Health Bill

Tuesday 7th July 2026

(began 2 months, 2 weeks ago)

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09:25
09:27
None Portrait Speaker 2
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Thank you very much, sir. I would like to speak to amendment 78, tabled by my honourable friend, the member for Wells. Um, this is an amendment that really, uh, is on behalf of the of the approximately 1.2 million people in England who live with myalgic encephalomyelitis or me, because five years after the introduction of nice guideline Ng 206, little has changed service provision, according to ng to Essex, remains patchy and poor, with many patients having traumatic experiences. So the amendment would require that the period must be set within which the Nice guideline Ng 206 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 9206 across the NHS in England. The introduction of the guideline after sustained campaigning represented a major reform after years in which MI was treated as a psychiatric psychiatric condition. And patients were pushed to follow graduated exercise therapy often get had disastrous consequences, precipitating serious deterioration that patients never recovered from. Credit is due to the current Minister for Public Health and Prevention. For her determination to bring about this change while in opposition.

In a written answer published last week, the minister confirmed that all Icbs have a statutory obligation to ensure that there is sufficient care provision for its population. But the experience of those with me is far from that. In some icbs, we know that no services for me are commissioned in others. The provider has a history of providing services that do not reflect Ng 206 but rather the old condemned approach of DIT. Some services are located out of psychiatry departments. A huge red flag for those with any information on the quality of services.

But results from the big survey of more than 5000 people with MI or long Covid in late 2025, painted a bleak picture. More than half said that they had been disbelieved by an NHS healthcare official. 1 in 3 had been made to feel that their MI was their own fault, and almost 2 in 5 had an encounter with a clinician that was trauma, traumatic or traumatizing. Five years after its introduction, Ng 206 is far from being complied with, and so members of the Me community, approximately 1.2 million people, as I said, to open, are desperately asking that something is done to address this.

The amendment represents a route to this to offer hope for the many long neglected and mistreated people. Um, so I don't intend to push that amendment to a vote, but I do hope the minister will be able to respond on moving forward. Uh, the consistency of provision for people with me. Um, just moving on to clause 58. More generally, the clause, is we broadly support the intention of the clause, but we do think there needs to be more safeguards built into the principle around the powers that are being handed to the Secretary of State, because, um, the clause which makes provisions for the period of time for compliance with a nice recommendation, um, doesn't have any detail on how it will work in practice or how often the secretary of State will change the kind of standard three month rule that.

Nice currently. Requires, uh, there's no ceiling on the compliance period, no criteria governing when the period may be extended, no duty to consult or set out reasoning. So would the minister be able to set out what the process will be for when the Secretary of State intervenes?Um and the period of time for compliance with a nice recommendation, uh, we would have thought that there would be some mix of evidence requirements, consultation, a statement of reasons, impact assessment, or some kind of parliamentary scrutiny, because we would think at least the Secretary of State should have to set out their reasoning why this new power has been used.

Um, the value of the current requirement is almost entirely due to the compliance period being short and fixed. The three month rule is what 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 isn't removed. It's timing is made discretionary, for which for a patient awaiting treatment, can't amount to the same thing. A variation power isn't 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 power is criteria based, triggered by a defined financial threshold subject to a defined process and time limited in effect. So, as I say, we're not a overtly. Tied to this power in principle, but we do think there should be more safeguards built into the criteria around it being applied and had great. Offer some guidance from the Minister on that.
09:31
None Portrait Speaker 3
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Element.
09:31
09:31
None Portrait Speaker 4
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Thank you chair. So, um we start with amendment 58. In the name of the honourable member for Wells and Mendip Hills. So I have sympathy with the principle behind this clause. Um, the honourable lady is right to say that individuals with me have not always received the very best quality care. Um, it's a debilitating and incredibly frustrating condition in many cases in around 10 to 25% have severe me, meaning that they're housebound or bedbound. And so we know that, um, some patients are not believed sadly by medical professionals.

And in 2021, uh, Nye said that most medical students have little or no training about the condition. The government previously committed to increasing the uptake of Me modules amongst NHS professionals. And could the minister give an update on what sort of progress she has seen in that uptake over the last couple of years?Um, the government committed to develop and run a public awareness initiative with implementation expected by May 2026. This was in the Me CFS Action Plan chair. So can the Minister confirm whether the department has developed this initiative yet, and if not, what the responsibilities for the delay isn't marked as completed on the government website, but with this amendment in particular, what it's essentially doing is it's legislating guidance into putting a guidance of medical medical professionals into legislation.

And my concerns about that are twofold. Um, it may slow down in. Improvements in the future if individuals have to legally follow this guidance, how can they innovate?How can they improve this treatment without having to come back here for more legislation, which will take time and may actually mean that people then may get worse care in a short term rather than better?Um, the other thing it would do is it would limit clinical judgement because if a patient had a particular set of symptoms or particular set of conditions or a particular set of medication, which meant that the clinical judgement of the doctor looking after them or the clinician looking after them was that they needed to vary from the guidance, which is intended from Nice to be guidance rather than law, then they wouldn't be able to do so because of the guidance in law that that's what they must do.

And so my concern would be that it would be overly restrictive and actually could cause whilst it's a well-meaning and well-intentioned, and I think it's a good idea to ensure that guidance is followed where possible, um, it could be too rigid. And therefore, um, I wouldn't support it, but I do support the aims of better treatment. Clause 58 itself. So essentially this amends the Health and Social Care Act 2012. And it inserts into into that section eight a provision made under subsection A may include provision about a period within which a recommendation is to be complied with, including provision for the period to be determined by the Nice or the Secretary of State.

So at the moment, uh, the Nice technology appraisal, uh, it checks the value of the product, whether that be a drug or a technology. And it recommends it, it makes its nice recommendation. It's then supposed to be the case that within 90 days, so three months, the Icbs ensure that these technologies are available. But in the real world, we know that it takes longer, sometimes 12 to 24 months for some things to become available. And that can be because technology is buying.

Training needs to happen. So sometimes it can take a bit longer. So I can understand why there may be variation and why the government may want to consider varying it, but it's not clear why. They need to do so. So they do have the possibility at the moment they can vary on an individual basis. So for example, the hybrid closed loop systems for diabetes. The government had a five year limit rather than a 90 day limit for introducing those.

Because the technology, they do require proper training, and they were never going to be able to be rolled out in such a short period. The other one that's notably got a longer time is Tirzepatide, which is more commonly known as Mounjaro. And I suspect that's down to more likely to cost, but I'm not certain about that. Um. So why does the government want to change the 90 days?Because what this does is it turns it, um, from the patient has a right to have treatment within.

This approved product within 90 days to a patient has a right to get the product when the secretary of state says so, which is not really a right at all in many ways, because, you know, it doesn't give them any comfort. And it may mean that products are received later. So the government's put this into the bill. So it clearly intends to use it. So given that it has the powers to currently vary on an individual basis, why does it need the power to um.

Vary on a blanket basis. Does it intend that it will. Extend the 90 day limit across the board and if so, by how much. Because there is no ceiling, there is a submission into our evidence pack from Henry Birkett from O2 strategies. That made the point that there is no ceiling, no maximum time. There's no duty to consult, and there's no reason why. There's no necessity for the Secretary of State or Nice to give reasons why the delay has been occurred.

So, um, the other point I wanted to make, chair, is that the life sciences industry talk about how they want to see things rolled out. They, when they do it, investing in this country and research in this country, they want to see their, their new products, once they have been approved, rolled out as quickly as possible. And this is a sign that that might be delayed. I can understand that the government might want to be able to vary certain products, but they can already.

The question is why they want to, um, vary it on a more general basis, presumably to slow it down. But how much by.
09:37
09:37
09:37
None Portrait Speaker 4
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Um, and so clause 58 relates to the time period for compliance with nice recommendations in respect to health and social care provision. And as we've heard, it enables that time period to be determined by either Nice or the Secretary of State, Nice technology appraisals and its highly specialised technology guidance play a vital role in ensuring that patients in England can access treatments that are both clinically effective and a good use of NHS resources. And when Nice recommends a new treatment, the NHS is usually required to make funding available within three months.

This means patients can consistently benefit from innovative treatment. That said, there are cases where the three month time frame is just not realistic. This might be because of affordability pressures or practical challenges such as a stretched workforce. In these 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 in place the necessary routine testing systems and to train healthcare professionals.

Sometimes the opposite is true, and partly to the point of the opposition spokesperson. I didn't, I don't think, raised this issue, but the opposite is sometimes true and the NHS issues guidance, which provides swifter access to medicines and medical treatments, for example, cancer medicines can be funded from the point of a positive draft recommendation and at present NHS England decides whether a nice treatment is funded more quickly or should be shorter. While Nice determines whether the funding period should be extended, typically following a proposal from NHS England.

So the abolition of NHS England means that these roles and responsibilities will need to be reconsidered, and this clause provides the flexibility, but does not mandate, that a final decision on funding timelines to sit with either nice or with the Secretary of State and to the point of the honourable Lady from Shropshire. The government does intend to set out further details of these arrangements in regulations using the enabling power of this Bill. Now, importantly, this clause does not reduce Nice's independent role in assessing the clinical and effectiveness and sorry and cost effectiveness of new treatments.

Nor does it weaken the NHS obligation to provide timely treatment. Instead, it ensures that decisions on funding timelines remain flexible, sustainable and that the system is equipped to respond effectively to future pressures. Now to clause amendment 78, which is moved by the Honourable Leader of North Shropshire. Um, and I want to begin by recognising the vital role that Nice guidelines play in improving quality and consistency of care across the NHS. And Nice 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.

However, the government and the government would not accept this amendment. I know the honourable Lady has withdrawn it, but that is because, just to be clear, and I think partly to again, to the opposition spokespersons point, it does reflect long standing and deliberate policy position that reflects the role. Nice guidelines have never been mandatory, and that reflects the role they play in supporting patient care because 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's 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 services are appropriate to the needs of their local populations, and I think the honourable lady made some important points about me over many years that many of us have encountered with our constituents, and I pay tribute to the honourable gentleman for Farnham and Bordon for his work on supporting, uh, constituents with this condition.

Um, so to be clear, the Department does fully recognise the need to support and improve more consistent implementation of the Nice guideline on me. And that's why we're already taking forward practical measures in this area, in particular, Department of NHS England are developing a service template specification aligned to our Nice guidelines to support commissioners and providers in delivering appropriate services for people. With me, we'll continue to work with stakeholders, the industry, and NHS on doing that, and these steps will help drive improvement in care without undermining clinical judgement or imposing flexible statutory requirements.

And on that, sir Roger, I commend the clause to the committee.
09:41
None Portrait Speaker 1
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Helen Morgan.
09:41
09:42
09:43
None Portrait Speaker 4
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Thank you, sir Roger. So I will turn first to clause 59 and schedule eight. And this clause provides for the abolition of the health service 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. Now, the core purpose of this function remains unchanged. I think that's a really important point to stress here this morning, and that is 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 different 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. HCV has been isolated, undermining its efficacy. We will bring him into the mainstream as a core but distinct part of CQC.

This will enable him to use its functions more strategically. Working in partnership with the National Quality Board. This clause achieves that by conferring responsibility for those investigatory functions on the Care Quality Commission through the provisions set out in schedule eight. In doing so, it embeds a comprehensive investigatory framework within 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 which seek it. Within CQC, each functions will continue to operate as a discrete unit and retain its independence for providers, allowing it to identify learnings and take a no blame approach.
09:45
09:45
09:46
09:47
09:47
None Portrait Speaker 4
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Well, again, I thank my honourable friend for that intubation and of course, patient safety is absolutely what we need to get right. And I will come on to this in my in my comments, the. A lot to go through in this particular in this particular clause. Um, and we can see from the number of organisations and a number of channels that exist to go through that. And I've said this before, um, and I'm sure as constituency MPs, we've all struggled to understand how best to support our constituents who are either as patients or indeed as staff through this system to understand the best route forward on patient safety.

I think we've all got the same aim in, in, in our in our minds. So I think we should be very clear about that. The issue is about how best to achieve that aim. And he's absolutely right. The test is about impact. It's about learning. It's about making the system change and change in that culture. But to my honourable friend, my hon. Friend the member for Lewisham East, who specifically asked me about the confidence, um, and the fear that sometimes that staff have about speaking up, which is obviously an important part of, of that, of that landscape.

We want to make sure that we take the learning on both those points forward into the new body. Um, so the new framework ensures that the essential characteristics of safety investigations, as I've said, 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. And we are maintaining the principle of safe space and introducing strong safeguards in the process so that staff and the public can trust, they can speak of their experiences openly, without fear or favour, to provide learnings for the system.

Now, we have included protections for safe space materials and restrictions on disclosure, including from the regulatory functions of the CQC and limits on the use of reports in legal proceedings. This is designed to support openness and candour and 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. So, Roger clause 59 also provides the Commission with the necessary powers to carry out investigations effectively, including powers to require information, enter premises and coordinate with other bodies while maintaining appropriate protections such as legal privilege and safeguards against self-incrimination.

While the commission will decide which incidents to investigate, the clause preserves the power for the Secretary of State to direct it to investigate a specific qualifying incident or category of incidents. This ensures that where issues of significant public concern arise, or where urgent scrutiny or particular risk is needed, there is a clear mechanism to ensure they're investigated. Now, the struggles of the Care Quality Commission have been well documented, and we will only commence these provisions when we are satisfied that CQC has improved. The CQC has been supported and held to account to recover its effectiveness, and we will continue to support them and work closely with the newly appointed chair on their journey to rebuild.

We will work closely with the CQC to ensure their readiness to receive the investigations functions from the health Service Investigation Safety Investigation Board. Maintaining a centre of excellence for investigations will be integral to the CQC culture. Without this clause, the opportunity to deliver the ambitions of the ten year health plan would not be realised, nor would the broader patient safety landscape, as set out in the Dash review, be fully addressed and it is therefore a necessary and integral integral reform. So, Mr. Chairman, turning to clause 60, this clause makes provision for the transfer of property rights and liabilities from health Services Safety Investigation body to the Care Quality Commission in connection with the abolition of the former and the assumption of its functions by the latter, it's a key technical provision to ensure an orderly and legally compliant complete transition between the two bodies, where functions are transferred between public bodies.

It's essential that all associated assets, obligations and legal arrangements are also transferred in a way that ensures continuity and legal certainty. This clause provides the statutory mechanism to achieve that. The clause provides a flexible framework to enable the continuation of actions and ongoing matters, including legal proceedings, and ensures references to HSF in existing documents are treated as references to the Care Quality Commission to avoid legal uncertainty. The clause provides for staff protections equivalent to two and allows for shared ownership or use of property where needed, supporting a smooth and effective transition.

The overall effect of this clause is to enable the smooth, comprehensive and legally robust transfer of property rights and liabilities care quality to the to the Care Quality Commission, ensuring continuity of function and avoiding disruption to ongoing operations. Without this provision, there would be a risk of legal uncertainty and operational disruption during the transfer process. Finally, sir Roger, I turn to clause 61, now 60. Clause 61 is a necessary and practical provision. At its core, this clause provides a power through the regulations for HMM Treasury to ensure that transfers made from HHC to QC are delivered smoothly and on a tax neutral basis, like the equivalent provision for the NHS transfer in clause three.

This 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. This ensures that the tax consequences of the transfer can be properly aligned with the policy intention of a smooth and orderly transition, and, importantly, the scope of the clause is limited to specific relevant taxes, including income tax, corporation tax, capital gains tax, VAT, stamp duty and stamp duty reserve tax like clause three. Without this power, there's a risk that transfers could trigger unintended tax liabilities that would divert money public money away from frontline services and undermine the policy intent of legislation.

Clause 61, therefore, protects value for money and ensures that organisational change does not come with avoidable fiscal costs. So, Mr. Chairman, clauses 59, 6061 and schedule eight are necessary to strengthen the framework for patient safety investigations and ensure a more coherent and crucially effective system for learning from incidents across the health services to make all our constituents and patients safer. I therefore commend these clauses to the Committee.
09:53
09:53
None Portrait Speaker 7
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Thank you, chair. Um, these clauses are about patient safety. And as has already been pointed out this morning, patient safety is the absolute key here. That's why I recognised I think across the House it's well recognised amongst the public and it's well recognised across the National Health Service. Before going any further, chair, I should declare an interest as a patient of the NHS, as a member of the British Medical Association, a member of the Royal College of Paediatrics and Child Health and as a consultant paediatrician.

Chair. When I was interviewed in 2012 for my current consultant role, I was asked for the interview to produce a presentation and the title of the presentation was. How to demonstrate to the Trust Board that paediatric services in the hospital were safe and the. First question I posed in. I won't go through it all. You'll be pleased to know. But the first question I posed in that presentation was what is safe?Our football stadiums.

London Underground safe?Are aeroplanes safe?Broadly?Yes, I think we would say that they are. But they've not been without incident. They've not been without the. Safety issues. So the healthcare in is is similar and it involves millions of people. It involves clinical judgment. It involves human decision making and a. Huge variability in the way that patients can present with different symptoms for different problems at different times.

And these. Healthcare safe. Yes, it is safe. But again, we know from the very many reports that we've read that there is a long way to go in making it to make it better. And we need to prepare for that. We need to make sure that we, um, essentially design out room for error. We design processes that limit the risk that the opportunities for error. We use technology to limit the risk for error.

And that we train people in a way that reduces the risk of error. One of the key factors in that is accepting that we have human decision making. Mistakes can happen, and that we need to identify and we need to learn from those mistakes. And one of the key factors in determining that is this balance between accountability and blame. If you have insufficient accountability, you can have an unclear escalation process that people don't know who to go to when they identify a problem.

You can have a careless culture. That can develop in places where there is not enough accountability. But if you have too much focus on faults and whose fault it was, then you get a blame culture. This can lead to failure for people to come forward and. Therefore, failure to learn from mistakes. It can either lead to a culture of cover up to avoid getting people into trouble, whether that be themselves or their colleagues. And this chair is where each SIB comes in.

Because like the Air Accident Investigation Bureau, there were similar ones for rail and Maritime. They provide a safe space and. The safe space is important in ensuring that people can speak up freely without fear, and know that we can get to the bottom of the problem and understand the why and the how something went wrong, because that is how we fix it. And at the time, um, it was established, um, there was consensus. 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 that we welcome the establishment of HSB. Doctors must feel able to report errors and reflect on the 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.

NHS providers told Parliament that NHS providers welcomes the creation of HSB as an opportunity to develop a just culture in the NHS, and a focus on learning for each SIB to succeed in contributing to improved patient safety. Any investigations associated with it must be carried out independently and without conflict of interests, and be perceived as such. And the Minister for Secondary Care herself is also on record as having said that, SIB is a really important new body. It must absolutely be built on high standards of trust when it comes to the wider system and the general public.

So I think I've demonstrated, chair, that creating SIB was a matter of consensus, and it was confirmed that it was the right thing to do and it needed to be independent without conflict of interest to work. NHS staff backed it, the providers backed it, the patients backed it. Even the minister backed it. And that's what makes the government's plans for him so perplexing. And I'm not sure. I'm not aware of a single Royal College or union that supports folding it into the CQC.

So why is the minister Minister, what have ministers said?Ministers have essentially said that this is because of the dash review and the dash review say so. So that's what we're going to do now. I have huge respect for people who are saying, well, I've I've asked for some experts advice and they've given it, and therefore I should follow it. Minister also ministers also commissioned Lord Darcy's advice and Lord Darzi's report said a top down reorganisation of NHS England and integrated care boards is neither necessary nor desirable.

And yet here we are doing exactly that. So it's perfectly possible for um. Ministers to take one one report as gospel and the other as guidance. So if the minister could explain that. The other reason being given is to declutter the landscape. Yet few people outside government seem to think HCB is responsible for cluttering the landscape. The Health Foundation, for example, chair wrote in their submission. The government needs to do more to explain how the abolition of Habib and transfer of its functions to the CQC will meet its aim of reducing complexity and, most importantly, maintain the essential focus on improving patient safety.

It's in a adjournment debate on this topic last evening, chair. Um, where my right hon. Friend the member for Harwich North Essex, highlighted that 1400 recommendations have been issued across the last few few years from 30 public inquiries across NHS across England and Wales. But he has issued only 5056, I think, recommendations. It also does so much more cost effectively. The budget for the HSE is much lower than the budget for a public inquiry, for example, much lower than an individual inquiry.

So if H C accounts for less than 3% of all recommendations issued in the last 30 years, if its investigations are cost effective, what is the government trying to achieve by folding it into this CQC?It doesn't. It just doesn't it doesn't make sense. The recommendations that have been given have been specific, relatively low in number, targeted and effective. So why would we not want that?The other question is how will this work in practice?The minister told the House that combining H, SIB and see who's sees function would be to the benefit of both.

The impact assessment speaks of a more strategic approach to the commissioning of patient safety investigations and economy of scale savings. So it sounds like the benefit may be financial, not operational. I think we've demonstrated that that doesn't really make sense either. The impact assessment also makes clear that the National Quality Board will provide clear direction to the new investigation Unit, considering that the National Quality Board is directly tied to the NHS, how does direction from the Ncbi square with independence for the new investigation Unit?And on top of that, the Minister will be aware.

The impact assessment says that they expect the vast majority of the investigations to be directed by the Secretary of State in terms of the topic. So again, this is having an effect on the independence. Now, there is currently a power to direct that it has been seldom used, whereas the government seem to intend to use it more frequently. The other question is more fundamental what will happen to if each SIB is rolled into the CQC?But the problem with the health care that the H SIB unit finds is a problem with the CQC failure to properly regulate or properly inspect.

In the witness section of this committee, I asked the chief executive of how this would work in practice and I quote, if we were a directorate in the CQC as outlined in the legislation, it would be very difficult for us to comment on how the CQC was looking at different areas and how it was managing certain aspects of safety. I think there is also a concern about our ability to make effective recommendations to the CQC. If we were a directorate within it. So there is a serious risk of a chilling effect of.

These clauses are just waved through by the committee. The impact assessment makes clear that ministers say they want to preserve a safe space, but I just don't see how that is feasible. The King's Fund has written in its submission the transfer of functions to Habib into the Care Quality Commission also raises questions about being able to trust the system and come forward with their concerns and the issues. How sure will people be when they're responding to this safe space?How willing will they be to speak when they know that there are also reporting to the regulator in the same breath?Of course.
10:06
10:08
None Portrait Speaker 7
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I thank the honourable gentleman for his intervention. And if he is, of course, right, because when someone comes forward, they need to have trust in the system. Because if they think that coming forward will cause them harm to their job, their career, or perhaps that of their colleagues, they they may be more reluctant to do so. Now, there is a difference between a mistake and a reckless act. And of course, if if people are behaving recklessly and badly, that needs to be dealt with for the accountability.

But if an individual is aware of a mistake or aware that there is a loophole, perhaps that where a mistake could have been made, if only something else hadn't stepped in at that Where a mistake could have been made if only something else hadn't stepped in at that moment. Then they will be. They need to come forward and say so, and it would be much more difficult for them to do so in the. If they're in a culture of fear and in fact, doctor.

Neuwirth made it clear to members of the committee that we're still working in a culture of fear that makes it difficult for people to come forward. People come forward now because they know each step is independent, and they are less likely to come forward. When H is in office in the CQC, that is independent in name only, and the chair of the Health and Social Care Committee chair, the member for West and Abingdon, said 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. Perception is everything. Well.
10:11
10:14
None Portrait Speaker 7
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I thank the honourable gentleman for that intervention. And and he is he is absolutely right. I mean, that answer was quite shocking, really. And the the pause before it and the reaction was, was, was, was, was, was, was something, um, remarkable really, because the, the purpose of HIV is to be able to investigate without fear or favour and for people to be able to come forward in a safe way. But if it was folded into CQC, the regulator, and as I said, the problem was the regulator, then how would how would it investigate itself and 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's incompetent?How does that work?And the answer was, the new one seemed to know.

And it also seems ministers haven't thought about how these H subunit would be vulnerable to political pressure, either. Um, because as the bill stands, um as I said, the government is planning to direct the vast majority according to the impact assessment of these investigations. And the quality board is going to have, um, some influence over the recommendations, which again is under the direction Secretary of State. Now, I'm aware that the Liberal Democrats have tabled amendment five, where they have a committee, but I don't think that's I understand that's well intentioned and that we recognise the same problems and the same flaws in the government's approach.

Um, but I don't think it's enough to solve the problem. I think even if the law says the oversight of the investigative unit remain operationally independent, I just don't see how that is possible in this situation. I can see she's trying to help create something that's better than what the government has produced, but I just don't think it's enough. We've also tabled some amendments. One is new clause 42, and this is to effectively ensure that the there is some operational independence in terms of the choice of investigation, because it requires the Secretary of State to adequately fund and resource patient safety investigations, including some initiated by the um, the CQC, as it would be this unit themselves.

Amendment 55 is essentially a probing amendment. We noticed that much of the legislation was sort of lifted and shifted from the previous act, but there were some things missing, and one of them was national security grounds. And we'll just I'm just wanting to understand why that was removed. Um, there are some, um, very occasional examples of health events that do have national security, um, connotations. Remember the Salisbury chemical weapons attack, um, for example, in such circumstances, restrictions on investigatory capabilities potentially could be necessary.

I don't know, it's just interested really to understand why the government have chosen to remove that particular clause. Because it's been a it's been a deliberate removal. And I just want to understand why. The Third Amendment is tabled is 56 um, which allows. The Commission to recoup charges in excess of the costs incurred in providing assistance. So this this program, this programme is, is a world leading um programme. People are looking at it from across the globe.

And indeed some people have asked for training or information on it that we have previously been able to recoup, not just recoup costs, but actually to charge for and I. I don't understand why they've removed that provision because, um, it's an opportunity to, for the government to get extra money for, for without taking off people in taxes. Movement want to lose its international standing or does it want British taxpayers to subsidise training for foreign health services?It's not clear, but I'd be grateful for the Minister to explain.

We need to come back to what the honourable gentleman said at the beginning about, um what. Was the purpose. The purpose is patient safety. No. I will of course give way.
10:21
10:23
None Portrait Speaker 7
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Gentleman for his intervention, but I think this comes to part of the problem. So producing a list of faults, producing a list of things that are wrong with a service and saying we need to improve the culture, it needs to be better. Okay. But how?What is going to be the deliverable, measurable way of doing that?What how are we going to go about improving things?Um, the benefit of HCP is that it tends to produce a. For example, there's a problem.

There was a problem with patients with aortic dissection. How are we going to prevent that produces a plan. A plan is implemented. Patients are safer. Um so I think it's about the delivery plan. Um is part of it. The other part of it is he talked about progress and monitoring progress, but it isn't his job to monitor progress monitoring. You've got, you've got a situation where a mistake or an event happens. It is investigated by H.

H produces a set of investigations based on understanding how and why that happened. Because of the safe space. And then those recommendations are put forward to the government, the government then ideally implement those changes. But the minister is there to ensure that those are implemented. It will be her job to ensure that having decided recommendations to be implemented, that is done fully and properly. And so it's sort of a separate function. The the CQC is a regulator.

Is an investigator, and the minister is there to ensure that things are delivered properly. Um, so going back to patient safety chair, at the end of my interview, I essentially told the panel, I can't tell you that anything is 100% safe. The assurances that can be provided are that the staff, equipment and 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're not repeated. And that is the key to find the learning and to spread it more widely.

And as the honourable gentleman said, implementation is a challenge because implementing it on an individual basis or implementing a lesson within a unit that has had an error or a mistake is, is is possible. Spreading it more widely is heard in every unit across the country is more challenging. So I, I think fundamentally, I don't think I've heard anything from any of the ministers who've explained this, and I don't think it's in the report either. Why does the government believe that rolling it 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?Um, how does that make patients any safer?Decluttering the landscape does not make patients any safer.

Rolling it into rolling into CQC doesn't make anything safer. And in fact, one of the. Things I don't understand about it is the government say on the one hand, don't worry, it's okay. We're basically recreating each SIB within this CQC, in which case they haven't decluttered the landscape, they've just hidden it and sort of pushed it out the way while while, while and. Hidden it also almost in CQC, but they haven't removed it. Either that or they have decluttered the landscape and they have removed it.

And it doesn't seem clear which the government think. They've done. So um, I'd be grateful. When the minister wraps up her comments to understand why she thinks this move will improve patient safety. That we're all we all receive across the NHS. Thank you chair.
10:31
None Portrait Speaker 1
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Alan Morgan.
10:31
None Portrait Speaker 2
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Thank you very much, sir Roger. And I declare an interest as a member of the Patient Safety All-Party parliamentary Group, which is opposed. The changes that are proposed in the Bill to Hscrp. Over the last couple of weeks, I think we've been reminded why we need an appropriate safety landscape for when things go wrong. We've had the review. Into Nottingham Maternity, we've had Baroness Amos, National review into the picture. Following a range of maternity scandals across the country.

Um, and yesterday evening I attended the debate on the regulations to compensate victims of the infected blood scandal. So I think safety is at the top of all of our minds at the moment, as it should always be. And something that's come across very strongly from members, from all parties on both sides of the House, is that culture is critical to ensuring that these types of issues, these huge scandals, never happen again. And indeed, smaller scandals 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 that they operate, um, that they will be safe to do so without jeopardising the rest of their career and that those concerns will be acted upon and the lessons learned. And I think everybody here wants to achieve that. I don't think anybody is arguing about the kind of 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.

And that's why I share the shadow ministers sort of lack of understanding, really, about why rolling into the CQC will change that culture, because the CQC is a regulatory body and each step is an investigatory body. And so their their mission, if you like, are fundamentally different. And putting them together, compromises the independent investigation element in a way that's very difficult to overcome. I think, um, we, uh. We were told in the evidence to the bill committee that, um, in fact, from HSBC chief executive told the committee that they often get told, we tell you this, we wouldn't tell a regulatory body.

And it's clear that that this perception of safety is critical to the way in which people interact with each SIB. We also heard in the evidence to the committee that the CQC warned that, as it stands, the Bill could leave it fighting it against itself in the High Court. So you could get a scenario where the regulatory arm of the CQC could end up seeking access to the confidential investigation. Reports of each SIB, while the investigative branch tries to kind of keep them secret to protect its independence.

And that's not a situation I think anyone wants to end up in, and I'm sure that's not the intention of of this clause. Um. It's also important. And I think the shadow minister has already made this point, so I won't labour it. That investigatory body must be able to examine the regulatory frameworks, commissioning decisions and oversight arrangements without institutional conflict. So I can envisage a situation, for example, when I look back at the scandal that unfolded in Shrewsbury and Telford Hospital Trust over the maternity failings the CQC had given that trust a good rating.

During the course of all of those terrible things going wrong. So the CQC process own process clearly failed in that situation and it's and it's difficult to imagine an arm of the CQC turning around in that in that scenario and saying that the CQC got its own assessment wrong and if. If they had tried to do that, it's difficult to imagine how that might have played out and the confidence that people might have had raising that problem. Concerns about this because the CQC, as the Minister has already alluded to, has faced significant criticism in recent years and has publicly admitted that it has failed to carry out its functions to the best of its abilities over recent years.

So while I welcome the Minister's assurance that this would only happen once the CQC was in a better place again, it does raise the issue that the CQC might be part of the problem in some of these instances, and needs to be able to point to that where where that is appropriate. So the Lib Dem amendment number five attempts to introduce the principle that if this must happen, there needs to be a firewall within the CQC to keep each SIB operationally independent. Now, the, uh, the amendment that I've laid down talks about inserting a committee into that process that is operationally dependent of the CQC has a majority of people that aren't on the CQC.

In order to achieve that. But I also recognise that the opposition. New clause 42 seeks to be the same thing. Um, and I would be open to any suggestions that the Minister might make to be able to reassure us that he will continue to be operationally independent, for all the good reasons that honourable members have outlined in this debate.
10:39
None Portrait Speaker 3
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Thank you very much, sir Roger. And before I start talking about these clauses, I just wanted to put on record that 21 years ago this morning, 52 people were murdered by Islamist terrorists in London, along with 784 injured. And I want to pay tribute to all the medical professionals who treated those people in such difficult circumstances at that time. Sir Roger, I'm going to speak to clauses 59 to 63 together because they all concern one of the most significant structural changes proposed in this bill, namely the abolition of the Health Services Safety Investigations body as an independent statutory organisation, and then the transfer of its functions into the Care Quality Commission.

At first glance, this may appear to be a relatively modest machinery of government change. The Minister argues that each sib's functions will continue, that its statutory safe space protections will remain, and that Operation Independence will somehow be preserved. However, when one examines the evidence presented to this committee and indeed the evidence given to the Health and Social Care Select Committee, of which I'm 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 not, therefore, simply whether each SIB statutory functions can be transferred into another organisation. The question is 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 organisations about which they are complaining.

Air accidents are investigated independently by the Civil Civil Aviation Authority. 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, it should demand an even greater degree of independence, because learning from failure depends upon the confidence of patients, clinicians and families that they can speak openly without fear that the information they provide will later be used for regulatory or enforcement purposes.

That is precisely why HSB was created. Its purpose was never to attribute blame. Its purpose was 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's 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 into the Care Quality Commission. In doing so, it brings together two organisations with fundamentally different statutory purposes, different powers and, perhaps most importantly, different cultures. HSB investigates the CQC regulates. One exists to ask why did the system fail?The other exists to ask has this organisation complied with the required standards?Those are not the same questions, nor do they require the same relationship with those from whom evidence is obtained.

An investigator depends on trust. A regulator depends on compliance. An investigator encourages candour. A regulator necessarily retains enforcement powers. Those different roles are not a weakness of the current system. They are precisely why Parliament chose to establish a separate organisations. I would be therefore grateful if the Minister could explain what assessment has been made of the impact on public confidence. When the investigator and regulator become part of the same statutory organisation. More specifically, what assessment has been made of the likely effect of clinicians willingness to speak openly if the organisation receiving confidential evidence also contains the regulator responsible for inspecting and enforcing standards.

Because this concern does not merely arise from the opposition. Indeed, we've heard from the honourable member, for Lewisham East raising similar questions, but it has also been raised repeatedly by independent experts. Indeed, even the Care Quality Commission itself has expressed reservations. Evidence submitted by the CQC to the Health and Social Care Select Committee earlier this year acknowledged that there remains a lack of clarity regarding the respective roles of each SIB and the CQC, rather than resolving that uncertainty, the proposed merger risks deepening it.

The CQC warned that preserving an effective separation between its investigative, investigatory and regulatory functions would be essential if confidence in ship's safe space were to be maintained. It recognised there is a genuine risk of perceived conflicts of interest if those functions become blurred. Now, I think that should give this committee pause for thought when the organisation receiving these additional responsibilities is itself warning about the difficulty of maintaining those boundaries, we should listen very carefully. If the CQC believes these 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 each SIB should remain institutionally independent so that its evidence based recommendations can continue to command confidence across the health system.

These concerns, as I've 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. Indeed, during our oral evidence sessions, I put a straightforward question to doctor Penny Dash. I observed that I could find almost nobody apart from her and the department, who believe. Moving each SIB 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 this proposal. Yet despite that breadth of concern, the government have not produced compelling evidence that each SIB, as presently constituted, is failing. Nor have they demonstrated that the current separation between investigation and regulation is itself creating harm. Instead, ministers have repeatedly assured us that Sib's operational independence will remain, that safe space protections will remain and that investigations will remain independent. If that is indeed the government's position, then an obvious question follows if each SIB will continue to operate independently, if its investigations will continue to be conducted independently, if its statutory protections will remain intact, why is it necessary to abolish the independent organisation at all?And I think that question, in my view, goes to the heart of clauses 59 to 63, because throughout the evidence presented to the committee, I have yet to hear a convincing answer.

The government asked Parliament to believe that everything which makes each SIB valuable will continue unchanged. Yet at the same time, they asked Parliament to dismantle the very institutional structure that was deliberately designed to protect those characteristics. This is not merely an administrative contradiction, it's a constitutional one. If institutional independence genuinely matters, then it should be preserved. If institutional independence doesn't matter, then ministers should explain why Parliament was wrong to establish it in the first place. It is that question of necessity that leads directly to the government's principal justifications for these clauses the Dash review the government have repeatedly relied on that review as the intellectual basis for abolishing each SIB as the independent body.

Yet one. When one examines both the report itself and the evidence given by its author to this committee, the case becomes increasingly difficult to sustain. The review undoubtedly identifies a genuine problem. It concludes that the patient safety landscape has become crowded and in places confusing. Doctor Dash told the committee that she 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, and I quote, busy and confusing, and that there was distracting and that this was distracting clinicians from improving the quality of care. So, Roger, nobody disputes that unnecessary bureaucracy should be reduced. Nobody disputes that duplication should be removed where it genuinely exists. Nor, I think, would anyone argue against simplifying an overly complex landscape if doing so allows frontline clinicians to spend more time caring for patients. The question, however, is whether each SIB is the problem, because when one examines the evidence, the government have not demonstrated that it is.

Indeed, each SIB represents only a tiny proportion of that landscape. In its first 30 months of operation, it produced just 38 recommendations. Its annual budget is around £6 million. By comparison, more than £160 million is spent each year across patient safety activities. The overwhelming majority of recommendations within the system do not originate from each SIB at all, but from regulators. Public inquiries, Royal Colleges, NHS England and many other organisations. So I ask the Minister again if the concern is excessive bureaucracy across more than 150 organisations, why has the government chosen to abolish one of the smallest, most focused and arguably most cost effective organisations within that landscape?How does removing one body responsible for just a handful of carefully targeted, systematic investigations simplify the wider system in any meaningful way?And where is the evidence that each SIB itself is responsible for the duplication identified in the Dash review?These are important questions because during her evidence, doctor Dash repeatedly referred to simplification and alignment.

She explained that, and I quote the point of bringing it into the CQC is that we are trying to simplify this landscape. The hope is that by bringing each SIB into the QC, you can align the work of the two, end quote. But alignment is not in itself an argument for abolition. Many organisations work alongside one another. That doesn't mean they should be merged. Indeed, through public administration, we deliberately maintain institutional separation precisely because organisations fulfil different constitutional functions.

Investigators are different from regulators, auditors are different from departments, ombudsmen are different from the bodies about which complaints are made. That separation is not duplication, it's a safeguard. And as my hon. Friend the member for Harwich and North Essex has said, the Dash review itself gets some basic facts wrong. The review claims each SIB could not retain maternity investigations because the Health and Care Act 2022 made no provision for them. That is in my hon. My hon.

Friend's words wrong, in fact and law. The problem was not powers. It was safe space protections. So why have ministers accepted this assertion and many others that are simply untrue?The review then claims that each SIB has expanded beyond its remit by making systemic recommendations. My hon. Friend for Harwich and North Essex called that complete nonsense. Each SIB was created to do exactly that. Like the AIB, the MIB, the AIB.

It exists to identify system failures and recommend change. That was Parliament's intent from the outset. My hon. Friend speaks with particular authority, I think, because he chaired the Select Committee that proposed eight SIB and the committee that scrutinised that legislation. So why are ministers relying on a review that misstates both the law and Parliament's intent?Most concerning is the recommendation three in that report, and I, as my hon. Friend calls it the fundamental flaw in Dash.

It proposes that most safety investigations remain with provider organisations. Yet, as the Honourable Lady for North Shropshire has pointed out, Ockenden and Amos exposed the weaknesses of trusts investigating themselves. Families do not trust organisations to mark their own homework. Clinicians don't trust it. Patient safety groups don't trust it. Amos was clear where families lose confidence in local investigations, they should have access to an independent one. If not SIB, then who?That is the question ministers have yet to answer.

Now, during our evidence session, my hon. Friend the member for Sleaford and North Hykeham asked directly about the obvious conflict created by merging into CQC. Her response was strikingly brief. She said, and I quote, I don't see a conflict. I think they're complementary, end quote. With respect to doctor Dash, that assertion does not answer the concern. Two organisations may be complementary. That does not mean they should become one organisation, the police and the Crown Prosecution Service are complementary.

The National Audit Office and the Treasury are complementary. The Air Accidents Investigation Branch and the Civil Aviation Authority are complementary. Yet Parliament deliberately keeps those institutions separate because each performs a fundamentally different role. I therefore put a series of questions. I therefore put a series of questions directly to doctor Dash during our evidence session, I reminded her that the King's Fund, the Nuffield Trust, the Health Foundation, appeared before the Health and Social Care Committee and all three advised against bringing her into the CQC.

I observed that no one, apart from her and the department thought it was a good idea, and that observation, I think, remains true today. Concerns have been raised by former health secretaries, by patient safety organisations, by the professional bodies, by those working with within SIB itself, by academics specialising in patient safety and even by the Care Quality Commission. That breadth of concern must give ministers pause. I then asked what I believe is the central question before this committee. I asked doctor Dash and I quote, if the safe space element would be retained and each SIB would operate as an independent organisation.

How can you square the fact that it would remain independent and yet be part of the CQC if it does remain independent, what is the need to bring it into the CQC now?Sir Roger, I have reflected carefully on her answer. She returned once again to simplification. She spoke about aligning work and reducing duplication, but she did not explain why abolishing the independent statutory body was necessary. If, as the government repeatedly assures us, operational independence, safe space protections and investigative independence will all remain exactly as before, and that contradiction runs throughout the government's case.

On the one hand, ministers tell us nothing of substance will change. On the other, they ask Parliament to dismantle the very institutional framework that Parliament itself established only a few years ago. Those two positions cannot comfortably coexist. If institutional independence is essential to maintaining confidence, then it should remain institutional. If institutional independence is unnecessary, ministers should explain why Parliament was right to legislate for it in the first place. The government cannot simultaneously argue that independence is indispensable while abolishing the independent institution itself.

Nor is this simply an academic debate about organizational charts. This goes directly to confidence. Patients, families and clinicians do not read statutory drafting before deciding whether to speak openly. They judge organisations by what they are today. HCV is clearly understood to be an independent safety investigator. Perhaps tomorrow, when this law becomes law, when this bill becomes law, under these clauses, it would sit within the Care Quality Commission, the very body responsible for regulating, inspecting and assessing providers. However carefully internal governance arrangements are drafted, the public perception will inevitably change.

And once confidence in independence is weakened, rebuilding it may take many years, which is why I remain unconvinced. The government have demonstrated either necessity or the proportionality of these clauses. They have identified a real challenge across the wider patient safety landscape, but they have yet to demonstrate that abolishing one of the few internationally respected independent safety investigation bodies is the appropriate solution. Sir Roger, if the government's argument is one of administrative efficiency, the evidence we have heard from those who have spent years improving patient safety demonstrates why efficiency cannot come at the expense of independence.

Perhaps no better witness. Sorry. No witness was better placed to address that question than my right hon. Friend the member for Godalming and Ash. As the longest serving Health Secretary in recent history, and the minister who championed a new approach to patient safety following a number of tragic failures in the NHS, he reminded the committee why each SIB was established in the first place. He told us, and I quote, Modelled on the airline industry, where the Air Accidents Investigation Branch had a superb track record of identifying safety breaches.

There was a very good rail Accident Investigation Branch that does the same for the railway industry to make sure lessons are learned, end quote. That comparison is fundamental. The government present this merger as though it were merely an organizational restructuring. It is not. It represents a departure from a principle that's underpinned accident investigation in every major safety critical industry for decades. Those functions are deliberately separated because investigators must earn the confidence of those whose evidence they seek. The objective is not to establish blame.

It is not to prosecute. It is not even primarily to determine liability. It is to understand why the system failed so that the same tragedy does not occur again. My right hon. Friend explained exactly why the model was adopted for healthcare. He said, and I quote, the heart of what the AIB has is this concept of safe space where people can talk to it completely without fear that what they say will get passed on or used against them in a court of law.

And so they are very open about what may have gone wrong, allowing a rapid conclusion to be drawn. End quote. That sentence captures the entire philosophy behind each SIB. Safe space is not a procedural convenience. It is the mechanism through which investigators obtain the evidence that would otherwise remain hidden. People speak honestly because they trust the institution. They trust that investigators are there to understand, not to punish. That trust cannot simply be written into legislation.

It actually has to be earned, and it must be protected. For once it's lost. It is extraordinarily difficult to rebuild. My right hon. Friend went on to to his conclusion a very clear conclusion. He told this committee, and I quote, I am against the transfer of HSB to the CQC for two reasons. First, I am worried that it will undermine that safe space principle. I think the safe space principle is the bit of HSB that is working very well, and I'm worried that this will undermine that.

End quote. Sir Roger, that's a remarkable piece of evidence. The architect of this approach to patient safety is telling us that the feature of HSB that has proved most successful is the very feature that these clauses place at risk. He's not arguing that safe space will disappear overnight. He is making a more subtle, and I would suggest, more important point. Safe space depends upon confidence. Confidence depends on independence, and independence depends not only upon statutory wording, but upon the institutional identity.

Patients, clinicians and families know today that HSB is separate, separate from the regulator. However, carefully, ministers draft governance arrangements that perception inevitably changes. The government repeatedly assure us that Operation Independence will remain, but operational independence is not the same as institutional independence. Indeed, that distinction was brought into sharp focus during our evidence sessions. Doctor Rosie Winkworth, the chief executive of HCV, explained why safe space matters in practical terms rather than in legal theory. She said, and I quote, safe space means that people can talk freely to us about things that have gone wrong without fear of sanctions being told off by their line manager or losing their jobs, end quote.

She went on to describe the reality within today's NHS. We hear all the time about people who have ended up losing their jobs or getting into trouble because they've raised concerns. We are still working in a culture of fear. End quote. That evidence should concern every one of us on this committee, because the success of HCV was never based on an assumption that the NHS already possessed an open speaking up culture. Quite the opposite. It was created precisely because too many staff still fear the consequences of speaking openly.

Doctor Bennewith continued by explaining the SNP's independence gives confidence not only to staff but to its patients. She said. And I quote, this enables staff working in the service and patients to talk to us freely. Patients sometimes worry that we'll be treated differently. This enables patients to talk to us in the knowledge that they will not be named. End quote. Perhaps most tellingly of all, she described the trust that HSB had spent years building. She said, and I quote, we are now in a stage where we are growing that trust.

When we launch an investigation, organisations right across the country say, please come and see what's happening here. I worry that that might be impacted by the changes ahead. Those aren't the words of an organisation resisting change for its own sake. They are the considered concerns of the organisation Parliament established specifically to investigate patient safety without fear or favour. The government argued that statutory protections will remain, and I don't doubt the sincerity of ministers in making that commitment. But legislation cannot legislate for trust.

It cannot compel confidence. It cannot guarantee that a frightened junior doctor, an agency nurse or a bereaved family member will feel exactly the same about approaching an investigator housed within the regulator, as they do about approaching an entirely independent statutory body. It's not a legal question. It's a human one. Indeed, Doctor Bennewith recognised that if Parliament proceeds with the proposal as outlined in these clauses, legislation itself must go further than is currently proposed. She told us there needed to be, I quote, much more clarity about government's to protect independence, and that it is vital that there is a legal duty for the CQC to protect safe space, end quote.

Even the organisation being abolished is telling Parliament the safeguards in the Bill are insufficient. I therefore return to the central question if the government's objective is to improve patient safety, why jeopardise one of the very few organizations that have successfully built trust amongst clinicians, patients and families?Why weaken confidence in the one institution specifically designed to investigate systematic failure, independent of regulation and enforcement?And why abandon a model that aviation, rail and indeed every other major safety critical industry continues to regard as essential. Those questions remain unanswered.

Sir Roger doctor Dash sought to challenge the comparison with aviation. She accepted that she was aware that the Air Accidents Investigation Branch and the Civil Aviation Authority are two separate organisations. However, she argued that healthcare was somehow different. She told the committee and I quote, the more I've looked into it, the more I think there are limits to that analogy, end quote. She suggested that aviation investigations were more focused on identifying specific technical failures, such as a faulty component, and that healthcare safety issues were broader.

Questions about quality of care. With respect, I do not think that argument addresses the fundamental point. The lesson from the aviation industry is not whether a safety failure involves a bolt on an aircraft medication error in a hospital, or a failure in clinical pathway. The lesson is about how high risk systems learn. The principle is that those investigating failures must be trusted by those who provide the evidence. The principle does not depend upon whether that failure occurred at 30,000ft or at the bedside.

Indeed, the more complex the system, the more important that independence becomes. Modern healthcare, as we all know, I think, is one of the most complex systems in society. When something goes wrong, the answer is rarely a single individual's mistake. It's usually a combination of pressures, incentives, processes, communication failures, workforce issues, and organisational organisational decisions. That is precisely why each SIB exists. The purpose is not to determine who should be blamed. The purpose is to understand why the system allowed harm to occur.

That distinction is fundamental, my right. Of course I will.
11:32
11:34
None Portrait Speaker 1
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Very sad.
11:34
None Portrait Speaker 3
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Well, my hon. Friend makes a number of key points there, first of which is that he's absolutely right. What problem is the government trying to solve here?Because if if we believe in independence, if we believe in investigatory body, why. And we believe it's working well, why on earth and it's demonstrably working well, why would we change it?But he goes to that further point, which is not only are we just these clauses potentially looking at a translation transfer of each SIB into CQC, but it's adding risk and failure within that procedure.

So his point about how can we be confident that this system is going to work if a patient or a clinician doesn't want to stand up and put their head above the parapet because they're frightened that there will be some regulatory consequence, has to be a fundamental problem with what the government is proposing. And as I think I've said a number of occasions during my speech, we haven't had the answer to that. And there doesn't seem to be any answer forthcoming. But I may I may touch on that in a bit more detail in a moment.

Going back to my right hon. Friend for Godalming and Ash, he was very clear about this when he gave evidence. He told the committee, and I quote, my concern was that the NHS and actually health systems across the world are not very good at learning lessons when there are tragedies. That is the problem. He was created to address, and that's why I struggle with the government's argument, because 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 learn not to weaken the independence of that organisation.

The Right Honourable member identified the precise part of the system that remains broken. He said, and I quote, 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, end quote. That's the crucial point. The government's justification for this merger appears to be based on a concern that there are too many recommendations, too many reviews and too much duplication.

But the right hon. Member for Godalming. Ash's evidence highlights a different problem. The issue is not that we don't know what needs to change. The issue is that we we too often fail to act on what we already know. The answer to that problem is not fewer independent investigations. The answer is stronger accountability for implementing recommendations. Indeed, my right hon. Friend made that point very powerfully in his evidence. He explained that what there needs to be is a formal system with a legal obligation on the government.

He warned that too often recommendations disappear into what he described as agree in principle, which allows organizations to acknowledge a problem without committing to a timetable for fixing it. The government are proposing structural change because recommendations are not always acted upon, but that problem is not the existence. But the problem is not the existence of the problem is the absence of a sufficient accountability when recommendations are made, the government appear to be addressing the wrong failure. There is another important point from the right hon.

Members evidence. He explained that one of the long term purposes of HCV was actually to reduce the need for expensive public inquiries, he told the committee, and I quote, 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 were confident this wouldn't happen again. End quote. But 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. End quote. That's an important warning. If confidence in HCV is reduced, the unintended consequence may be more public inquiries, not fewer. More costs, more delay, and most importantly, more time before lessons are learned and acted upon. That is the opposite of what the government says it wants to achieve. Sir Roger, the government's second argument is that safe space can be protected through legislation, and I do accept that ministers intend to preserve those protections.

However, the evidence we've heard demonstrates that the issue is not simply one of statutory wording. It's about culture and confidence. 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 health care organisations, hospitals and GP practices care deeply about whether they are rated outstanding, good, requires improvement or inadequate. His concern was this and I quote, if a staff member is talking openly to SIB 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 that could affect my hospitals rating. End quote. That's the practical problem. The government argument. 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. And 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. A similar point was made by Professor Karl McCrea of Nottingham University. He stated while giving evidence to the Select committee, and I quote, 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.

End quote. The government's case depends on trust surviving that merger. The evidence tells us that trust is precisely what is at risk. Doctor Bennewith made a similar point from her perspective. She told the 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 proceeds, there would need to be much stronger safeguards, including, and I quote, a legal duty for the CQC to protect safe space.

End quote. I think that evidence is significant because this is not a witness arguing that change is impossible. This is the organisation at the centre of this proposal telling Parliament, telling us on this committee that the legislation as drafted does not yet provide sufficient reassurance. The government's response cannot simply be that they intend to be careful. The former Secretary of State said that the integration would be approached with, and I quote, enormous care. But we've got to ask, what does that actually mean in legal terms?Where are the enforceable safeguards?What prevents a gradual erosion of independence?Once he is part of the regulator?Because 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 and still drift over time. That is why Parliament creates independent institutions in the first place. It's not because ministers are untrustworthy, it's because good governance recognises that structures matter. And in this case, I think the structure matters enormously. Sir Roger, 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, then independence of each ship can be preserved.

But the evidence we've heard suggests the challenge is much more fundamental. The question is not simply whether information is legally protected. The question is whether staff, patients and families will continue to believe that it is protected and that distinction matters. During our evidence session, Doctor Bennewith 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 within the CQC might have access to protected material. She said, and I quote, the legislation needs to be much clearer about the protection of protected disclosure materials to give the system confidence in our ability to hold and not share confidential information.

End quote. That's the crucial point. The success of HCV depends upon confidence that information provided in confidence will remain within the investigation process. If there is uncertainty about when the information could move elsewhere within the organisation, then the very existence of that uncertainty risks undermining safe space. Doctor Bennewith went further. She explained there needs to be a legal duty on CQC to protect safe space. Sir Roger, that's a remarkable admission. The organisation, whose functions are being transferred into CQC, is telling Parliament the Bill as drafted does not provide that sufficient certainty, and 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 the independence, regardless of who happens to lead an organisation in the future, or who is secretary of state, or who is in government. And that is why Parliament creates these independent bodies in the first place. There's also a practical issue which can't be dismissed. Doctor Pennyworth explained that HCV is unique because it can investigate every part of a healthcare system, including national bodies. She told the committee, and I quote, at the moment we have the ability, being an independent organisation, to investigate any part of the system where there is concern.

End quote. 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 them. A regulator may look at whether an organisation has complied with standards. An independent investigator can ask a different question why did the system make it possible for failure to happen?Questions are complementary, but they are not interchangeable.

Indeed, Doctor Bennewith 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. Independent investigation can identify whether the system itself needs to change. Both. Both functions are necessary, but combining them risks weakening both.

These concerns also sit within a wider challenge around candour in healthcare. The statutory duty of candour was introduced following the Francis inquiry into the failures of Mid Staffs. Its purpose was straightforward when something goes wrong, patients and families should receive an honest explanation. Yet despite that legal duty, there remains evidence 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's precisely why the safe space matters, because each SIB 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 this, of course, is that government argues this merger will strengthen patient safety. Yet the evidence suggests it could weaken one of the most important ingredients of patient safety openness. Sir Roger, I also want to raise concerns shared with me directly by people working within HCP.

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 him into the CQC represents a backward step for patient safety. They also express concern that the rationale for the merger has shifted. Initially, the argument appeared to focus on streamlining and reducing duplication. Increasingly, however, the argument appears to be about reducing the number of safety recommendations being made. That misunderstands the problem.

The challenge, as I have said before, is not the existence of recommendations. The challenge is ensuring those recommendations lead to action. Indeed, I was informed that SIB has already been developing 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. And that brings me back to the evidence from my right hon. Friend for Godalming and Ash. He identified what I believe to be the central weakness in the government's argument.

He said, and I quote, the Bill does not do anything to address the bit that is not working well. And that bit is the NHS is still very poor on acting, on the recommendations that are made. That is the point that ministers need to answer. If recommendations are not being implemented, strengthened, strengthen implementation. If accountability is weak, strengthen accountability. If learning is not embedded, create mechanisms to ensure learning happens, but do not weaken the independence of a body responsible for identifying those lessons.

Because the risk is the government solves the wrong problem. It removes the independence of the investigator while leaving untouched the failure to act on what investigators discover. So, sir Roger, after considering the evidence presented to this committee and the evidence that we heard at the Select committee and the conversation that I've had with my constituents and others, I remain unable to support clauses 59 to 63. It's not because I oppose reform. It's not because I believe the current 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. And when. The evidence suggests that Hcbs independent investigative model is one of the things that are working and that failure lies elsewhere. They lie in whether recommendations are being implemented. They lie in whether organisations learn quickly enough. They lie in whether staff feel safe enough to speak up. And the answer to those problems is not to remove independence, it's to strengthen it.

The creation of HSB represented a recognition by Parliament that healthcare needed the same principles of independent safety investigation that served aviation, rail and other high risk industries so well. Those principles exist for a reason. When someone something goes wrong, society needs an organisation so that people trust to ask what happened?Why did it happen, and what must change to prevent it 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. Government says those 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, the trust matters. And for those reasons, I really do urge the minister to reconsider these clauses. If the government believes that there are improvements that can be made to co-ordination, accountability or implementation, then those discussions should absolutely continue.

And I know on this side of the House we would welcome that discussion. But clauses 59 to 63 go much further. They remove that independent status, which is so important. And they give. And 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.
11:40
None Portrait Speaker 11
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Thank you very much, sir Roger and I was particularly keen to speak on clauses 59 to 63 because in the 2022 act, which I took through as a minister, Habib was a key part of that, and I was grateful at that time. Alongside fearless and tough questioning from the now minister who was on this side of the chamber, I was grateful for her support. When column 564 of Committee Stage, she said, was a really important new body. And that column 566 it is a new and important body, which we are all desperate to ensure works well, and I think it is fair to say it does work well.

And my hon. Friend the member for Farnham and Bordon has set that out very clearly in his very detailed remarks and the thread running through his remarks, which I think is particularly important in this context, is the thread of trust. Trust by those who for whom something has gone wrong, or for where they report a problem, that it will be looked at independently and dispassionately. So I fear that what is proposed here is a deeply misguided decision, which has at its heart the heart of its logic, a fundamental flaw.

It fails to recognise, as I think, the Honourable Lady for North Shropshire set out in her remarks, a fundamental difference, that each SIB is very, very different in its role to the QC. It is an independent investigator, it is not a regulator or an enforcer. And yet somehow this seems to be conflated in what the government is trying to do here, and it's simply failed to make a logical case for the change. Now, the honourable gentleman who I always listened to with great interest on these matters, the member for various and Edmunds highlighted that patient safety should be what is at the heart of this.

And that's absolutely right. But patient safety goes hand in hand with those working in the system, feeling confident to speak out, to put forward the evidence, which will improve patient safety. It's not an either or. One is complementary of the other. So I think that it is important that this safe space remains, because that provides the conditions in which patient safety can be improved. Now, in her evidence, in um the first session of this committee, doctor Dash stated that she found more than 150 or so organisations operating in this space.

When she undertook her review. But she then, in column five of the evidence in Hansard 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. Only six out of 150. That doesn't ring true. That's not a tidying up of the landscape. That's a very, very narrow focus. So can I ask, um, when the minister comes to her concluding remarks, can I ask the minister who specifically determined those six organisations for doctor Dash and told her to look only at those ignoring the other 144 plus organisations, because my fear is.

And we all know that what a review comes up with is, to a large degree determined by the scope that is set for it. So I fear that by picking a mere six out of 150 plus, 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. Now, before addressing um. Specific concerns about the approach being adopted with the abolition of HS2, I do want to highlight a real challenge with.

Even if one accepted the premise, which I don't where it is proposed, those functions are transferred to. As my hon. Friend member for Farnham and Boredom has set out. As doctor Dash said at column four of her evidence on CQC, it still has a long way to go and we all need to acknowledge this. She then went on to say again in her evidence I would have hoped that by now many of those challenges have been addressed. Some of them have been, but some of them have struggled.

So we are talking about moving an effective organisation into another organisation. Quite apart from whether the merger is appropriate in terms of their different remit, but moving it into another organisation which, by the own admission, in evidence of the author of the review, is basically not in a fit state to receive those new functions. And 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, I would say, why make these changes at all?Because at the moment it doesn't look like the CQC is going to be ready, at least in the near future.

Based on the evidence we have heard. Of course I will.
11:40
None Portrait Speaker 1
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Mr. Johnson.
11:40
11:40
None Portrait Speaker 11
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Well, she's my hon. Friend. The Shadow Minister is absolutely right to highlight the. For want of a better way of putting it, the cumulative challenges that were potentially going to be piled on CQC at the top of the pre-existing challenges with how that organisation is functioning, and I, I read with great care the debate that took place last night in the chamber, which has been referred to by a number of honourable members, um in the name of my hon. Friend the member for Harwich and North Essex, and I do pay tribute to him for his work in this space.

I worked closely with him in the context of the passage of the 2022 act, and I know that patient safety is one of the issues that is is fundamental to what he seeks to improve and achieve in his place in this House. But I have to say, I agree with him that I fear that the dash review simply fails to make the case for these changes. And also, as honourable 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.

But the key and the fundamental challenge here is to establish. A way that people feel confident and trusting in. Challenging a culture of denial and blame. And we've seen this most recently in the context of maternity failings and maternity scandals, the need for that space, the need for that organisation and that ability to challenge the institutions is very, very clear. And I fear that what is put forward with this change actually weakens the ability to do that. Doctor Dash's.

Review, I fear, fails to fully recognize just how important that space safe space concept is, not just in how it's drafted, how it's framed legally, but in terms of, as my hon. Friend has said, in terms of how it is perceived by those who need to use it. Now, the CQC, of course, as we know, has a legal duty to act on information it receives, but that risks being conflated here. And I saw last night, for example, in the debate, I quote column 147 of the debate.

This was illustrated by a comment made by the minister's colleague, the parliamentary Under-Secretary of state. When she was responding to the comments from the honourable member for Harwich and North Essex, and she was talking about the criteria for disclosing protected information. Outside the investigative function, she said, and I quote those criteria set a high bar for any disclosure as high as it is currently with each SIB, and the CQC will publish further guidance, setting out much more detail. And this is the key point.

She goes 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 chief executive officer. That is an inherent conflict. If you've got the person who is the head of the regulatory body, who's making the decision on whether or not information should be disclosed by each SIB in its folded in form, that will do nothing to inspire confidence in disclosure and the safe space provisions.

So I fear that that drives a coach and horses through some of the arguments being made, that there are sufficient safeguards within this merger that will ensure he can continue, as it has done thus far. Now, the crux of some of Doctor Dash's arguments appear to be that there are, and the minister's also alluded to this there are too many recommendations being made. It is a complex landscape. Yet, as my hon. Friend for Hydrogen North Essex, set out yesterday, has made 56.

He went on to say it's the 30 or so public inquiries and other investigations that have delivered 1400. So it simply doesn't follow that SIB is the problem in that complex landscape. And what was made very clear again by my hon. Friend the member for Farnham. And boredom is that, of course, the concern is not the recommendations, it's not the organisation making the recommendations that is responsible for the fact they're not implemented. It is the NHS itself, its inertia, it's unwillingness and department's unwillingness to take them forward in a coherent fashion to drive those recommendations through and monitor whether they have actually been delivered by the NHS.

I give way to Shadow Minister Johnson.
11:40
11:40
None Portrait Speaker 11
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Well, I'm grateful to my honourable friend, and I do think that the scope of the review and who determined those six organisations and how it was looked at is important, and I'm sure the minister will be able to clarify that when she makes her concluding remarks. But there are a couple of other issues that that concern me in some of what what was in the review, which seems to be the basis on which this is being done. Finding six, suggested of having expanded it, and I quote, scope of work beyond the original remit goes on to say, for example, H.

There was originally established along the lines of safety, investigatory bodies and 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 2022 legislation through, that is simply not the case. The act does not limit Habib investigations to individual incidents, and in some of the debates, in the context of the Habib clauses in that legislation, if I recall, I think we alluded as a committee to the need for it to be able to look beyond individual incidents and try and draw common themes.

So that simply does not appear to accord with my recollection of the purposes of that legislation. And then again, I think my hon. Friend the member for Farnham and Boredom has highlighted this. Um, recommendation three proposes most investigations into safety incidents should continue to be managed within provider organisations. That is the real challenge here. Habib's independence is what allows it to range across the piece, to have issues raised with it, and to look at individual organisations, because 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've made the complaint as they have a right to expect.

Yes, of course, I'd be.
11:40
11:40
13:59
14:00
None Portrait Speaker 2
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Um, of course, the shadow minister is absolutely right. Um, perception is a problem, but the reality on the ground is perhaps the even greater problem. And both of those are issues here with what the government plan. Now, there could be there could be a reason why this merger or the abolition of hcid needs to happen. But we haven't seen that compelling argument. We have seen some attempts at a justification, but they seem to be incredibly thin, and that's being generous.

The principal argument seems to be that there is a busy and confusing landscape when it comes to investigatory and regulatory bodies. Indeed, I think figure that doctor Dash put forward was something like 150 different organisations, and she was asked to review just six of those. So even if she were to have abolished all six of those, it clearly does nothing to reduce the busy and confusing landscape. And my honourable friend the member for Farnham and Boredom made that point very, very well. But a busy and confusing regulatory landscape should not be a justification for getting rid of an essential investigatory body and disincentivising the investigation process and whistleblowing and disclosures by tying it up with the regulator, which itself may be at fault.

Streamlining dealing with the busy, busy and confusing landscape these are objectively good reasons to do something, but not this. And again, in evidence. Friend the member for Farnham has referred to this, but I'll say it again in evidence at this committee. The question was put to doctor Dash, the author of these recommendations. What. Dealing with the busy, busy and confusing landscape. These are objectively good reasons to do something, but not this. And I think that is the central point.

And again, in evidence. AM I right, hon?Friend the member for Farnham has referred to this, but I'll say it again in evidence at this committee. The question was put to doctor Dash, the author of these recommendations. What happens if there is a problem with the QC?One once eight H has become part of it, and I think we rightly expected a fairly clear answer on that. The answer that. What happens as a. Rhetorical response what happens if the problem is this organisation or that one.

That was the response from doctor Dash. But we're not talking about what. If there's a problem with this organisation or that one. We're talking about the QC, the organisation that will become. If there's a problem with another organisation, H SIB can investigate it. If there's a problem with the QC now, H SIB can investigate it, but when he becomes the QC, there is plainly a problem with investigating the C QC, and when that question got put to the very author of this report on whom the government is relying, no answer was provided but a rhetorical question.

Back to my right hon. Friend who put the question to her in the first place. So I urge the minister to reflect. There is a major issue here that hasn't been addressed, and until she can articulate it, or those on whom she rely can articulate it, I urge her to delay these proposals.
14:05
None Portrait Speaker 3
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Doctor Peter.
14:05
14:06
None Portrait Speaker 5
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Thank you, Miss Lawrence. Pleasure to serve under your chairmanship this afternoon. And we've had a, you know, a really good and fairly detailed, um exchanges this morning about patient safety, learning and the role of Hsu. And I want to start by really being very clear that I absolutely take, uh, you know, often qualities are very confrontational and divisive, but absolutely take at face value that every single member who has spoken that I have met with in including people who want not to see this change, uh, do so with the best of intentions, which is to understand how patient safety and as long as we can talk about safety, we talk about quality of service, let's focus on the safety aspects here are trying to navigate something and seeing a change and change is always difficult and ensuring we get that right.

And it's absolutely right that we do that in committee here. We'll do it at report stage, and we'll do it in the House of Lords. And that is absolutely right. Um and we will continue to take notes and comments of all points made and, and seek to address them. And I will do that now. I've fortunately, Miss Liu had the the break of lunchtime to be able to reflect and do that a bit more carefully. Um, this afternoon.

So I do want to pay tribute to all of that. And I think the other thing, um, for people here and reading our deliberations is of course, what is difficult about a bill and we understand this as legislators in the bill, we are abolishing an organisation and moving functions that stands within a wider framework of changes to the safety and quality landscape that the government is seeking to do. Uh, and, um, you know, one focuses on things that you are abolishing. Uh, that's a sort of very binary, isn't it?So I will try and locate some of that without veering too far.

Miss Lou, from the matter in front of us. Um, so it is this question, um, and I think amongst all the discussions, there's a couple of key questions that I want to address. Um, amongst a lot of discussion, um, which is why I do this and through the passage of coming through with this bill, in fact, many people in the wider landscape have just said to me, why are you bothering, why are you bothering having a row about this?Um, now I do find that quite shocking actually, um, as a sort of riposte, because the answer is simple really in the context that it is too important not to attempt to get this right and to make some changes to something that clearly isn't working.

And I don't think I've heard anybody say that the current system is working. Um, and as the honourable member for Milton System noted, I said during the passage of 22 act, um, that the function, the functions of HCG is really important and must be built to the highest standards. And I, of course, absolutely stand by that. So the issue isn't it isn't working. It's why we're changing it. And that's why we're also though, preserving the function within a new system, which we seek to improve.

I'm going to try and go through these points because I have listened very carefully to everybody's everybody's contributions, and if there is something outstanding, I'm happy to come back to it. So if I can take first the dash review itself and to answer some of the questions that were put to me, um, I don't recall, again, anyone particularly disagreeing with the findings of that review when it was published or indeed when we put it forward in our ten year plan, which we did last year. Now, while everybody, I don't expect everyone to agree with every single recommendation, every single point that was made in that review, it was informed to an earlier point that was made by the opposition, by a really broad range of evidence and perspectives from across the health and social care system, including engagement with commissioners, providers, patients, families, people harmed by poor quality care, as well as charities, academics and national organisations.

And it looked really closely at what hasn't worked and why. And I do commend, as I did previously, honourable members, to really go back to that and to to the work that Penny Dash was asked to do and the wider report. Um, now, one of the questions that was raised, I think, by the honourable member for Farnham and Boredom, and I think reiterated by the Milton's system, was about why did the review only cover six organisations?And just to be very clear, the then Secretary of State authorised the Dash review to look at six organisations in this space who are directly overseen by the Department, and that's why it did so many other organisations in this space are not directly overseen by the department, so they weren't in scope of that review.

And obviously they have their own regulatory landscape, the colleges, etc., etc. and that is that is why six organisations that we oversee were looked at. And again, and the Minister made this clear from the despatch box last night the. Rationale of why we're making this change is not based on cost. It is not based on the. The recommendations being too expensive, rather, as I'm sure um colleagues will agree, we've seen far too many recommendations regarding patient safety, but two little action and inaction is not helping improve patient landscape.

Uh, the patient landscape. And again, we've heard from colleagues opposite and I think, and a great respect and spoken to the former health secretary, the longest serving health secretary, the member for Godalming and Ash. Um, uh, about the need for the NHS to change, uh, or that it won't change. It won't adopt the recommendations. I mean, I profoundly I think that's profoundly depressing prospect. If we predicate our laws and the landscape on the basis that the culture cannot and will not change, it is not possible to continue in a way, with the NHS accepting that the culture cannot and will not change the recommendations.

And the way we have now got to in the last decade or so. And it's not a party political point this, but it's a point made across lots of areas is that we need to do other things to help move from a defensive culture into a culture of learning, into a culture of keeping that safe space so that people are able to speak. We've heard a lot about this word perception today as well. I accept that. I accept there's a perception, negativity that is damaging to patient safety and people speaking up, but that overall, as part of our wider reforms, is what we are seeking to do.

Honourable members, I will briefly.
14:12
14:12
None Portrait Speaker 1
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Minister.
14:12
None Portrait Speaker 5
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I thank my hon. Friend for that. And and he and others on all sides of the House with their clinical experience, including the Honourable Lady, the spokesperson opposite, do bring those very lively examples that shock the layperson, that things can happen and do happen. Um, and, um, you know, how they, how they can be led clinically to change, which I think is really important, but it is up to government to make sure that the overarching framework and legislative framework does help with that. Um, can I, I do want to make some points and I will pick up any other points that are outstanding, the abolition of Hib and the transfer of its functions to CQC is being done.

I want to be really clear about this, to strengthen the link between patient safety investigations and the action being taken on the front line to simplify the patient safety landscape, we want to align. We want to align the recommendations with action. So honourable members quoted evidence that doctor Dash gave to this committee. So let me also remind you of something else. She told the committee during her evidence about how HHC functions can be better aligned as part of the CQC, she said by bringing him into the CQC, you can align the work of the two.

For example, if the CQC is going around the country and spotting a particular problem with the way in which anesthesia is being given or with managing patients post-surgery. The CQC would then say to him that the team with specific expertise, can you go and look at this?Can you do a detailed review of this particular area of care that we are spotting through our visits, and which seem to be a particular challenge?The CQC can identify a problem and then ask HHC to review it in detail, and hopefully it can bring its expertise in investigations into the CQC to enable the CQC to go deeper and then come back to the NHS to enable best action.

These organisations can learn better from each other. Now, transferring investigation powers to the Care Quality Commission will be an opportunity to strengthen the CQC and as you know, as I've outlined, we have to move away from a defensive culture to one of shared learning if we are to improve patient care, CQC can learn and improve from best practice. It can take a more holistic approach to patient safety. The regularity and investigatory functions can learn from each other in exchange skills strengthen the link between learning oversight and improvement, leading to real, sustained change across the system, which they can drive on safe space.

It's a really important issue, and I've said it before, and I'll say it again the bill protects safe space, safe space protections will continue to apply following the transfer of investigation to CQC. Sensitive information obtained by the CQC during the course of an investigation may not be disclosed to a third party by the CQC or its investigators, as is currently the case for the Health services safety investigations body. The bill sets a high bar for exceptions to this prohibition on disclosure. This is a point raised by the opposition, so I did want to address this.

The limited circumstances in which disclosure may be permitted are set out in the Bill, and the CQC will appoint a designated responsible person, and we do envisage it being the chief executive who'll be responsible for decisions relating to the disclosure of protected information, ensuring that any such decisions are made consistently and in accordance with the statutory framework. The CQC has provided assurance that the high bar for decisions to disclose in exceptional circumstances will be upheld, and this would ensure that disclosure of the regulatory to the regulatory function may only occur when a statutory exception is met, providing the confidence to stakeholders that safe space at the level and strength that it operates under.

The HHC body is maintained and continues to be an integral principle to investigations. In terms of the other issue that was raised by, I think, members of the opposition, this issue about CQC looking into itself, and I can reassure the Committee that, if necessary, the CQC investigatory function will be empowered to do this. The investigations function within the CQC will have autonomy to launch investigations into any part of the health system, including other parts of the CQC if required, and make recommendations to any part of the system, just as it does now.

There will be no. No barrier to investigating whether CQC inspections are causing unintended harm, and if they are. And the investigator feels a recommendation for change should be made, they will make it. The insight gained from investigations will continue to inform recommendations concerning the CQC regulatory functions, and the Bill allows for the investigation functions to make recommendations to CQC in its report, and the CQC would be legally required to respond to such recommendations. There'll be no no need for litigation through the courts.

I think this is an important point. Again, I'm addressing the points that we made opposite. Now many organisations, um, are, you know, and I think we continue to set this out more clearly for members. I'm happy to find different ways to do that. Many organisations have different functions and responsibilities that they have to discharge simultaneously. This is a wider point about whether you can have an investigatory and a regulatory function in the same body. Um, we've also heard a lot about the the safety body, which of course is part of the Department of Transport.

This happens across a lot of bodies. I totally accept that it is helpful for the debate to be clearer on what some of those bodies are, and we will come forward with more information on that. But it is the. I'm going to I'm going to persist on some of these points. I think I've addressed all these points. Um, it is the job of effective leadership to manage those interests and responsibilities. And that is what we expect of the CQC leadership.

Miss Liu, if I can turn to the various amendments, also moved on this topic that we've gone through this morning. And can I thank the member for Sleaford and North Hykeham and the honourable member for North Shropshire for tabling them. First on amendment 55, which would make provision for the Secretary of State to Disapply investigation. Powers in certain circumstances, and I recognise the importance of ensuring that investigatory powers are not exercised in relation to sensitive crown or government premises where there is an interest of national security.

And I want to be clear, this bill already provides for this. The bill also amends section 96 of the Health and Social Care Act 2008, so it applies to the new investigatory function of CQC, and section 96 makes provision for the application of CQC legislation to the Crown, and. This means the mechanism. The amendment is seeking to introduce is already in place within the existing legislative framework. Additionally, the Bill already provides for a power which enables the Secretary of State to disapply these investigatory powers in relation to Crown premises when it is in the interest of national security.

The amendment would therefore duplicate an existing provision and would add unnecessary complexity to the legislation without delivering any additional benefit on amendment 56. This amendment would allow the Care Quality Commission to recover charges that are higher than the actual costs it incurs in providing assistance to anyone other than an NHS body or the Secretary of State. Now, I understand the intention behind the amendment, which is to give the Commissioner greater financial flexibility, but the government doesn't really think this is necessary. The charging framework in the bill is based on a clear principle of cost recovery, and removing subsection nine would mean the commission could charge more than it actually costs to provide the service, and in fact, this would shift away from recovering costs and towards allowing the commission to make a surplus from its charging powers.

But I would on that point.
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None Portrait Speaker 5
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Um, my I'm happy to get back to you on that specific point. That's the case. Um, but essentially it's about recovering costs and not making a surplus in this area, which I think is what the amendment does. If that's not the case, I'll make sure that she gets a proper correction. The government does not think there's a good case for it, because the aims of the British, as I've said, are to provide for a cost recovery and a fair and transparent way not to raise particular extra income beyond its cost.

I'm not sure if she's alluding to it. It might be a good thing for for them to make additional funding, but if that's not clear, I'm happy to go back to her. Um, it makes it makes recovery across more predictable and consistent for those who have to pay with them. And that is usual for these public bodies. Um, new clause 42 relates to funding provisions for the axes, new investigative function. The department already provides grant in aid to the CQC to adequately provide funding for investigations and special reviews.

And similarly, this budget is provided through grant in aid and is set each year when CQC takes on functions. These funding streams will remain distinct and CQC will have to provide assurance to the department that the amount allocated to the new investigation function is being used for that purpose, and funding decisions for the investigation function will continue to be captured in wider departmental budget planning processes and considered centrally. This provides assurance that business and strategic priorities for the investigation functions can be met, and robust financial oversight will require the CQC to demonstrate that grant in aid is used appropriately and solely to support the investigating function, without the need to prescribe funding arrangements in legislation, as already an operational mechanism for the Secretary of State to provide adequate funding and resources for investigation, this amendment is not needed.

It would also be inappropriate to prescribe the funding form or level in legislation, and it reduced the department's ability to manage funding through established spending review estimate process, introduce unnecessary rigidity as the merged function evolves, and risk creating binding funding expectations that may not align with future or fiscal constraints. A non-legislative approach ensures flexibility, scale, and adaption of adapt the function while maintaining robust oversight. Moving Miss Lowell to Amendment five. Moved by the Honourable Lady for North Shropshire. Um again, I recognise and agree um actually with the intention behind this amendment, which is essentially, as I understand it, to ensure that the health service safety investigation, body functions that are transferred to the CQC retain that high level of operational independence and continued to command the confidence.

A word we heard a lot this morning and I completely agree the confidence of patients, family, healthcare professionals and the wider public. And similarly, I understand the objective is to maximise the perception. Again, a word I come back to this perception issue, which I think I've tried to address early, to maximise the perception of independence within the CQC. So we have protected safe space in legislation. And I agree that operational independence of the investigation function is required. Our plans are supportive of this and enable it, and for this reason we cannot support the amendment because the amendment would impose a highly prescriptive governance structure on the CQC by requiring the creation of a separate statutory committee setting out in primary legislation detailed requirements regarding its purpose, membership appointments and operational arrangements.

And while the government fully agrees that effective safety investigations must be conducted independently, objectively, we do not consider it necessary to place such detailed organisational arrangements on the face of legislation because the Bill already provides a clear legislative framework for the transfer of these functions and enables the CQC to discharge them appropriately within its broader statutory responsibilities. Further, the CQC already operates within a robust statutory framework and is capable of establishing governance arrangements that support the effective delivery of its functions, including appropriate safeguards to protect investigative independence and the handling of safe space material.

And the amendment would reduce organisational flexibility by mandating a specific committee structure, it would constrain the ability to adapt its governance arrangements over time in response to operational experience, changing circumstances or future improvements in best practice and governance. Arrangements would become fixed in statute rather than being capable of evolving as the organisation learns and develops, and these additional administrative and governance requirements would increase bureaucracy and complexity, which is exactly what this government is looking to reduce. So, Miss Lou, and again, I think this is key. I'm going to re-emphasize this point.

In addition, a statutory committee would weaken the important links between learning and action that the transfer of this organisation is intended to support. And one of the key benefits of bringing these functions into the CQC is that opportunity to strengthen strategic oversight, ensure that learning from investigations can more readily inform improvement activity across the system, and creating.
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Minister.
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Again, I think we're probably going to not agree on this point because I think have made the point several times, and I think we've made that in the Dash review about bringing these organisations together. As I said again in my opening comments, it's about the opportunity to get this right, to share that learning. And it's not about the cost, it is about aligning the recommendations and the actions that follow through from it, and that learning, that opportunity to push that through, I think, is one that we should absolutely grasp.

Coming back to the amendment, creating a separate statutory committee risks introducing additional layers of separation that could slow the flow of intelligence and impede timely action in response to emerging patient safety concerns. We believe the integration of investigatory functions can be can be secured through clear statutory functions and appropriate safeguards, rather than through two rigid organisational structures set out in primary legislation and establishing detailed governance requirements in statute may also make future improvements more difficult to implement without legislative change. For these reasons, I understand and respect the concerns underpin this amendment, and the government believes the bill already provides the necessary framework for the safe and effective delivery of health services safety investigations following their transfer to QC.

Now, we will, of course, work closely with the CQC and HCB on their transition arrangements through a Transition board where the issues to ensure operational independence of the investigation function and the ways in which that learning is shared, and to the further to the opposition spokespersons point, how we make sure that learning is shared and actually creates an impact and those that impact is felt most clearly. And it's for those reasons I ask the honourable members to withdraw their amendments and commend clauses 59, 60 and 61 to this committee.
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She said.
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Practically no.
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I.
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I.
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No.
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Robertson.
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No.
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Joe. Robertson.
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I.
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Karen Smith.
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No.
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Offered a.
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No.
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A.
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Jerry. Robertson.
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A.
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No.
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Nine.
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No.
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I.
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Laura. Kirk-smith.
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I.
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I.
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No.
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None Portrait Speaker 5
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Thank you. And clause 62 underscores the importance we place on special reviews and investigations. And it maintains the Care Quality Commission's ability to conduct them. So the clause simply ensures that the Cqc's investigatory role remains properly aligned with its original statutory purpose. The CQC is the independent regulator of health and care providers, and in the case of commissioners, it has the powers to undertake a special review or investigation when requested by the Secretary of State on 30th of January 2024, the Secretary of State commissioned a section 48 review into the mental health services in Nottinghamshire following the tragic events of June 2023.

As we know, it reveals serious and systematic failings and led to strengthened oversight and a clear improvement plan. With NHS England being abolished and its functions transferring into the Department and across the wider system, this clause removes NHS from the scope of section 48 and allows ministers to set out, through regulations, the future scope of section 48. NHS England's commissioning functions will mostly transfer to the integrated care boards, but, as we have discussed previously, NHS most specialised commissioning functions will transfer to the Secretary of State and in future regulations will set out the specific commissioning functions which the Secretary of State is responsible, and that CQC may review or investigate the scope of the special reviews and investigations will continue to apply only to commissioning functions under the NHS act 2006, or section 117 of the Mental Health Act 1983, remaining within the CQC existing remit.

This approach ensures that CQC investigation powers are not automatically extended to departmental functions, which would fundamentally change the relationship between an arm's length body and a government department, and which would not align with the original intention of section 48 reviews. And for that reason, the bill provides for scrutiny through secondary legislation. This sets out a transparent and accountable way to specify which commissioning functions are in scope, enabling parliamentary scrutiny and CQC oversight where it is genuinely relevant to patient safety and quality. This approach also provides important flexibility as commissioning arrangements change.

The right function can be brought into scope without unnecessary delays and taken together, this course protects the Cqc's independence, maintains accountability and provides a sensible framework for scrutiny where it adds real value for patient safety and care quality, and I therefore commend this clause to the committee.
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Thank you.
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Miss Liddle. The ten year health plan reaffirms the government's commitment to families affected by bereavement or serious harm, ensuring that lessons are learned from their experience and that more cases are fully reviewed and acted on. Families seek closure following serious harm or death of a loved one by wanting to understand what went wrong, what could be done to stop other families experiencing similar trauma, and to hold someone to account. And families often turn to the Care Quality Commission for help. Clause 63 extends Cqc's power to bring proceedings against a health and social care provider for serious breach of regulations from the existing limitation of three years from the date of the offence to five years.

Now, let me be clear with the committee the extension to the three year limitation from the time of the offence does not alter the first requirement that the CQC should act within 12 months of sufficient evidence when it becomes available about a serious breach of regulation. That 12 month window for action, once the regulator is aware of the offence, remains unchanged. The extension of the limitation period to five years from the date of the offence will mean fewer events that should be considered by the regulator will effectively time out and go beyond the reach of the regulator's action.

Now, CQC is not the only body with an interest in investigating serious breaches of regulations that result in an unnatural death. There are other investigatory bodies, such as the police, with equal interest and powers, to investigate deaths for the purpose of pursuing criminal prosecution. The coronial process serves a different purpose. A coroner's role is to establish facts surrounding an unnatural death, rather than finding fault for a complex case, a police investigation or a coroner's inquest. Sometimes both can take time to conclude, and these independent processes are a useful source of information to the CQC to form a full picture of a breach of regulation.

Further, a culture of learning from investigations, enquiries, errors and poor care should be the norm in the NHS and it is therefore expected that a service provider may also commission its own internal investigation to learn from an unnatural death. Furthermore, there are cases where the CQC is approached late with information after an offence may have been committed. For example, CQC may only discover, having received information two and a half years after offence is committed, leaving little time in the remaining six month period to investigate. Extending the period to five years would help mitigate against such in such circumstances, and that's why we're extending the statutory limitation period, and this will ensure that in far more cases, CQC has the ability to address the serious regulatory failings that it should and must risk.

It must do without a risk of falling foul of a time limitation and are therefore commend this clause to the Committee doctor. Caroline Johnson.
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None Portrait Speaker 1
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Johnson, I was saying that the minister talks about changing the time period from which proceedings can be affected from three years to five years, but also that once, um, once the, the um. Once they're aware that it could be, it could be brought that there is evidence that it needs to be looked at, they still only get the same 12 months. So, so that hasn't been changed. And I just wondered what the rationale for that was. I'm not criticizing it, just asking the question.

The other question is it's prospective. So that. Means that if an offence were to be committed immediately after the act was passed, effectively for the first three years, things will be as they are now because it will be only after three years that the change from three years to five years will be relevant. So the commencement clause 71.2, says it won't come into force until two months after the act is passed. And I just wondered why, given that it will take three years to come into effect.

In any case, in practical terms, it doesn't come into force on the day the act receives royal assent. The other um. The other question is in relation to how many additional cases the impact assessment talks about. 2 or 3 cases a year and talks about £4.3 million cost over ten years, with fines of £2.7 million costs over ten years. So, um, a couple of questions. Will, will the um the regulator keep the fines themselves or do they go back into the Treasury and does the um can.

The minister guarantee that the additional funds that are required are estimated to be required for the additional cases under this new regulation?Will they can she guarantee that that money will be provided so that they can do the investigations, that she's providing them the opportunity to do?
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Minister.
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Thank you, Miss Liu. Um, and clause um, a popular clause. As is right, I absolutely recognise that this is this is a provision in this bill that has um listed a lot of interest amongst our constituents and, and the wider public. So it absolutely right. I look forward to hearing people's contributions. Um, because um the clause and the schedule taken together do provide for the abolition of health watching, which is something that we, the step that we're not taking lightly in some areas I want to pay tribute to actually everybody who's involved in this work.

Um, but in some areas, Healthwatch has played a really important role in amplifying the experiences of patients, families and carers. And those insights have helped shape services over many years. But the system for capturing feedback has become fragmented, with, again, multiple routes for producing large volumes of information. Without clear ownership or indeed crucially, action and impact to make the changes that are needed. The arrangements we have are divorced. They divorced those listening to patients from those with the power to make the change.

Patient voice has left outside lobbying in too far away from local commissioning and national policy making. Decisions take place, and as set out in the ten year health plan, we are simplifying the landscape so that listening to patients and users is not something done at arm's length. It's not something that you have to do as part of your commissioning process. And, you know, partly tick the box. It's fundamental to the commissioning process and the work of these organisations is a core responsibility at the heart of government and across the NHS and local authorities, and that's why we are bringing patient voice in House to give it a greater profile at the national level.

Within the Reform Department of Health and Social Care. This will lead to a step change in how the department considers patient experience as an ongoing part of national policy making, and with the appointment of a director of patient experience within the department, they will be responsible for overseeing a more coherent approach. This will include stronger national surveys to collect feedback, a reformed complaints process that's easier to navigate, and clearer local arrangements so that concerns are heard early and resolved quickly. The creation of the new Patient Experience Directorate does not need legislation.

However, the requirements in the health Bill for the Secretary of State to oversee and have the ability to issue guidance, to Icbs and local authorities and best practice for obtaining use of views will ensure the department plays a central role in strengthening patient voice and holding the system to account. The Patient Experience Directorate will also ensure the experience of diverse communities and seldom heard groups feed into the design and delivery of services. This, in turn, will help improve experiences and outcomes and reduce inequalities. I know that some are worried about across this House, and the committee are worried about abolishing Healthwatch England and that we could weaken the patient and user voice, and I cannot stress more clearly that that is absolutely not our intent.

Our intent is the exact opposite. We want to make feedback easier to give and crucially, harder to ignore and more directly linked to improvement. Patients and users should not have to work out which organisation to tell the government should be accountable for listening and taking action. And I'd also remind honourable members that there is no shortage of independent outside scrutiny of government in NHS, from the Parliamentary and Health Service Ombudsman to the Patient Safety Commissioner now sitting within the MHRA alongside a wide number of the voluntary and community and social enterprise sector organisations, all of which in our in our in our local communities, we know well we have not lacked recommendations.

Rather, and we've heard this in recent debates. What we've lacked are the actions to fix the issues they address. And this is why this clause is vital to bring in patient voice in house into the department, and will ensure that patient and user insight informs policy and decision making at the highest level, where it cannot be ignored. And I therefore commend this clause to the committee.
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None Portrait Speaker 1
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Thank you, Madam Chair. I rise to discuss Group 47, which includes clause 64 and schedule nine. Um clause 64 abolishes Healthwatch England and introduces schedule nine to facilitate it, something which I believe is in the state. The impact assessment talks about the roles of local Healthwatch and Healthwatch England, with local Healthwatch obtaining reviews, making reports and recommendations, promoting and supporting public institutions, and providing. Signposting advice and giving the views to the Healthwatch England more nationally. Healthwatch England is then to provide leadership, guidance and support to the local Healthwatch.

Escalation to the CQC, which we've heard a lot about already, and advice to the Secretary of State for NHS England. Now. Members may be familiar with the term nothing about us. The idea that policy shouldn't be decided and services shouldn't be shaped without participation of those who will use those services, those who will be affected by the decisions that are made. And as a medical practitioner, I believe that's an important principle. Patients must have a voice because it is they who have the lived experience of their conditions.

They know their specific needs better than any, um, their specific needs, better than any person or civil servant in Whitehall. They know what's working and they know what needs to change. Um, and if you look at the history of patient voice chair in the two decades after the NHS inception, the provision of care was really quite paternalistic. Patients didn't really have any role in shaping the services that they received. This changed in 1974 with the establishment of the Community Health Council, made a volunteers and they commissioned.

They carried out research. They conducted visit to inspect standards and. They represented communities. When changes were proposed. They also helped the public with information about local services, including how to make complaints. So it's a very similar sort of processes. Um, the Labour government abolished community health councils in 2003. Um, although a cursory trip to Hansard reveals that the government had repeatedly stated before the publication of the NHS plan that at that point they envisaged no immediate changes to community health councils, but they did go on to do so.

Um, and again, this reminiscence at some point of today, because abolishing Healthwatch wasn't in the Labour Party manifesto anyway, in 2003, the community health councils became the Patient and Public Involvement forums, and five years later they became local involvement networks. So the names have changed and the structures have changed. But the principles of patients having an independent voice remained in Healthwatch is the latest iteration, to be precise. Healthwatch England was established initially, initially as a committee of the Care Quality Commission in 2013, operating the hub and spoke model with over 150 local health watchers spread across local authority area.

Chair Healthwatch has played a vital role in exposing problems in the health service. Indeed, even The King's Speech contained a reference to Healthwatch England. According to Healthwatch, England, May 2025 report, nearly 1 in 4 adults have noticed inaccuracies or missing details in their medical details. Medical records, such as incorrect personal details, inaccurate records of medicines, diagnosis, treatments and conditions. I also noticed that the minister herself has relied on Healthwatch when bringing the problems facing her constituents to the House. And I quote in a recent adjournment debate about Bristol in the South West, I raised the issue of pregnant constituent who was unable to access care at a critical time.

This is the number one issue raised by Healthwatch. Patients are struggling, so Healthwatch is valuable, and I invite members to look at the impact Healthwatch had in 2023 2024. Over 925,000 people used their local Healthwatch to get advice and information about their health and care. More than 329,000 people shared their experiences to help improve services in Healthwatch England, helped secure changes by Royal Mail so that NHS letters can be delivered to patients on time. They also led new NHS guidance that patients commencing cancer treatment should have priority access to an NHS dentist.

A piece of Healthwatch research indicated that millions of eligible adults may be missing out on social care. Recently my local branch, Healthwatch Lincolnshire, produced a report on the challenges facing carers nationally. Chair Healthwatch has influenced the future of ADHD care, encouraged uptake of cervical cancer screening and so much more. And that's why many of the public and health experts are alarmed by the government's plans. Healthwatch has success, as we've heard today already, from in relation to each SIB. So the success with Healthwatch is due to its independence.

But the government wants to do away with this independence. Its policy paper commits to replacing Healthwatch with a new patient experience directorate that will sit inside the minister's department. So instead of organisations embedded in communities sitting on local health and wellbeing boards, the public will need to interface with the minister's department. How can the Minister guarantee the independence on the perception of independence of the new directorate?How can she be sure the public will have a trust in it?I remind members what the councillor, what doctor?Wendy Taylor of the Local Government Association said.

She said the current proposals to disband Healthwatch and allow health and social care services to gather and respond to feedback, rather than being challenged by an independent voice, risks organisations being seen to mark their own homework. When Healthwatch conducts surveys, it often solicits information that proves problematic for the government of the day. How can the public have confidence that the new directorate's process will do the same?What will stop the Secretary of State asking what?Deciding what questions get asked and what data gets published?AM reading of the bill chair.

Nothing. The government has made clear alongside the new director of Icbs will take over several patient voice functions and I appreciate this is straying slightly into the following group chair, but it's very difficult to separate Healthwatch and local Healthwatch in the debate. So the government's made clear that alongside the new director of Icbs will take over several patient voice functions, and the patient Association has warned that splitting local Healthwatch between icbs and local authorities risks creating a patchwork of accountability. With no single body responsible for ensuring patients are heard.

If responsibility to deliver these functions is shared between different parts of the health system, who becomes accountable if it isn't funded?Who is accountable if people fall through the cracks?If accountability is divided, it often means that accountability is somewhat diminished. Chair. Also, members need to ask whether it's financially feasible for Icbs to deliver patient voice. In its evidence submission, the Health Foundation wrote. Moving the functions of local Healthwatch organisations into newly enlarged ICB footprints could result in the loss of a more nuanced understanding of the public's priorities and needs, with particular implications for seldom heard and vulnerable communities.

We know Icbs are under financial pressure because this Labour government's decision they've had to slash operating costs by 50% and many are pencilling in cuts to front line services. So against this backdrop, how can they afford to deliver patient voice functions?Chair, your guess is as good as mine. We've not heard about any additional funding for government for the purpose of patient voice. Healthwatch England was provided £3.3 million in 2005 2006 with local authorities between 14.1. How much of this money will be redirected to the Patient Experience Directorate and the Icbs?I tabled a written question asking about the benefits of the public purse, abolishing Healthwatch ministers response was the potential savings from abolishing Healthwatch England and local Healthwatch are dependent on future policy decisions regarding the approach taken to collecting user experiences post abolition, future policy decisions, the Minister set out an intention, but there was and still is an absence of a plan, and this is something we've heard again and again, both in this committee and really throughout the two years of this government has been in power in relation to health, in absence of a plan of how things are going achieved lofty aims, you understandable goals.

Um, sometimes really good goals. But no, no, no understanding of how they're going to get there. And it's not just us on this side of the House that are concerned. If I gave some examples in relation to other honourable members on the honourable Lady side of the House, the. The honourable member for Birmingham Erdington said one of my biggest concerns about this bill is the reduction in independence. Independent patient representation, including the abolition of Healthwatch structures. The honourable member for York said replacing Healthwatch will mean that ultimately patients will not have confident confidence in commissioners.

The honourable member for Blaydon and Concert said I understand the government. Government's. 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 DHS will not provide that independence. Will the Minister commit to looking again at how that independence can be built in and with the ability to pull the levers?We've also heard from Health and Social Care Committee, but the one member that the minister may be most interested in is the honourable member for Makerfield.

Because he wrote to the former Secretary of State. Former Secretary of State last year, saying, people speak to Healthwatch because they are outside the system. They are impartial, trusted and provide a safe space for concerns to be heard. Does the minister agree with that and if so, why does she want to remove the independence?The honourable member for Makerfield also said the independence of resident and patient voice. Is a necessity without. It will be losing the trust of the public, the richness of lived experience and the ability to challenge and improve the system from within, particularly during a time of significant system reform.

So I think. Chair, the plea from my perspective, would be to think again about the importance of the independence of patient voice. People will give their views when they think they can give their views independently and safely. And with similar echoes of the debate from this morning. And removing the independence doesn't seem necessary. I don't understand why the minister thinks it will improve patient care and thereby patient safety. And it's clear that not only on our benches but right across her benches and in fact, potentially the new Prime Minister, um, from from next week or the week after may think the same.

So I would be encouraging her to reconsider this step.
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None Portrait Speaker 8
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Thank you, Madam Chair. Um, for over 50 years there's been a statutory independent patient voice in the health and care system. And the creation of Healthwatch was in part a direct response to the issues raised by the Francis inquiry into the staffs in 2020. For almost a quarter of NHS patients. In a Healthwatch poll, said they had experienced poor care in the last year. And yet more than half of those took no action. And of those, 56% of people, 20% of them said it was because they were scared that giving negative feedback directly to NHS services would affect their ongoing treatment with women.

People living in areas of greater deprivation, disabled people, unpaid carers all significantly more likely to give fear of retribution as a reason for not speaking up. The government is stripping patients of their voice in our NHS, rather than being able to go to an independent body and express how the NHS can work better for them, patients will now only be able to give feedback to the same organisation that might have failed them. You actually have personal experience of this. In the last few weeks my partner Emma has had endometriosis and it's been an ongoing long term, um, condition for years, and she was really worried about speaking to the local hospital trust about the treatment she had received, specifically because she was worried about how it might affect her, her treatment going forward.

Um, the government has argued that this will bring patient insight closer to decision making, and it will be much more effective at securing change. But the member for Ilford North, the former health secretary, stated that patients don't need ventriloquists.
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None Portrait Speaker 9
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Their complex and often competitive systems, yet alone. The. The whole communities who have pre-existing distrust of the system. We believe removing Healthwatch as leaving the health service to mark its own homework, which creates conflicts of interest. It will significantly undermine public trust as well as independence is removed. Are vulnerable people who have suffered harm or poor experiences in health and care system really going to have faith in a system headed by a director in the Department of Health and Social Care, which is the organisation, ultimately runs the system and cause them harm in the first place or on a local level.

Will they have faith going to the same ICB that oversees the providers that have failed them?One only needs to look at Mid-staffordshire, the long list of maternity failings, to see that internal functions can fail catastrophically. We know all too well that the NHS default is sometimes a cover up. The public also knows this and independence, therefore, is everything, and Healthwatch has been keen in spotting and exposing challenges in the health service, such as widespread failures in NHS referral process. Yet there have been no incentive for the new system to investigate issues like these, which are invisible in the NHS main performance metrics.

Simply, the system does not always know what questions it needs to be asking and therefore an independent route for unsolicited feedback is important. Madam chair, we also think it will disadvantage hard to reach communities and those who may harbour distrust towards NHS and public authorities. So making it harder to gain the feedback and concerns of these communities that only then risks further baking in inequalities and inadvertently, more widely. No clarity has yet been provided on how these functions will be funded. So this reform is coming alongside major reductions in ICP running costs on Healthwatch currently receives almost 26 million a year.

That's already 60% less in real terms than the DHS originally estimated should fund the network. There's a risk that this money will be absorbed into wider budgets, and then never spent on the patient experience. Infrastructure. Wants to see the value of Healthwatch, Madam Chair, they need to look no further than the Cabinet Office's King's Speech briefing for the bill, which references a May 2025 Healthwatch report on missing medical records to make the case for the single patient record. And fundamentally, the government is conflating patient voice with patient involvement in decision making.

While greater patient voice in commissioning and decision making is needed, this is not a replacement for the advocacy and other functions of Healthwatch. Healthwatch helps vulnerable people navigate complex health and care, navigate a complex health and care system, and it performs signposting functions. And finally, Madam Chair, splitting local health watchers functions across ijbs and local authorities, once again separating out health and care as reinforcing these existing gaps between health and care. And as we know, many issues span both these areas and need a joined up investigative approach.

How will the new new model ensure a joined up view of people's experience across the NHS and social care?Um, so we urge the minister to reconsider this decision. We've seen overwhelming support for Healthwatch across the sector, and it's becoming increasingly clear that many people within the NHS and within the medical professions think this is a huge mistake. Um, just to speak specifically on Healthwatch England, um, this has played a central role in escalating findings of local health watchers in advocating nationally. So some well, three examples will give actually, um, publishing research highlighting inequalities in waiting times for disadvantaged groups and calling for demographic breakdown of waiting lists.

Now that is a call that the NHS obliged with last summer. Another good example is after Healthwatch Sunderland supported a patient of learning disability who had received accessible screening information but inaccessible follow up letters risked risking missed care. So Healthwatch England raised this gap, with national bodies, highlighting inconsistencies in communication. And following this, the national easy read templates were introduced across the cancer pathway, which improved accessibility and reducing risk. And another example is feeding back horrific patient stories of care, including a pensioner specific pensioner left on the corridor to NHS leaders and lobbying for increased transparency and oversight.

When it comes specifically to to corridor care. So three, um questions. As well several questions in three of forms really. Um, just to press. The minister really appreciate her comments on this. Um, are we genuinely sure that a director of patient experience and the DHSc will be so eager to advocate for patients and flag issues at a national level, they would essentially be flagging to their bosses whether the work is up to scratch. Um, are we sure?The same level of persistence that has so often been needed to advocate for change at a national level would be forthcoming from this director that was employed by the DH.

And, um. What will be the mechanism for local concerns to be escalated where they indicate national or systematic or systemic issues?And I'd also like the minister to explain how they envision the the new director sitting within the DHS structure and what will be the reporting lines. How will they ensure they have the resources and sense of operational independence to actually investigate and raise concerns nationally?And often we know that Healthwatch England have flagged issues to MPs, and the Health and Social Care Committee as a route of applying pressure on the NHS leaders and ministers to enact the change.

Yes, I'll give way.
16:09
16:10
16:11
None Portrait Speaker 6
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I'll.
16:11
None Portrait Speaker 9
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Okay, I'll carry on. Um, just to speak to clause 48 while I hear, um, this clause would ensure that um Healthwatch England and the local Healthwatch organisations are funded to the level estimated by the Department of Health and Social Care in 20 1314. So we don't just want to protect Healthwatch, we actually want to strengthen it. Um, I mentioned before receives almost 26 million a year, spread over 153 organisations. So this is about 60% less in real terms than the 43.5 million in the DHHS originally estimated would be needed to fund the network.

Um, the. Healthwatch network does all the amazing work previously raised. I won't go through them all again. Despite being underfunded compared to original estimations. Um. Imagine the work it would do if it was adequately funded. But even more worryingly, there's still no clarity on how Healthwatch functions will be funded once they've been transferred into the new system. So given the ongoing constraints, the cuts to ICB running costs, there's a real risk that the funding for Healthwatch will simply end up being incorporated into wider ICB budgets and money for the patient experience.

Infrastructure could end up being cut entirely. So this amendment, Madam Chair, aims to ensure that Healthwatch Network is properly funded, but also to raise the point that if this change is to go through funding for the patient experience, infrastructure must be protected. Otherwise, this bill risks not just weakening patient experience, but removing it altogether as the funding gets swallowed by wider NHS operational demands. Thank you.
16:14
16:14
None Portrait Speaker 10
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Can I say, as ever, it is a pleasure to see you in the chair this afternoon. Um, we all know as we debate Healthwatch today, we all know that Healthwatch was established, at least in part as a response to the Mid Staffs scandal. Uh, and it's not lost on me that we've heard mid staffs come up three times in the evidence sessions a couple of weeks ago. And by the member for Winchester just now. That really matters for obvious reasons. But it does have a particular resonance to my role in Parliament.

Because many of my constituents were harmed by the failing at Mid Staffs. Um, I was born in that hospital and speaking as a Staffordshire MP, it is not something that any of us in this place should ever forget or ever allow to be swept aside without examining. There were a huge number of failings at Mid Staffs for over a long period, and including that within. That is where oversight was just not in the room where decisions were making and staffs, county Council's Health Overview and Scrutiny committee clearly didn't do that job.

And the Francis report did state that the arrangements for public and patient involvement and for local government scrutiny in Stafford were a conspicuous failure. Report then went on to recommend some changes to ensure that Healthwatch was funded properly because it was in the process of being set up. At the time the report was funded. Um, and I think the framing of today's debate in that light is very important. And it's also timely. Healthwatch has been going for well over a decade, and it's right that after that time, we examine the impact that Healthwatch has had, because it is a significant part of what we expect with patient voice within the NHS.

And for us to be able to step back and actually say, what is the impact that it has, is particularly timely. And what is very clear is that despite the very best efforts of huge numbers of hard working staff and an army of committed volunteers across the country, that the quality of local Healthwatch organisations is pretty changeable. Um, over the last few weeks, I've been speaking with honourable and right honourable members from right across the House, and some of the feedback that you get is that, yeah, my local Healthwatch team is great.

They're brilliant. I work with them really closely. They've really helped out with a huge amount. They deliver great things in my constituency all the way to. I have some pretty significant concerns about the impact that they have, and in a couple of cases, what's helped?What's Healthwatch?I've never heard of them. How will they.
16:19
16:20
16:21
16:22
None Portrait Speaker 10
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Thank you. Mr. Lau. Yeah, I appreciate the intervention. Um, I think in isolation I think that that criticism would would be legitimate. But alongside some of the other changes that are happening, as I will get to shortly. Um, there are ways to mitigate around that. Um, the idea of local Healthwatch being truly local is something that I do have concerns. I know the Healthwatch in Staffordshire hasn't held an event in my constituency, um for a number of years now.

And the previous three I think they did, were just volunteer fairs trying to get more volunteers involved. That's not to say there aren't significant numbers of people working very, very, very hard to try and support people through the health service and through their engagement with the health service there. But that geographical changeability is very real on a. Scale, though Healthwatch England obviously has a huge role to play. And what I do want to take just an example to talk through some of the things that we've seen around maternity services.

As an example of kind of assessing the impact that Healthwatch is having, and I must say that I don't think it shows that despite the best efforts of those involved, that it is working particularly well. And after the Mid Staffs scandal in particular, there were issues in a large, uh, a large part of the trusted staffs, but it was particularly pronounced in maternity. Healthwatch was set up in 2013. Two years later, the Morecambe Bay report comes out. Now. That is two years and a lot of what the Morecambe Bay report was talking about was historic before that, but there was very little mention in the Morecambe Bay report that actually in the intervening two periods, things were starting to change and some of the conclusions in the recommendations from the Morecambe Bay report are that the trust should increase public and patient involvement in resolving complaints.

Another one was that the NHS complaints system at the University Hospitals of Morecambe Bay NHS Foundation Trust failed relatives at almost every turn, and although it was not in the report's remit to examine the operation of NHS complaints systems nationally, both the nature and failures of persistent comment from elsewhere led them to suppose that it was not unique to the trust. They believed that the fundamental review of the complaint system was required. Particular reference to strengthening local resolution and improving its timeliness. Um, it doesn't sound like patient voice was particularly close to decision makers.

With the situation that we saw at Morecambe Bay six years later on in 2021. The East Kent report is written, and it says that the trust was using high level information inappropriately as reassurance, taking comfort from the grouping that at least there were other trusts in the same boat. At times it has used this false reassurance as a bolster against the plethora of evidence from other sources that there were very significant problems in its maternity services. Now, that very much seems like the decision makers are being bound by the directorates in in the NHS, they're being bound by their bosses, they're being bound by the structures that exist to hold them to account.

And that because of health watches, independence or its remoteness, in this case, they weren't hearing the patient voice in the way that they should, with disastrous consequences for huge numbers of families. Now, five years later on just last week, Baroness Amos report again reported on maternity and neonatal care. And there are repeated mentions in that report of mothers not being listened to and. It seems again, sorry actually further in that one of the recommendations is that we need to engage the trust, the maternity services need to engage meaningfully with women, birthing people, families and representative groups to inform priorities and decision making, and champion approaches to listening to women and families that lead to visible action and change.

And it is that that final part of that recommendation that I think is so important. It needs to lead to visible action and change. And I was very taken with some of the points that the member for Winchester made in his speech, where he was talking about Healthwatch publishing research, and that's great, and that's valuable. And that research will obviously be helpful. But if it's not in the room with the commissioners, if it's not in the room with the decision makers, is it leading to visible action and change?And the examples that I've given there show that despite all those hard working people, and I'm not in any way trying to get down on the hard working staff within Healthwatch, and that's committed group of volunteers who are only trying to do things for their community and working very hard to try and achieve that.

They're just not being given the structures that they need to be able to lead to visible action and change where it's necessary. And what I'm quite impressed with in this bill is, yes, there are changes to Healthwatch coming. Yes, that will be a challenge. Yes, it comes with risks, but by moving the responsibility for patient voice to be in the room with the commissioners to be a core responsibility, a key responsibility of commissioners to listen to patient voice. It gets over this barrier.

It gets over that remoteness, and it puts it in the heart of the room. It puts it in front of the people who are making the decisions, because as we've seen for over a decade now, all of those hard working people and all of those recommendations that the honourable members opposite were talking about in long speeches this morning, thousands. Of recommendations which aren't necessarily being acted on. We need to get that patient voice into the room with the decision makers, and I will make some progress if I can.

There are concerns that actually, because if we're going to roll things into Icbs and we're going to roll some things back into councils that we need to make sure that the department is making sure that it's not something that gets pushed to the wayside. It's not something that the funding does remain for genuinely patient voice. I'm I'm actually reassured that there will be a patient experience directorate within the department and that will get, obviously, decision making into the Department of Patient Voice close to the department. But it will also be able to keep an eye on what is happening with those icbs and making sure that there are standards that the Icbs are looking to try and hit.

Um, the department does need to make sure that it's going to be doing the sharing of good practice, making sure that it is keeping oversight of LA commissioning into social care. And the CQC are starting to do this. And I think there's some indicators that that might be looking quite positive. There's obviously more work to do and we need to make sure we stay on top of that because, as I said earlier, there are risks whenever you try to make any change with healthcare, I'm quite reassured that actually bringing this patient voice into the room with decision makers is the right way for that patient voice to enact change.

I'm just about to close, so I'll allow you to come back when you make your speech shortly. Um. Yeah. The final point I do want to make is particularly around, um, local government. Um, I'm hoping that the Secretary of State will be issuing guidance about how local government will be looking into the commissioning of adult social care services. And I'm very much hoping that we get annual reporting from Icbs and local councils about how they are using that patient voice.

And I know the Secretary of State is going to have the ability to intervene, and I would expect him to do so. Should those annual reports show that that patient voice is not being used, not finding its way into the room and not leading to that meaningful change that the the report suggests?Thank you.
16:30
None Portrait Speaker 7
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Thank you very much. Um, Miss Lowell and I. Will confine my remarks to Group 47 conscious. I think with the next group we'll have the opportunity to talk about local arrangements. I'll stick to the um National. I think we are all aware of the significant role that Healthwatch England plays. Um and also indeed its, its popularity and the trust that's placed in it by many. Now as a minister in the passing department, I was on the receiving end on occasion of some sharp or firm suggestions by Healthwatch England, but that's what it's there for.

It was there to be the grit in the oyster. They often came up with useful suggestions, and that independence meant that they were able not only to put those reports to me, but were able to speak out publicly. They published them. They were able to give them, for example, to my hon. Friends who serve on the Health and Social Care Select Committee, they were able, if they so wished, to go on the media to talk about them, to try and make sure that that voice was heard now.

And that's where, for me, the challenge with what's proposed come in, because a new directorate in the department, staffed by civil servants, will simply not be able to do that. We all know that those who work in department, however excellent they are, report upwards ultimately to the Permanent Secretary and to ministers. They are answerable to the political leadership of that Department. So would they be able to decide that something was coming through regularly from patient feedback, and publish it independently of any ministerial powers of any approval by the permanent Secretary, or to hand it out to the media, and that that director would be able to champion that patient voice by going on the television themselves, irrespective of any ministerial approval of such a decision.

The reality is, of course, they couldn't. It would all be kept in-house in the department, part of a closed process which wouldn't actually, in reality alter the decision making because the decision making is already happening in the department. And the department should look at Healthwatch reports from Healthwatch England as part of the decision making by the ministers or senior officials. What this simply does is removes the independence. It weakens that voice by making it something that happens within the department and not in the public sphere to the same degree, because, quite rightly, those officials will not be able to have their own independent voice out there, irrespective of the leadership of the NHS or of the minister.

So I genuinely worry that what we see here is the continuance of a theme, which we've seen running throughout other aspects of this legislation, a theme of of centralisation and of removing independent external challenge and bringing it inside the system, be it the department or be it the NHS. And when that happens, my fear is that the people who will lose will be the patients whose voice will no longer carry as loudly.
16:30
16:31
None Portrait Speaker 8
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Thank you very much. It's a pleasure to serve under your chairmanship again this afternoon. And I think honourable and right honourable members will be disappointed to know. I'm not going to speak too long on this, but don't worry, the next, next, the next, the next grouping back to usual service will resume. Um, but I do want to pick up a few points on, on the abolition of national Healthwatch. Um, the first of which I take to the evidence that we took from Sarah Oldknow from the King's Fund.

Uh, during the evidence session, I asked her a fairly open ended question. Uh. Reflecting on the time when she was at the Health and Social Care Select Committee giving evidence, and I put it to her that when she was doing so, she seemed to suggest that the government could achieve what it needed to do in the ten year plan without this reorganisation. And I asked her about that, and she gave me an answer which essentially said, yes, all of this could be done without the need for the reorganisation that is in the current NHS Bill.

I then asked the similar question would you agree with that to Mr. Lunt?Who was Jacob Lunt?Who was the representative from National Voices and unprompted, because I didn't mention Healthwatch in the in my question, Jacob Lance replied this. Yes, I kind of think, as the debate goes on, that with the changes to Healthwatch in particular, you could achieve so much without legislation. You could beef up the internal functions for listening to patients and engaging with them. Without legislation, there is no requirement for that.

You could invest more resource in that, and you could do the same with Healthwatch. So I think that, um, we already know from the evidence that we received unprompted from national voices and indeed from the King's Fund, that the abolition of NHS England is not going to solve the problems that the minister and the government and the Department thinks is there, and indeed could be done in a different way. And I listened very closely to the honourable member on the other benches who spoke earlier, and he seemed to be presenting a number of problems.

But the solution that the government has come up with doesn't hold water, as honourable friends have said, the removal of NHS England and the introduction. Sorry, not NHS England, Healthwatch England and the introduction of a director for patient Experience simply doesn't work because, as on my. On my colleagues and honourable friends and right hon. Friends have mentioned the independence which is so fundamental to Habib that we talked about, uh, independence. Of local health watches, which we're going to talk about, and of NHS Healthwatch England is absolutely fundamental to the ability for that organisation to do its job.

And I reflect in a previous career, when I worked for the getting it right first time programme in the NHS, when that programme was first started, it sat outside the structures of what was then NHS improvement, NHS England and at that point we could make recommendations to the NHS essentially. And I don't mean this flippantly, uh, in a in a way that was unrestricted as soon as we were brought into NHS England into a governmental structure, the recommendations that we put forward were looked at, they were scrutinized, and we were told often we don't have the money to afford that or that's not in our plan.

And that's precisely what's going to happen if complaints. I'm sorry if recommendations are put through the director of patient experience and as others have said, as this director of patient experience arrives at a select committee, he's there. He or she is there to represent and defend the department and ministers, understandably, because that's who he works for. He or she works for. They are not going to be able to stand up, go on the television screens, on the radio, do the broadcast interviews, make representations because they are a creature of the system rather than a scrutineer and a advocate, a scrutiny of the system, and an advocate for patients.

So I think this is a fundamental problem. And I think whilst I accept what's been outlined, that there may be ways to improve Healthwatch England, this simply doesn't do it. I want to move very briefly on to the amendment. Sorry. The new clause, in the name of the honourable member for rugby, as the honourable member for Saint Edmunds has has moved it. Um, I have a lot of sympathy for what the honourable member is trying to achieve here, clearly, and I hope I'm not putting words into his mouth.

The reason he's putting this forward is because he has similar skepticism about the effectiveness of what is being proposed by the government. Otherwise, why review it?What I think there are some problems in that. I think he talks about complaints, and I fell into that trap whilst speaking a moment ago. In this little. But actually they don't really deal with complaints. They deal with raising issues and systemic failures that can be brought up through the system.

And likewise, I have a concern that there is nothing in this new clause. Once the government has done its impact assessment, even if the impact assessment were to come back and say, actually, this has been a terrible idea, there's no there's nothing the government can do. And to be honest, once it's abolished these things, it's going to be extraordinarily hard to pull them back. So I have a lot of sympathy for the amendment. I just probably think it's not going to, unfortunately, achieve what I think he and I want.
16:32
None Portrait Speaker 2
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Um, thank you. Mr.. It's a pleasure to serve with you in the chair. This is another example of government seeking to abolish an independent voice and merge its functions into an organisation which, frankly, will probably benefit to some extent without having that level of independent scrutiny, but not for the better of patients, not for the betterment of patients, or indeed for improving the system. NHS. Uh, sorry, Healthwatch England is effective specifically because it's independent and independent voice for patients.

And again, we haven't seen or heard any compelling arguments of why just because a system isn't perfect, any change is better than leaving a lone. The argument that's been advanced is that this brings patient voice closer to decision making. Well, I would hope what brings patient voice and the voice of the people close to decision making in the Department of Health is the directly elected ministers who of course, represent people. They should be the ones bringing patient voice into the heart of decision making.

And I'm sure they do. Of course they do. And there are other means that already happen by which the department formulates policies and decisions. It doesn't need to remove an independent patient voice through Healthwatch England, which serves a different purpose in order to enhance that. And the different purpose is this it is some uncomfortable truths. Some of the things that Healthwatch England advocate and shine a light on are uncomfortable for decision makers are uncomfortable for the Department of Health.

It looks to me for. Far too cosy to now bring that function into the decision making process. Of theseissues need light. They need the light shed upon them that comes with an independent organisation giving patient voice. We've heard already about how the Select committee. And it's not just the select committee. MPs too, in their. In their free ranging backbench function benefit from hearing the voice through an independent organisation such as Healthwatch England.

It allows them to fulfil their scrutiny function. This isn't all just about decision making, it's about scrutiny of decisions once they've been made. What is the select committee going to do?What is MPs going to do?What are journalists going to do when they no longer have the light shed by that independent voice?Because, as the honourable member for my right, my honourable friend for Farnham and Boardman has already pointed out the representatives employees within the Department of Health and Social Care rightly have other overriding primary duties, and that is to their employer, to the department itself.

So let's ensure that this patient voice is articulated by those who don't have a primary obligation to their employer. Their obligation is to their own independent organisations, whose functions serve solely to amplify and project the voice of patients. There are a number of issues which relate to the abolition of local health watches, but I will save that for the next section of this debate. But I do wish to, um, make the wider point that there is a centralisation issue here, too, whether the government likes it or not.

This is centralising powers into the department. It is taking powers that exist outside of Healthwatch England and taking them in-house. That is nothing short of a centralising power. As the Minister needs to address the justification for that, because the more negatives there are to this decision, the more we need to understand the positives. And so far they are light indeed, or have been failed to be articulated. I think there is a reason the positives have failed to be articulated is because they simply don't exist, and I look forward to the minister, and I would urge her to perhaps take some more interventions, because the arguments she has put back to the committee so far in her in in her speech that comes at the end of each clause, has tended to raise more questions in some cases than it has answered.

And we can only really deal with that by interventions. On what she says or is about to say.
16:33
None Portrait Speaker 5
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Thank you, Miss Lill. Um, and I think the record will show that I have taken several interventions throughout the course of the recent days and continue to do so. And I've been very clear that we have some fundamental disagreements and some disagreements on philosophy and approach. Miss Lou, I'm going to desperately try not to veer into the next groupings, but it may be tricky, as I'm sure you'll steer me through. And I do want to pick up on some really helpful and good points that have been made.

Can I pay particular tribute to my friend John Litchfield for the comments he raised?I absolutely appreciate, um, you know, in areas and mid staffs, particularly with regard to Healthwatch, it is a listed a lot of debate and concern and I commend him for really following this through on behalf of his constituency and other members. I know in Staffordshire really wanted to understand that the future plans that the government has, um do make sure that they address the very real concerns that they have. And that is also true of other areas that have experienced really shocking, um what we call scandals in that area.

So I take this very seriously and um, I will, I'm going to pick up this slightly on this, this, this question of independence, which we've heard before, which was mentioned by the, the opposition spokesperson. And she raised concerns and issues raised by the member for Makerfield. Um, I heard what she said, um. And Litchfield and Winchester. Um and again, I think we'll return to this point about independence. And as one from Litchfield said, about being in the room of making those decisions and changing the entire culture of the organisation to do something different.

And the question is, then, whether Healthwatch a national level, and again, I commend the work and the individuals involved for their work, whether that is the right method. And can I also, um, honorable mentioned Jacob lantern, National Voices and the King's Fund. And I, you know, they have worked with us very well to challenge and to try and make this, uh, you know, legislation better. And I really appreciate their work. And we will continue to talk with them. Um, the, the honourable member for Farnham Broughton mentioned Goethe.

I couldn't, I couldn't help but respond to this point because um, he suggested that being inside the organisation now somehow has made that less effective. And I couldn't disagree with him more. Actually, it's not because he's left and is in here. Obviously his presence is missed from Goethe and very much welcomed here. But to be very serious, every meeting I have with NHS England, every thing we are attempting to do with reforming outcomes for patients on the ground, on electronic health involves girth.

They are now at the very heart of NHS England. Do so. Um, I think actually coming inside the organisation, had they done exactly some of the things that we want to try and do, which is drive that cultural difference and change inside the organisation rather than being outside of it. And that's, you know, this, this is a this is a, an argument, as I said before, slightly philosophical argument, slightly political argument. I appreciate views on on either side, but that is absolutely what our intention is with doing some of that.

So if I can just assure people in terms of patient safety, patient experience director, which has been raised by, um, many honourable members, particularly, we do recognise that public trust is going to be really crucial in getting this right. And we're clear that it's about making sure that there is system learning across the piece. Uh, patient experience director has to earn the trust of the public and parliamentary parliamentarian. And we'll do that by designing in a way that means it operates transparently and sits at the centre of decision making rather than at its margins.

And ministers, as we've heard, will be accountable for and answerable to Parliament on the work of the Patient Experience Directorate. We're absolutely clear that there has to focus on the voices that are too often overlooked, and the central priority of the director will be to reach underrepresented and seldom heard groups, ensuring engagement is accessible, inclusive and proactive so that the experience of vulnerable people help inform and shape the decisions that affect their lives. If I can turn Miss Lowell to the new clause 78, which I think was raised in the name of the honourable member for Shropshire, um, I wonder whether.

I will.
16:35
None Portrait Speaker 3
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Liz Twist.
16:35
16:35
None Portrait Speaker 3
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Minister.
16:35
None Portrait Speaker 5
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And I thank her for that. And being clear, um, with the committee, um, the intention of her comments. And I think that's absolutely right. And we do need to be able to assure, as I say, build that trust, um, in patient voice and patient experience coming forward. And I think we'll pick up some more of that in the local Healthwatch discussion coming forward, because that is, of course, where most of us experience, um, experience our healthcare locally. But that is perhaps where members of Parliament are particularly, particularly important as well, but also particularly pick up on how we make sure that happened.

Of course, there are national levels, many voices and organisations continuing to review, to report, to challenge the government, whether it be in the many reports that they provide meetings with with ministers, meetings in this place. Um, you know, highlighting the very good work that they do, um numerous committees and obviously, uh, Department of Health ministers appeared before the Public Accounts Committee, the Health and Social Care Committee, uh, the Lords committees. Um, I've appeared before the Science and Science Select Committee, and that obviously is an important way of being able to ensure that the work of the department and the new experience director is, is, is, is accountable.

Uh, turning to new clause 78, then, um, uh. I mean, as I mentioned, I do recognise the important contribution that Healthwatch has made in capturing patient insight and informing the design and delivery of services. Um, but we do not believe this amendment is necessary. The amendment is inconsistent with the purpose of the bill, essentially. Um, whilst I aware of the honourable members views on these issues, it is the government's policy to abolish Healthwatch and ensure that patient and public voice is more directly connected to decision making.

As I've said, it would therefore not be appropriate or consistent to legislate for a specific funding level for organisations that would no longer exist in order to constrain how funding is deployed to support the new arrangements. Secondly, this amendment risks presenting.
16:36
None Portrait Speaker 3
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Helen Morgan.
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16:36
16:36
This debate has concluded
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