Training (Prioritisation) Act 2026 so that British citizens who have studied at international branch campuses of UK higher education institutions can be prioritised for foundation programme training places. Prioritising British students in the selection process would have been the right thing for the Government to do, but way the Medical Training Act has been drafted places British students who studied at international branch campuses of British universities at a disadvantage.
On Second Reading of the Act, a Member spoke of a constituent who had been given
“a formal guarantee that he would be at no disadvantage if he chose to study at the Malta campus.”—[Official Report, 27 January 2026; Vol. 779, c. 801.]
Another Member said that he had
“representations from all quarters, both in the UK and in Malta, about the impact on Malta of this.”—[Official Report, 27 January 2026; Vol. 779, c. 802.]
My right hon. Friend the Member for South West Wiltshire (Dr Murrison) asked about
“British students who for various reasons train at, for example, St George’s in Cyprus or St George’s in Grenada and who then want to come back and practise in our national health service”. —[Official Report, 27 January 2026; Vol. 779, c. 803.]
The hon. Member for Uxbridge and South Ruislip (Danny Beales) spoke of a constituent who was schooled and grew up here and was
“given a guarantee by the university that she would face no disadvantage compared with students on the London campus.”—[Official Report, 27 January 2026; Vol. 779, c. 842.]
These concerns are shared across the House.
Young British people who have trained at a British or London-based university and gone to study in Malta, perhaps in an adventurous spirit—it is a beautiful place to go—and have graduated with a British degree have found themselves at the back of the queue, unable, round after round, to get jobs in the foundation programme in their home country. That will not just be the case for students who are due to start their degree; it is the case for students who have just completed their degree. They have done the five years of training, they have worked really hard and they have passed their exams, but suddenly they cannot get a job on the foundation scheme in their home country to complete their full registration with the General Medical Council.
Our new clause would ensure that British citizens who studied at international branch campuses of UK higher education institutions can be prioritised. I invite Members to do right by our constituents and the NHS and to vote for it.
Karin Smyth
I appreciate the intention behind new clause 87, but the Government cannot support it. The Medical Training (Prioritisation) Act is designed to support a sustainable medical workforce that can meet population health needs and deliver the best patient care while reducing the UK’s reliance on an unpredictable international labour market. By creating a clear pathway for medical school to speciality training, we also strengthen domestic talent and improve retention.
What matters is where a doctor is trained, not where they were born. Data shows that domestic graduates are more likely to stay in the country they trained in than those trained internationally. Doctors trained primarily in the UK are also likely to be better equipped to deliver healthcare that is tailored to the UK’s population, because they have a stronger understanding of UK-specific epidemiology and NHS practice.
In addition, the Government set UK medical school places based on future health system needs. Student intakes and graduate outputs of overseas campuses are not included in our domestic workforce planning. If we prioritised British citizens for foundation training regardless of where they studied, it would undermine our aim to build UK-trained capacity while ensuring that we do not provide more foundation programme places than we need.
I would like to emphasise—this is an important point—that prioritisation does not mean exclusion. Non-prioritised applicants can still apply for the foundation programme and will be offered places if vacancies remain after prioritised applicants have received offers—I understand that is already happening for the 2026 recruitment round. For individuals who do not secure a foundation post this year, there remain alternative routes to pursuing a medical career in the UK. Those include obtaining GMC registration through the established pathways, such as completing an approved internship in the country where they trained and entering the UK healthcare system through a locally employed doctor role or other non-training posts. I ask the hon. Member for Sleaford and North Hykeham to withdraw the new clauses.
Dr Johnson
There are fewer than 100 students who are British citizens studying in Malta this year. Many of them have struggled to get a role on the foundation scheme. The Government have created a situation in which a British student doing a British degree at a British university with an overseas campus is put into the foundation scheme behind a foreign student studying here, or indeed in the same prioritisation group as a foreign student studying at a foreign university. That cannot be right, so I would like to push the new clause to a vote.
Question put, That the clause be read a Second time.
Joe Robertson (Isle of Wight East) (Con)
I beg to move, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss
New clause 97—Publication of annual dementia care report—
“(1) The Secretary of State must publish annually and lay before Parliament a report on—
(a) the provision of NHS care in relation to dementia, and
(b) provision of social care in relation to dementia.
(2) In preparation of the report under subsection (1), the Secretary of State must have regard to targets, standards and outcome measures set out in national plans, guidance and frameworks relating to dementia services.
(3) In preparation of the report under subsection (1), the Secretary of State may have regard to any such measures or information that they consider appropriate, including—
(a) an assessment of any variation in dementia services and outcomes between integrated care board areas,
(b) information on workforce capacity, capability and training standards relevant to dementia care,
(c) information on access to ongoing post-diagnostic support services, including support for unpaid carers,
(d) information on continuity and coordination of care for people living with dementia, including access to a named professional responsible for coordinating support across services,
(e) outcomes and experiences for people living with dementia and unpaid carers, including crisis prevention, carer wellbeing, and experiences of joined-up care,
(f) progress on dementia prevention and risk reduction, and
(g) dementia research activity in the NHS.
(4) The Secretary of State must publish the first such report under subsection (1) within 12 months of the passage of this Act.”
This new clause would require the Secretary of State to produce an annual report on the delivery of dementia care by the NHS and social care sectors against relevant national targets, standards and outcome measures.
Joe Robertson
It is a pleasure to serve with you in the Chair, Ms Lewell. These two new clauses, the latter of which is in my name, deal with the publication of an annual report detailing NHS and social care provision for dementia care and how the Government are performing against targets, standards and outcome measures set out in national guidance and frameworks relating to dementia services. I would like to thank three important charities working in this area: the Alzheimer’s Society, Alzheimer’s Research UK and Dementia UK. All three back the two new clauses.
The data requested is imperative to ensuring that the Government can measure and monitor progress against relevant national targets, standards and guidance, including the new modern service framework on dementia, the forthcoming Care Quality Commission statutory guidance and outcome measures that may be set in future NHS operational planning guidance. That is crucial to improving transparency and accountability, allowing systems to see the full picture of dementia provision in England and highlighting challenge areas or inequalities. The Bill makes provision for the establishment of information systems to collect, analyse and publish health and care data that is in the interest of the health service in England. The clause fits into that and would require the collection of data on the provision of dementia services in health and social care.
I do not propose to speak too long, but I do want to make a couple of remarks on the current situation, which sets these new clauses in context. Dementia data is not currently comprehensively or consistently collected, analysed and published. That means that we cannot fully understand the provision of NHS care or social care for dementia, which is the biggest cause of death in the UK; how national targets, guidance or frameworks are being met; and where inequalities and challenges lie.
As well as being the leading cause of death, dementia is a disease that around 1 million people live with. That number is expected to rise to 1.4 million by 2040. That will, of course, impact many more friends, families and carers who support those living with dementia. More than a third of people living with dementia in England do not have a formal diagnosis. Those who do receive a diagnosis live with the condition for an average of three and a half years before that diagnosis. Post-diagnostic care and support is often fragmented, leaving people affected by dementia without a clear point of contact, co-ordinated care, or access to specialist support for those with complex needs. Recent findings show that only 14% of people with dementia have an advanced care plan in place. That is not good enough for a disease that affects so many people and is the leading cause of death in England.
Dementia puts immense pressure on our healthcare system: one in six hospital beds is occupied by someone living with the condition. Lord Darzi’s investigation into NHS performance highlighted how
“there is an important challenge to improve both the quality and quantity of care for people with dementia.”
The new clauses would go some way to addressing that, and I urge the Government to support them.
Karin Smyth
We largely agree with new clauses 96 and 97 and the comments of the hon. Member for Isle of Wight East. He cited some organisations: Alzheimer’s Society, Alzheimer’s Research UK and Dementia UK; hon. Members across the House have worked with them, and many other organisations in this field, and value the work that they do. The hon. Member rightly notes the work that they do to support the friends, families and carers of people with this disease, which is increasing in prevalence. He also commented on the importance of getting diagnosis earlier, and we are moving forward but we need to do so as fast as we can; I think we would all recognise that. I completely understand the rationale behind the new clauses and the urgency with which people want to have sight of the sort of information outlined in them, but we do not think that the new clauses are necessary. I will highlight why.
Some of the data that would be requested by new clause 96, such as details of research in the NHS and reports of lived experience, is already available and often provided by our charity partners, as well as by others. The new clause would therefore lead to a duplication of work. Provision of the other pieces of requested information and the data collection required to produce the report required by the new clause would likely be very onerous, placing additional stress on an already overstretched sector, and would distract from the core task of improving dementia care. It would be especially difficult to get consistent and comparable information from across the adult social care sector, where data can sometimes be fragmented.
Instead, we think that the modern service framework for dementia and frailty is a more helpful vehicle for setting national standards of dementia diagnosis and care, and will serve to hold the sector to account. Additional reports, such as those requested by the new clause, would distract from that and result in duplication.
The framework is still in development and work is ongoing to review the relevant data, metrics and targets to inform it. The framework will also set new national standards, which will help to inform meaningful analysis in the future—something that we are all very keen to see. For those reasons, I ask the hon. Member to withdraw the clause.
Joe Robertson
I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
New Clause 97
Publication of annual dementia care report
“(1) The Secretary of State must publish annually and lay before Parliament a report on—
(a) the provision of NHS care in relation to dementia, and
(b) provision of social care in relation to dementia.
(2) In preparation of the report under subsection (1), the Secretary of State must have regard to targets, standards and outcome measures set out in national plans, guidance and frameworks relating to dementia services.
(3) In preparation of the report under subsection (1), the Secretary of State may have regard to any such measures or information that they consider appropriate, including—
(a) an assessment of any variation in dementia services and outcomes between integrated care board areas,
(b) information on workforce capacity, capability and training standards relevant to dementia care,
(c) information on access to ongoing post-diagnostic support services, including support for unpaid carers,
(d) information on continuity and coordination of care for people living with dementia, including access to a named professional responsible for coordinating support across services,
(e) outcomes and experiences for people living with dementia and unpaid carers, including crisis prevention, carer wellbeing, and experiences of joined-up care,
(f) progress on dementia prevention and risk reduction, and
(g) dementia research activity in the NHS.
(4) The Secretary of State must publish the first such report under subsection (1) within 12 months of the passage of this Act.”—(Joe Robertson.)
This new clause would require the Secretary of State to produce an annual report on the delivery of dementia care by the NHS and social care sectors against relevant national targets, standards and outcome measures.
Brought up, and read the First time.
Question put, That the clause be read a Second time.
Dr Johnson
I beg to move, That the clause be read a Second time.
Under the Government’s preference-informed allocation scheme, when a doctor is applying for a foundation post, they are allocated randomly to a job. They get to express a preference, but there is no work they can do to make them more likely to get where they want to be; there are no certificates they can earn, there is no research they can do, and there are no exam results they can get that would improve their chances. That is fundamentally wrong.
The Government say that many people get their first choice, which is true. That is great for them, but it is not great for the people who do not get their choice and have no control over their future. We had a very good debate on this subject, attended by many people in this room, in January, and there was widespread agreement on both sides of the House that it was the wrong thing to do. The Minister said at the time that the Government would keep the system under review. Has the Minister reviewed the system? Does she believe that we should prioritise medical graduates with the most relevant qualifications, clinical experience and skills? Does she think that doctors should have the opportunity to have control over where in the country they work and what jobs they do? Should doctors be able to work harder, aim for better results or do additional activities in order to get themselves the job they want, or does she think it should all be done by a computer?
I would be interested to hear the Minister’s thoughts. The new clause makes clear our position that meritocracy should prevail and people should be rewarded for the work they do and the results they get, and that we should be hiring the best clinicians who apply for the jobs.
Dr Prinsley
I think the new clause refers specifically to the foundation programme—
Dr Johnson
It would amend the relevant part of the Medical Training (Prioritisation) Act 2026, so that when people are put forward for these jobs in the foundation programme, it should be done on the basis of merit. At the moment, as the hon. Member is aware, it is done on the basis of random allocation—preference-informed allocation—which I think is wrong. I would be interested to know the Minister’s thoughts on the subject.
Karin Smyth
This is an area of some discussion, some of which we have heard, but we do not think it is necessary, where we are now, to put such a measure in primary legislation. The Medical Training (Prioritisation) Act establishes a statutory process for prioritising certain groups for training posts; it is not intended to change eligibility for training or the high standards that applicants must meet. Embedding some of these provisions in primary legislation would leave them inflexible to future workforce needs or standards of education and training. If Parliament wishes to change how recruitment processes themselves operate, that is best done outside legislation through established routes.
The preference-informed allocation system was introduced in 2024 following stakeholder engagement, because the previous system was felt to be unfair and stressful for applicants, with a lack of standardisation across schools. Since its introduction, as I understand it, 82% of applicants have been allocated their first choice of foundation school this year, up from 71% in 2023. NHS England has committed to a review of the system, which will commence later this year. Prescribing the allocation method in legislation would pre-empt that review and limit our ability to make future changes to ensure that the system remains fit for purpose. On that basis, I ask the shadow Minister to withdraw the new clause.
Dr Johnson
The new clause deliberately says that applicants would be prioritised based on merit, and it gives examples of ways in which merit might be judged. I understand what the Minister says about some people getting the job of their choice, but the people who do not have no control over the process, and no ability to influence it through their own hard work and effort. That is fundamentally wrong in principle. Although I recognise that the current method was brought in as a result of consultation, I feel confident that the same consultation, done now, would reject it. We would like to vote on the new clause.
Question put, That the clause be read a Second time.
Dr Johnson
I beg to move, That the clause be read a Second time.
During a Westminster Hall debate in December, a Government Minister said:
“In the coming months, in the first half of next year, I confirm that we will publish the acquired brain injury action plan”.—[Official Report, 4 December 2025; Vol. 776, c. 472WH.]
We are now in the second half of 2026. Members may be familiar with the charity Headway UK, which does phenomenal work to support people affected by brain injury, including people in my constituency. Headway has called for the Government to treat the plan as a priority, reiterating that every delay has real consequences and that survivors need support now. The all-party parliamentary group for acquired brain injury, which the hon. Member for Blaydon and Consett has done a great deal to support, has called for the Government to take action.
So why is action not forthcoming? Why have the Government failed to deliver another policy on time? It is part of a pattern. The Government spent a year writing a 10-year plan. They spent another year working on a workforce plan, which still has not been published. It is simultaneously “imminent” as of 30 days ago and non-existent today. They are behind on the Hughes report, the modern service frameworks, universal 24/7 mechanical thrombectomy, fracture liaison services and more.
The new clause would simply commit the Government to delivering on their promise to the 1 million people living with the effects of acquired brain injury. I struggle to see how the Assistant Whip can compel Members to vote against that.
Karin Smyth
I think all Committee members can recognise the importance of this issue. An acquired brain injury is a life-changing event for those affected, and for their families and loved ones. Its treatment involves co-ordination between primary, community, secondary and specialist care, and is personalised to the needs and life circumstances of the individual. Its effects are not limited to a person’s health: it can impact their journey through education, their employment prospects and so many other aspects of life. Because of that, they rightly expect coherent, joined-up support from across Government.
Therefore, as we have discussed, we are working in partnership with eight other Government Departments, ABI charities, patient representatives and the NHS to develop an ABI action plan. We also continue to work closely with the United Kingdom Acquired Brain Injury Forum, which is the umbrella organisation for brain injury charities, as the plan develops and moves towards publication.
Liz Twist (Blaydon and Consett) (Lab)
I am glad to hear that work is going on, but as the Minister may remember, work has been going on for a very long time—some Opposition Members may remember that past work. The issue is clearly important to people, so we need to see action—again, it is about how we get to that end. I would like to see some commitment from the Government. I recognise that the Minister is not in charge of the acquired brain injury strategy, but could she help us by referring the issue to the relevant Minister for an urgent discussion?
Karin Smyth
I thank my hon. Friend for her work on and commitment to this issue, as was highlighted by the shadow Minister. I thank her also for her work on the APPG and with organisations such as Headway, to which we pay tribute for its work supporting patients and the public, and for her work with Members of Parliament and the Government on getting this right, which is legion. My hon. Friend has made similar comments in the House. The Minister responsible is continuing to work on the action plan, which I will talk about as we continue our consideration.
The new clause raises the issues of prevention, identification, acute treatment, rehabilitation, long-term support, care planning, workforce capability, data and research, all of which are being considered in the work being done across the eight Departments. The Government agree that there should be a plan, and the relevant Minister, to whom I will of course pass my hon. Friend’s comments, will be working on that.
The question is whether the proposals in the new clause are best placed to ensure that any plan will be robust, sustainable and timely for the patients it is designed to serve. I say gently to the shadow Minister that I think they are not. First, setting an arbitrary 30-day timeline for publication risks causing either an unnecessary delay or a duplicate plan. Secondly, as I hope she will appreciate, we have engaged more widely than with just the three Departments named in the new clause. As I have said, as many as eight Departments are contributing, which reflects the wide range of areas that are impacted by brain injury.
Let me give the shadow Minister the assurance that I believe she is seeking, as are others: a plan will be published as soon as possible. That plan is being developed with the breadth, rigor and pace that the issue demands and is receiving input from across the health system, as well as from other Departments responsible for supporting people with acquired brain injuries and sector-specific stakeholders and organisations. I hope that she will work with us to support the plan once it is published, in the interests of our constituents, who desperately require a new approach to ABI prevention, care and support. I ask her to withdraw the new clause.
Dr Johnson
The Minister said that the plan is being developed with the pace that is needed, but it is not. It was due to have been published already, but it has not been. It was due to have been published, then a later promise was made, and now she is making another promise with an uncertain date. I just do not think it is good enough. A theme of our consideration this afternoon has been all the different things the Government have promised but have failed to deliver.
Dr Johnson
Yes, I accept that it has taken too long, and that is the point. I assume that it must be ready to go, because the Minister has been working on having it published by the end of June, and we are in the middle of July. The Minister can inform us whether that is the case. We have reached a point where the Government keep saying “later”, “soon”, “imminent”, “in due course” and “working at pace”, but that is not helping to get this done. The new clause would force the Government to get on with it. That is what I think needs to be done, and that is why I will press it to a vote.
The Chair
With this it will be convenient to discuss new clause 106—Safe and proportionate reclassification of medicines—
“Within 12 months of the date on which this Act receives Royal Assent, the Secretary of State must publish an assessment of—
(a) opportunities to support self-care and prevention through the reclassification of medicines,
(b) barriers to appropriate medicines reclassification within the current regulatory framework,
(c) the impact of medicines reclassification on patient access, NHS demand and productivity, and
(d) steps being taken to support a proportionate and agile regulatory framework for medicines reclassification whilst maintaining patient safety.”
This new clause would require the Secretary of State to publish an assessment in relation to the safe and proportionate reclassification of medicines.
Dr Johnson
The Government’s 10-year health plan says that reducing hospital admissions is a key goal for the neighbourhood health service. These new clauses could help, because they would require the Secretary of State to support self-care and health literacy in neighbourhood health plans and to conduct a safe and proportionate reclassification of some medicines.
Pressure on GPs continues to grow, with the total number of GP appointments reaching almost 377 million in 2025. The new clauses are designed to relieve pressure on the healthcare system and allow people to take back control of their healthcare. There are medicines that could be considered for reclassification from prescription-only to being available from pharmacists without a prescription, in the way that medication for migraines, for example, previously had to be prescribed but can now be bought with supervision from a chemist. How might measures to increase self-care or pharmacy care square with the Secretary of State’s duty to improve health inequalities outlined in the Bill? In addition, the new clauses might help neighbourhood health centres in rural communities to increase availability of medicines closer to people’s homes.
I will stop there, because I know that we are running short of time. The principle is to give people the ability to take control of their own healthcare and to more easily access medications that are currently under a higher classification, where it is safe to do so.
Karin Smyth
On new clause 105, I can assure the hon. Lady that the Government are committed to supporting self-care. Community pharmacies already play a vital role by offering accessible advice and, where appropriate, over-the-counter medicines for minor ailments. Through Pharmacy First, patients can walk into a pharmacy or be referred by NHS 111, a GP or A&E for expert support, including access to treatment under the seven clinical pathways. That helps people get the right care quickly while easing pressures on other parts of the NHS.
However, we do not think that it is necessary to specify health literacy and self-care in neighbourhood health plans. The neighbourhood health framework is clear that ICBs and local authorities should work together through health and wellbeing boards to develop locally led neighbourhood plans to improve local population health and reduce health inequalities. The framework sets out what should be included in those plans, and is clear that neighbourhood health plans should be informed by local joint strategic needs assessments.
If local areas think they would benefit from having a greater focus on self-care and health literacy, they are of course free to do so. However, that is for them to decide, based on their understanding of the local area’s needs. That permissive approach recognises that local leaders know their communities best and are therefore best placed to determine how to meet the population’s needs. We are not setting a ceiling on what local areas can deliver, and that approach will drive progress more than dictating an overly prescriptive national approach would. For those reasons, we do not think it is helpful or appropriate to define the contents of a neighbourhood health plan in legislation.
Moving to new clause 106, the Government recognise the important role that medicines reclassification can play in supporting self-care, improving access to treatment and helping patients manage their health more effectively, where it is safe for them to do so. There is already an established, evidence-based, proportionate framework for medicines reclassification in place, which is overseen by the Medicines and Healthcare products Regulatory Agency. The UK is already a world leader in medicines reclassification, and the MHRA has reclassified more than 140 medicines over the last 30 years across varied therapeutic areas, including pain and inflammation, and continues to approve new reclassifications each year.
The Government have taken proactive steps to support further reclassification. The MHRA has worked closely with industry partners in recent years to streamline and improve the reclassification application process to ensure that it is as efficient as possible for applicants, while maintaining high clinical standards. Creating an additional statutory reporting requirement would not improve the assessment of individual applications, and nor would it accelerate access to medicines for patients. Instead, it risks duplicating activity undertaken in recent years and diverting resources from the effective operation of the current system. For that reason, I hope the hon. Member for Sleaford and North Hykeham has the reassurance she needs and will not press her new clause to a vote.
Question put, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss new clause 109—Hospices revenue funding—
“The Secretary of State must ensure that any funding for hospices is allocated for three-year periods.”
This new clause places a duty on the Secretary of State to ensure that funding allocations for hospices is made on a three year basis.
Helen Morgan
New clause 108, tabled by my hon. Friend the Member for Mid Sussex (Alison Bennett), will place a duty on ICBs to collect and publish data on the number of patients who died while waiting for end-of-life care. This is a fairly self-explanatory new clause, so I will keep my remarks brief.
We know anecdotally that palliative care provision is very patchy across the country and can be something of a postcode lottery, and that many people who die in hospital would have preferred to die at home with the support of hospice outreach services or in a hospice itself. The new clause would ensure that we understand how many of those people there are and where they are located, so that we can consider whether hospice provision is appropriately provided in the right places.
I hope the Minister will consider the importance of the new clause, which would allow us to have a much more comprehensive palliative care service across the country.
Dr Johnson
New clause 109, tabled in my name, is very simple, requiring hospice funding to be provided in three-year blocks. Hospices are struggling under the weight of the national insurance rise in the Government’s first Budget, so they would benefit greatly from having a bit more certainty over how much their funding will be from year to year. I am interested to hear the Minister’s response to the new clause.
Karin Smyth
This is a really important subject, as everyone approaching the end of their life deserves dignified, compassionate and high-quality palliative and end-of-life care. Hospices provide extraordinary care, and hon. Members are right to highlight the issues the sector faces. That is why the Government are committed to developing a modern service framework for palliative care and end-of-life care. The final framework will be published in the autumn.
New clause 108 would require integrated care boards to collect and report data on people who died while waiting for end-of-life care. It would also require the Department of Health and Social Care to publish that information nationally. New clause 109 would impose a single statutory three-year funding period on hospice funding. Both new clauses are likely to be answered by work already under way or included in the modern service framework.
On funding, we recognise that the sector faces a serious challenge, and the Public Accounts Committee found in March that integrated care board funding ranges from 0% to 80% of an individual hospice’s income, and that commissioning relies on grants and block contracts. There are also wider funding issues, such as the reliance on historic grants.
The Government are acting on those issues, and we have provided around £80 million over three years for children and young people’s hospices, or at least £26 million a year to 2028-29, adjusted for inflation. We have also provided a separate £125 million capital boost for both adult and children and young people’s hospices. That is the largest investment in hospices for a generation.
The MSF will support commissioning away from grants and block contracts to sustainable contracts based on integrated assessment of population need. It will consider contracting arrangements more widely, including a move away from short-term grant funding as part of the more comprehensive reform that the sector agrees it needs.
We are also strengthening data and evidence. We commissioned the National Institute for Health and Care Research’s policy research unit to build the evidence base on palliative and end-of-life care, including on inequalities in access and the identification of need.
We also expect the MSF to give us better insight into the performance of the system. Its metrics and accountability framework are being co-developed with people with lived experience and partner organisations from across the sector. It will measure identification, access, quality, outcomes and inequalities.
In the context of that ongoing work, the new clauses are not necessary. The MSF will give the House and the public a far more comprehensive picture of access to care than a single count could. It will also do so as part of improving the entire patient journey for people who need palliative and end-of-life care. Because this is a non-statutory approach, there will be more flexibility to adapt and change over time, rather than the system being required to follow requirements set out in primary legislation. I hope that that gives hon. Members the reassurance they need not to press their new clauses to a vote.
Helen Morgan
I thank the Minister for her response, and I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
The Chair
We now come to new clause 109 tabled in the name of Dr Caroline Johnson. I call Dr Johnson to move the new clause.
Dr Johnson
I would like to move the new clause. We see hospices in huge financial distress at the moment, and we need to get their funding on a more certain footing.
New Clause 109
Hospices revenue funding
“The Secretary of State must ensure that any funding for hospices is allocated for three-year periods.”
This new clause places a duty on the Secretary of State to ensure that funding allocations for hospices is made on a three year basis.—(Dr Caroline Johnson.)
Brought up, and read the First time.
Question put, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss the following:
New clause 110—Duty to promote the health and wellbeing of armed forces veterans—
“After section 14Z44 of the NHS Act 2006 insert—
‘Duty to promote the health and wellbeing of armed forces veterans
(1) Each integrated care board must exercise its functions with a view to improving and maintaining the physical health, mental health, and wellbeing of armed forces veterans within its area.
(2) In exercising its duties under this section, an integrated care board must have regard to—
(a) reduction of health inequalities experienced by veterans,
(b) prevention of deterioration in veterans’ physical and/or mental health,
(c) the need to ensure veterans are able to access appropriate preventative and other health services and support.
(3) An integrated care board must take reasonable steps to ensure that NHS bodies and providers of NHS services within its area provide veterans with information about support available to them for their health and wellbeing.
(4) In preparing a neighbourhood health plan under section 24 of the Health Act 2026 an integrated care board must include—
(a) an assessment of the health and wellbeing needs of veterans within its area,
(b) steps the integrated care board proposes to take to improve outcomes for veterans, and
(c) measures for reducing inequalities experienced by veterans.’”
This new clause would introduce a duty for integrated care boards to promote the health and wellbeing of armed forces veterans.
New clause 111—Duty to provide medical records on discharge from the armed forces—
“(1) This section applies where a person ceases to be a member of the regular forces or the reserve forces.
(2) The Secretary of State must by regulations make provision for a complete copy of the person’s service medical records to be provided to the person no later than one month after the day on which the person is discharged or otherwise ceases to be a member of those forces.
(3) Those regulations may specify the manner and form in which service medical records are to be provided under this section, including provision for records to be transferred directly to a civilian health body with the person's consent.
(4) In this section—
‘health body’ means—
(a) in relation to England—
(i) NHS England;
(ii) an integrated care board established under section 14Z25 of the National Health Service Act 2006;
(iii) a National Health Service trust in England;
(iv) an NHS foundation trust;
(v) primary care providers;
(b) in relation to Wales—
(i) a Local Health Board established under section 11 of the National Health Service (Wales) Act 2006;
(ii) a Special Health Authority established under section 22 of the National Health Service (Wales) Act 2006, other than a cross-border Special Health Authority;
(iii) a National Health Service trust in Wales;
(iv) primary care providers;
(c) in relation to Scotland—
(i) a Health Board constituted under section 2 of the National Health Service (Scotland) Act 1978;
(ii) a Special Health Board constituted under section 2 of that Act;
(iii) the Common Services Agency for the Scottish Health Service;
(iv) primary care providers;
(d) in relation to Northern Ireland—
(i) a Local Commissioning Group appointed under section 9 of the Health and Social Care (Reform) Act (Northern Ireland) 2009 (c. 1 (N.I.));
(ii) a Health and Social Care trust established by virtue of Article 10 of the Health and Personal Social Services (Northern Ireland) Order 1991 (S.I. 1991/194 (N.I. 1)), other than the Northern Ireland Ambulance Service Health and Social Care Trust.
(iii) primary care providers;
(5) For the purposes of this section, ‘service medical records’ means any records relating to the person’s physical or mental health care and treatment created or maintained by or on behalf of His Majesty’s forces during the person's period of service.”
This new clause places a statutory duty on the Secretary of State to ensure that all service personnel leaving the military receive a complete copy of their medical records within one month of their discharge date.
Dr Johnson
Under the previous Conservative Government, the NHS constitution was updated with a commitment to guarantee that
“those in the armed forces, reservists, their families and veterans are not disadvantaged in accessing health services in the area they reside.”
The previous Government also introduced the veterans’ strategy action plan, committing NHS England to providing millions of pounds for specialised support services. Ministers also introduced a single point for veterans to access mental health services and support. The previous Conservative Government also created an armed forces covenant duty. Today, we need to see the principles the covenant brought to life at all levels of Government.
Only last week, I received an email from a constituent who has moved around because of her husband’s service in the armed forces and who was struggling to access specialist services for her child’s health as a result. That is why we need new clause 112, which would require the Health Secretary to report on how they are meeting the duties under the covenant. Members will know that I am cautious about mandating any more paperwork, but veterans are being let down. We need some accountability. That report would hopefully achieve that, so I commend the new clause to the Committee.
Karin Smyth
On new clause 110, the Government are proud of the courage and dedication of our armed forces. We must all play our part in upholding the armed forces covenant, including for our armed forces veterans. The original covenant was under a Labour Government; I was proud, as part of my commissioning duties in Bristol, to work with the Royal British Legion to implement that more than a decade ago, and the work continues. I am therefore sympathetic to the intention to promote the health and wellbeing of our armed forces veterans, but I can assure hon. Members that the new clause is not necessary.
The Government’s vision for veterans is clearly set out in the veterans strategy, which recognises veterans as one of the UK’s greatest strategic assets. Furthermore, the existing armed forces covenant duty already places a legal obligation on integrated care boards to give due regard to the unique obligations and sacrifices of the armed forces when carrying out their statutory duties.
Helen Morgan
In terms of ICBs and their responsibilities to veterans, there are specialist veterans’ services around the country. One exists in my constituency, at the orthopaedic hospital in Gobowen, which has an excellent veterans’ centre. Yet the commissioning and payment for those services between ICBs is complex, messy and unnecessarily difficult. Would the Minister consider using the measures at her disposal to ensure that those things can happen more smoothly in the future?
Karin Smyth
I thank the hon. Lady for referencing that service in her constituency. I am not aware of the complications in the funding, but I will commit to getting back to her to understand that better, and I will see what the responses are from the commissioning function—I suspect it is a specialised one that falls between many different people. I am sure it has a long history, but I am afraid I am not directly aware of it, but I commit to getting a satisfactory response to her.
The covenant duty is underpinned by two core principles: first, that disadvantages arising from membership of the armed forces community should, where possible, be removed; and secondly, that special provision may be appropriate for those who have given the most, such as the injured and bereaved. Beyond that, ICBs have a range of inequalities-related duties relevant to the circumstances of veterans. They include a duty to have regard to the need to reduce inequalities between persons in accessing health services and in outcomes achieved from those services; a duty to have regard to the wider effect of decisions, including inequalities relating to health and wellbeing and to the benefits obtained from the provision of health services; and the public sector equality duty, with which all public sector bodies must comply.
Therefore, there is already a range of legal duties on integrated care boards to promote the health and wellbeing of veterans as part of the community the ICB serves. It is precisely because those duties already apply that we do not consider it necessary to replicate them in relation to neighbourhood health plans.
On new clause 112, a requirement on the Secretary of State to publish an annual report on compliance with the armed forces covenant duty would be wholly unnecessary. Legislation already requires the Secretary of State to lay a covenant annual report before Parliament each year covering the effects of membership, or former membership, of the armed forces on service people in the fields of healthcare, education, housing and the operation of inquests. Under that legislation, the Ministry of Defence must obtain the views of relevant Government Departments, including the Department of Health and Social Care, when preparing the report. Any annual report on compliance with the armed forces covenant duty produced by the Secretary of State for Health and Social Care would cover precisely the same subject matter and would be a duplication of information already publicly available.
New clause 111 relates to providing service personnel with their medical records within one month of discharge. The Government agree entirely that it is important that a patient and their care providers have access to their medical records. Primary healthcare for serving members of the armed forces is the responsibility of the Ministry of Defence and is provided by the Defence Medical Command. As a result, such care would be outside the scope of the amendment. There are established processes to allow for the safe transfer of relevant medical information to the service leaver and their new GP when that person leaves the armed forces. Service personnel receive a medical care summary, and are advised to register with an NHS GP and share the summary with their new GP.
Existing data protection legislation also allows an individual to request their full record on discharge. We recognise that, in some instances, the process does not work as well as we would like, which is why the Defence Medical Command is already working towards greater interoperability with NHS systems and the electronic transfer of medical records from Defence Medical Command to NHS GPs.
As hon. Members know, the single patient record will, wherever possible, draw on and connect relevant information in source records, such as GP IT systems and hospital electronic patient records, and allow the patient to see their record in the NHS app. That innovation further renders the measure unnecessary. For those reasons, and because the objectives are already being delivered through existing duties and ongoing reforms, I ask that the new clause is not pressed to a Division.
Question put, That the clause be read a Second time.
Helen Morgan
I beg to move amendment 77, in clause 68, page 47, line 27, leave out from “to” to the end of line 28 and insert “the affirmative procedure”.
This amendment ensures that all secondary legislation as a result of this bill is subject to the affirmative procedure.
Helen Morgan
Amendment 77 is a probing amendment in the light of our previous discussions in Committee about the extensive powers that the Bill transfers to the Secretary of State. It would make all secondary legislation under the Bill subject to the affirmative procedure. I do not intend to press it to a vote, but I hope that the Minister will take into account the concerns that we have raised during these proceedings about the sweeping powers that the Secretary of State is taking on board.
Gregory Stafford
I heard the Liberal Democrat spokesperson say that she will not press the amendment, but I would be sorely tempted to vote for it if she did so. This important amendment sums up a number of our concerns about the Bill, and the commencement amendments to follow are also appropriate.
As the hon. Member will not press her amendment, however, I will not speak for long, save to say that I have enjoyed the past few weeks on this Committee. I hope that the Minister is still in place when we return in September. If she is not, I wish her very well and thank her for all her hard work, not just in this Committee, but in her role over the past two years.
Karin Smyth
I will respond to the hon. Gentleman in a moment, but first I will address clauses 68 to 72, as well as amendment 77, which was tabled by the hon. Member for North Shropshire.
Clause 68 will allow the Secretary of State, by regulations, to make provision that is consequential on this Bill. Amendment 77 would amend that provision. The Government recognise the importance of parliamentary scrutiny of the significant changes proposed in the Bill. While the Bill contains some new regulation-making powers, the majority are existing powers that have been amended in the light of the abolition of NHS England. They will therefore be uncontroversial and consequential, so we consider it proportionate for the same parliamentary scrutiny arrangements to continue to apply in respect of those powers.
However, where we are introducing new regulation-making powers, we have carefully considered what parliamentary scrutiny arrangements should apply. For example, any regulations that are made to facilitate the single patient record will be subject to the affirmative procedure, because we understand the importance of debating that issue in both Houses. Furthermore, any statutory instruments made under clause 68 that amend, repeal or revoke provisions made by primary legislation will be subject to the affirmative procedure and will need to be debated and passed by both Houses. I hope that the hon. Member for North Shropshire agrees that a blanket requirement for the affirmative procedure would be disproportionate. She said that she will not press amendment 77 to a vote, but I hope that what I have said provides her with the reassurance she was seeking.
Clause 69 is a standard clause that appears in Bills that provide for the expenditure of public money. It simply provides for any expenditure incurred by the Secretary of State as a result of changes made under the Act, once it has received Royal Assent, to be paid out of money provided by Parliament.
Clause 70 sets out the territorial extent of the Bill. While most of its provisions extend only to England and Wales, some are UK-wide. The clauses in the Bill largely apply to England only, and in previous sittings we debated the consequences for Wales, Scotland and Northern Ireland, and any issues relating to devolution, as and when they have arisen. Amendments to other legislation made by this Bill will have the same territorial extent as the legislation that will have been amended.
Clause 71 sets out when provisions in the Bill will come into force once it has received Royal Assent. As is usual, the clause provides the Secretary of State with the power to commence the majority of the Bill’s clauses on a date to be set out in regulations. It may also be appropriate to bring different provisions in the Bill into force at different times, and the powers in clause 71 will allow for that. The powers will also enable the Secretary of State to make saving or transitional provision in connection with the coming into force of any provision, which will enable the commencement of the Bill to operate smoothly and efficiently.
Under clause 63, as the Committee has heard, the Care Quality Commission will be able to take action to bring proceedings against a health and social care provider for a serious breach of regulations. However, that provision will apply only to new offences. To ensure that we can act to prevent cases falling through the gaps, we are committed to bringing in the measure as soon as possible after Royal Assent, while respecting the routine two-month window, as is set out in the Bill.
Clause 72 is self-explanatory and provides that, once passed, the Bill may be cited as the Health Act 2026. I commend the clauses to the Committee.
Before I conclude, I put on record my thanks to you, Ms Lewell, and to the right hon. Member for Herne Bay and Sandwich (Sir Roger Gale), my hon. Friend the Member for Ealing Central and Acton (Dr Huq) and the right hon. and learned Member for Kenilworth and Southam (Sir Jeremy Wright), for guiding this Committee—[Hon. Members: “Hear, hear.”] I also thank the Clerks for everything that they have done behind the scenes. This is the first Bill that I have taken through a Public Bill Committee, and the work really is quite legion. The Clerks’ expertise is second to none and a delight to see closely.
Equally, I thank the officials in the Department of Health and Social Care and the lawyers, some of whom have worked on several Committees over the years. Again, I have learned so much from them and their expertise. It is a dedicated team, and their hard work and expertise on Bills over many years is good to see. I thank them for their support in making this Bill go forward.
I thank the hon. Members for Farnham and Bordon and for Sleaford and North Hykeham for their kind comments and good wishes. I also thank members on both sides of the Committee for their contributions over the past few weeks. Despite the heat, I, too, have enjoyed our discussions. I think that we have given the Bill a very good airing and there has been constructive engagement and scrutiny. They have given us lots of food for thought, which we have taken careful note of, regardless of whether we have taken up the amendments.
Dr Johnson
I echo the Minister’s thanks to the Clerks, House staff and others, as well as members of the Committee. Leaving aside the heat, I have also enjoyed our exchanges. I hope that the Minister has a good recess and that she does well in the upcoming reshuffle.
Karin Smyth
I thank the hon. Member for her kind comments. As the former Minister, the right hon. Member for Melton and Syston, recognised, I have been on the other side when considering a previous Bill. Opposition is hard work—the process is quite hard work on this side—and I commend Opposition Members for conducting that important scrutiny. I thank Members for their contributions and I think the Bill is stronger for those efforts.
Helen Morgan
May I associate myself with the Minister’s comments and thanks to everybody who has been involved in working on the Bill? I have also enjoyed my time on the Committee, despite the heat. I hope that the Minister remains in place when we come back on Report, because she is a hard-working and thoughtful Minister and it is a pleasure to stand opposite her in the House in my place as my party’s spokesman.
I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 68 ordered to stand part of the Bill.
Clause 69 ordered to stand part of the Bill.
Clause 70
Extent
Amendment made: 80, in clause 70, page 48, line 18, at end insert—
“(2A) Section (Medical Devices Regulations 2002: mutual recognition agreements) extends to England and Wales and Scotland.”.—(Karin Smyth.)
This is consequential on NC92.
Clause 70, as amended, ordered to stand part of the Bill.
Clause 71
Commencement
Amendments made: 81, in clause 71, page 48, line 25, leave out “Section 63” and insert “The following”.
This paves the way for Amendment 82.
Amendment 82, in clause 71, page 48, line 26, at end insert “—
(a) section 63 (Care Quality Commission: time limit for bringing proceedings);
(b) sections (Regulations: reference to agreements and standards), (Medical Devices Regulations 2002: mutual recognition agreements), (Consultation about medicines and medical devices regulations), (Medicines and medical devices regulations: parliamentary procedure), (Medical devices: parliamentary procedure for certain fees regulations).”.—(Karin Smyth.)
This provides for the new clauses listed to come into force 2 months after royal assent.
Amendment proposed: 37, in clause 71, page 48, line 28, at end insert—
“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the conditions in subsection (3B) are met.
(3B) The conditions are that—
(a) the Secretary of State has published a document setting out the operating model for the exercise of functions by the Department of Health and Social Care following the abolition of NHS England (the "operating model document"); and
(b) the Secretary of State has published a plan for the management of personnel affected by the abolition of NHS England and the transfer of its functions to the Department of Health and Social Care (the “workforce transition plan”).
(3C) The operating model document must include—
(a) a description of how each of the functions exercised by NHS England is to be exercised following its abolition;
(b) the governance and accountability arrangements for the exercise of those functions;
(c) the organisational structure of the Department of Health and Social Care as it will operate following the abolition; and
(d) the proposed timetable for the transition.
(3D) The workforce transition plan must include—
(a) an assessment of the number of personnel whose employment is affected by the abolition of NHS England;
(b) the arrangements for the transfer, redeployment or redundancy of affected personnel; and
(c) proposals for consultation with recognised trade unions and staff representative bodies in connection with the abolition.
(3E) Regulations to commence section (1) are to be made by statutory instrument and may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.
(3F) Before laying a draft instrument under subsection (3E), the Secretary of State must allow a period of at least 60 days beginning with the date of publication of the operating model document and the workforce transition plan (whichever is the later) before the draft instrument is laid.
(3G) A period during which Parliament is dissolved, prorogued or adjourned for more than four days are not to count towards the 60-day period in subsection (3F).”.—(Dr Caroline Johnson.)
This amendment would prevent the abolition of NHS England before the production of an operating model for the merged DHSC/NHSE and associated plan to manage personnel.
Question put, That the amendment be made.
The Chair
We now come to the final Question I must put—that I report the Bill, as amended, to the House. Normally, at this point, Members say nice things to each other, but we have already done that, so we can move on.
Bill, as amended, to be reported.