Health Bill
Thursday 9th July 2026
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11:30
Speaker 1
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Speaker 1
But there's loads of water. Silver is fizzy, blue is flat, and I'm happy to give a sort of blanket. Um, permission for people to take off their jackets. Because I think officially you're meant to individually ask me. But given the heatwave, um, have it off if you like. Okay. We now come to group 53, a new clause six. I call Helen Morgan to move the new clauses. Helen Morgan, thank you very much, Doctor hook.
11:31
Speaker 2
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Speaker 2
It's a pleasure to serve with you in the chair. New clause 50. Sorry. Nuclear six requires the creation of a health data charter which includes measures to protect data so as to ensure privacy and reasonable usage. Patients should be in control of their data. As we've discussed in previous sessions, we don't think the bill goes far enough to provide reassurances in this regard. Everyone agrees with the need for the single patient record. There's a genuine risk that I don't think anyone in this room wants to see that it could be derailed over very understandable and reasonable data privacy concerns, sufficient guardrails and transparency are key to this, especially around secondary uses of health data, and trust is essential.
As we've discussed on many occasions for this system to succeed. That's why we've tabled a health data charter amendment. It would set out guiding principles for data sharing across the NHS, including the single patient record. It would be led by data experts, but also, importantly, clinicians and patient representatives, ensuring the voices of doctors and patients are heard is central to building trust and therefore widespread use of any data sharing systems or technologies.
As we've discussed on many occasions for this system to succeed. That's why we've tabled a health data charter amendment. It would set out guiding principles for data sharing across the NHS, including the single patient record. It would be led by data experts, but also, importantly, clinicians and patient representatives, ensuring the voices of doctors and patients are heard is central to building trust and therefore widespread use of any data sharing systems or technologies.
11:32
11:32
11:32
Speaker 4
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Speaker 4
Oh, thank you very much, Miss Hook. And it's a pleasure. Doctor hook sorry. It's a pleasure to serve under your chairmanship again today. So new clause six. In the name of the hon. Lady raises I think, quite an important question about how we govern. One of the greatest the NHS is greatest assets, which is its health data. So the development of the single patient platform, the database and the wider use of linked NHS data, I think presents enormous opportunities.
And I think when used responsibly, healthcare data can support much more personalised care. It can improve NHS planning, it can accelerate medical research, enable earlier diagnosis and help develop new medicines and treatments. It can also improve efficiency and strengthen the evidence base for healthcare decisions. However, I think those benefits can only be realised if the public have the confidence that their data will be used safely, ethically and transparently. Public trust must be the foundation of any successful health data policy. It's important to recognise the think that NHS health data is currently overseen by NHS England.
Following the merger of NHS digital into that organisation. However, with the government proceeding with the abolition of NHS England and the transfer of its functions elsewhere, it's right, I think, that we consider future governance arrangements and so, in principle, I agree that an independent body may be needed to ensure the security, integrity and responsible stewardship of NHS data so that those things are maintained. With this considered, there is, I think, definitely scope for an independent body to oversee the management and regulation of the public's health data, because that proposal places privacy, patient privacy at its heart.
It would strengthen safeguards against misuse, give patients greater control over how their information is used, and provide meaningful mechanisms to opt out of certain forms of data sharing. It also promotes the use of anonymization and trust. Research environments, trusted research environments allowing valuable research to take place while reducing the risk of inappropriate disclosure something that we've discussed in a number of other clauses. And that's both inappropriate disclosure by a malign actor or even inadvertently so the new clause in the name of the Liberal Democrats, I think, also seeks to address a concern that has attracted significant public attention, ensuring where commercial organisations derive substantial value from NHS data, that the NHS itself shares in that benefit.
And whilst we didn't support a number of those proposals by the Liberal Democrats because of the poor drafting of the or the inadvertent, uh, implications of the drafting of those amendments, I do still have sympathy with the overall, uh. Thrust of what they were trying to achieve with them. So I think there is a strong argument that the value generated from data contributed by patient NHS patients should help support future patient care and research. Transparency is another important feature. Publishing data sharing agreements, increasing openness around decision making and consulting the public on significant new data initiatives would help strengthen public confidence.
The proposed trust would bring these principles together by overseeing data use, monitoring compliance with governance standards, ensuring transparency and, where necessary, suspending access for organisations that misuse their data. Of course, any new governance framework must avoid creating unnecessary bureaucracy or delaying important research, and I would be interested to hear from the honourable lady when she sums up. Um, what, uh, what analysis or evidence that she's been able to find when drafting this clause. Um, to give us reassurance that it won't give that, uh, that won't create a bureaucratic and, and, uh, block or a dampener or insert inertia into the system.
So I think that because I think that if we are going to do something like this, the oversight should be proportionate and should complement rather than duplicate or indeed frustrate any existing regulatory responsibilities. So ultimately, I think New Clause six has some potential benefits. It would establish that clear social contract for the NHS health data, something that hopefully would protect privacy and support research innovation, maintain public trust and ensure that patients and the NHS share in the benefits arising from the responsible use of what is, I think, a very valuable, valuable national asset.
Um, probably second to none in the world in terms of what that data could potentially be used for. But I do have concerns about, uh. Adding extra bureaucracy into the system, adding potential inertia into what we would want to see, which is a vibrant, uh, life sciences industry in this country that's able to use that data for the benefit of British citizens and British patients. And so I'd be interested to hear from the honourable lady about what she thinks would happen in that case.
And I think when used responsibly, healthcare data can support much more personalised care. It can improve NHS planning, it can accelerate medical research, enable earlier diagnosis and help develop new medicines and treatments. It can also improve efficiency and strengthen the evidence base for healthcare decisions. However, I think those benefits can only be realised if the public have the confidence that their data will be used safely, ethically and transparently. Public trust must be the foundation of any successful health data policy. It's important to recognise the think that NHS health data is currently overseen by NHS England.
Following the merger of NHS digital into that organisation. However, with the government proceeding with the abolition of NHS England and the transfer of its functions elsewhere, it's right, I think, that we consider future governance arrangements and so, in principle, I agree that an independent body may be needed to ensure the security, integrity and responsible stewardship of NHS data so that those things are maintained. With this considered, there is, I think, definitely scope for an independent body to oversee the management and regulation of the public's health data, because that proposal places privacy, patient privacy at its heart.
It would strengthen safeguards against misuse, give patients greater control over how their information is used, and provide meaningful mechanisms to opt out of certain forms of data sharing. It also promotes the use of anonymization and trust. Research environments, trusted research environments allowing valuable research to take place while reducing the risk of inappropriate disclosure something that we've discussed in a number of other clauses. And that's both inappropriate disclosure by a malign actor or even inadvertently so the new clause in the name of the Liberal Democrats, I think, also seeks to address a concern that has attracted significant public attention, ensuring where commercial organisations derive substantial value from NHS data, that the NHS itself shares in that benefit.
And whilst we didn't support a number of those proposals by the Liberal Democrats because of the poor drafting of the or the inadvertent, uh, implications of the drafting of those amendments, I do still have sympathy with the overall, uh. Thrust of what they were trying to achieve with them. So I think there is a strong argument that the value generated from data contributed by patient NHS patients should help support future patient care and research. Transparency is another important feature. Publishing data sharing agreements, increasing openness around decision making and consulting the public on significant new data initiatives would help strengthen public confidence.
The proposed trust would bring these principles together by overseeing data use, monitoring compliance with governance standards, ensuring transparency and, where necessary, suspending access for organisations that misuse their data. Of course, any new governance framework must avoid creating unnecessary bureaucracy or delaying important research, and I would be interested to hear from the honourable lady when she sums up. Um, what, uh, what analysis or evidence that she's been able to find when drafting this clause. Um, to give us reassurance that it won't give that, uh, that won't create a bureaucratic and, and, uh, block or a dampener or insert inertia into the system.
So I think that because I think that if we are going to do something like this, the oversight should be proportionate and should complement rather than duplicate or indeed frustrate any existing regulatory responsibilities. So ultimately, I think New Clause six has some potential benefits. It would establish that clear social contract for the NHS health data, something that hopefully would protect privacy and support research innovation, maintain public trust and ensure that patients and the NHS share in the benefits arising from the responsible use of what is, I think, a very valuable, valuable national asset.
Um, probably second to none in the world in terms of what that data could potentially be used for. But I do have concerns about, uh. Adding extra bureaucracy into the system, adding potential inertia into what we would want to see, which is a vibrant, uh, life sciences industry in this country that's able to use that data for the benefit of British citizens and British patients. And so I'd be interested to hear from the honourable lady about what she thinks would happen in that case.
11:36
11:36
Speaker 5
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Speaker 5
Thank you doctor. It's a pleasure to serve with you in the chair. Um, my honourable friend the member for Farnham and Bordon has set out the arguments clearly. I'd just like to add some of my own views. As he states, the single patient record provides a very unique and special opportunity to improve efficiency across the whole of the health and social care space, and also an opportunity to empower patients. It does, of course, face some very significant challenges.
And as I said in an earlier session of this committee, as I see it, the perhaps the biggest one of the biggest challenges is ensuring that it actually means something in practice. Now, the minister helpfully clarified in a previous session that the data that is currently held on a great variety of different databases and electronic record keeping systems within the NHS. That data will remain held on those wide and disparate recording systems, and therefore, it seems to me, the only way that the advantages will be realised is if these systems are all able to speak together and are fully interoperable.
I know through a previous time in my career that the reality is many of these systems aren't interoperable or are only part interoperable, or even when they do speak to each other, the data is collected and recorded in different ways, in things as simple as how someone's name or age or the principal field for the. Issue that they're presenting to a clinician with is recorded because they're not standardised. Systems that speak to each other can't easily transfer that data across. So the advantages of the single patient record will be only realised when all these systems are unified in some form.
And of course, this bill doesn't address that directly. I'm not necessarily suggesting it should, but I don't see anything else from the government that says, how do we make systems that are provided and contracted by private providers through procurement processes at a local level?How do we knit that all together?And it seems to me that somebody somewhere is going to have to produce some gateway software, a gateway system, to allow the patient single patient record to be accessed, and then every other system that currently exists needs to be able to speak and feed into that.
That sounds to me like the public sector is going to have a huge role. Private sector is going to sit behind to try and deliver it. It seems to me a huge project that could be fraught with difficulty and take very many years to establish before the single patient record is established. Regardless of when this bill is passed and I'm sure it be passed fairly soon, what I think this new clause six tries to do is address one of the other significant issues with the single patient record, and that is security and control of data.
Of course, the single patient record, if fully realised, will make it easier for data to be accessed and shared. That's the very purpose, isn't it?In order to ensure that systems and services are more integrated, the data flows more freely and you don't have these ridiculous situations where a GP sees a patient fills out a note and can't share it across to a secondary care provider, and so is left having to print it out and give it to the patient or printed out PDF and attach it to an email where somebody at the other end has to input it into their database.
Now, the issue with making it easier to share data and very, very personal data data of the most intimate kind in many circumstances is it is easier to once access by bad faith operators, it is easier for them to run riot and cause an awful lot of damage. It is also easier for inadvertent accessing to then be accidentally shared much more widely, much more easily, because the whole system is lubricated by the single patient record. So I do understand the health data charter, the reason for it, that the, uh.
New clause six is trying to, uh, the, the ills that it's trying to cure or the potential ills. And it says here, um, at new clause three, uh, new clause. Six three B and I quote include the primary goal of protecting people's privacy and their data from exploitation. Well, that's a fantastic goal. The goal we all support, of course, I don't respectfully agree that this is necessarily going to achieve that. And the added layer of bureaucracy, my good friend of Commander Horton has asked the rhetorical question that I hope will be answered by the front bench of the Liberal Democrats as to the bureaucracy issue and the effectiveness issue.
So I endorse that set of questions. So I minded not to support this proposal while agreeing with what it's trying to achieve. Perhaps the minister, if she doesn't support this proposal, this clause can explain how its aims and objectives are protecting people's privacy are nevertheless delivered by this bill, because there seems to be great scope for privacy being undermined. And abused, not only deliberately by bad faith actors, but inadvertently. Second issue here that I think the charter is trying to achieve.
Is this balance between security of personal data. But recognizing the value of the data that the NHS gathers in anonymized form for research and development because clearly data that is fully anonymized and cannot be unpicked through reverse engineering is of huge value. Commercially and also for the public good, commercially, in the public good are necessarily opposed to each other. In fact, very often they come together and. The NHS should be able to exploit is probably seen as a negative word, but exploit for the good.
The value of that anonymized data. But how do we balance that with people's right to privacy?And again, the possibility for inadvertently using data that where people can be identified for a wider public good, where it's intended to be anonymized?And I think this charter is trying to get to the heart of that issue as well. So I welcome, uh, indeed it does. I can see it quoted here, hold continuous oversight of all health data and oversee the trusted research environment.
So I welcome comments from the minister about how, if she doesn't agree with this clause, how the government's proposals balance the security of individuals personal data whilst simultaneously exploiting for the public good the value of the huge depth of anonymized data that the NHS holds and will hold, that can be used to drive so much innovative research development. Actually not only for the benefit of health delivery in this country, but across the world. And if something is that valuable as a commodity, it has commercial value and in fact can help to.
Deliver financial benefit to the NHS. And I think that's an area we can perhaps all agree. We haven't exploited to its best yet. And I think there's an opportunity to do it here with the single patient record. If done properly, with all the safeguards that are necessary.
And as I said in an earlier session of this committee, as I see it, the perhaps the biggest one of the biggest challenges is ensuring that it actually means something in practice. Now, the minister helpfully clarified in a previous session that the data that is currently held on a great variety of different databases and electronic record keeping systems within the NHS. That data will remain held on those wide and disparate recording systems, and therefore, it seems to me, the only way that the advantages will be realised is if these systems are all able to speak together and are fully interoperable.
I know through a previous time in my career that the reality is many of these systems aren't interoperable or are only part interoperable, or even when they do speak to each other, the data is collected and recorded in different ways, in things as simple as how someone's name or age or the principal field for the. Issue that they're presenting to a clinician with is recorded because they're not standardised. Systems that speak to each other can't easily transfer that data across. So the advantages of the single patient record will be only realised when all these systems are unified in some form.
And of course, this bill doesn't address that directly. I'm not necessarily suggesting it should, but I don't see anything else from the government that says, how do we make systems that are provided and contracted by private providers through procurement processes at a local level?How do we knit that all together?And it seems to me that somebody somewhere is going to have to produce some gateway software, a gateway system, to allow the patient single patient record to be accessed, and then every other system that currently exists needs to be able to speak and feed into that.
That sounds to me like the public sector is going to have a huge role. Private sector is going to sit behind to try and deliver it. It seems to me a huge project that could be fraught with difficulty and take very many years to establish before the single patient record is established. Regardless of when this bill is passed and I'm sure it be passed fairly soon, what I think this new clause six tries to do is address one of the other significant issues with the single patient record, and that is security and control of data.
Of course, the single patient record, if fully realised, will make it easier for data to be accessed and shared. That's the very purpose, isn't it?In order to ensure that systems and services are more integrated, the data flows more freely and you don't have these ridiculous situations where a GP sees a patient fills out a note and can't share it across to a secondary care provider, and so is left having to print it out and give it to the patient or printed out PDF and attach it to an email where somebody at the other end has to input it into their database.
Now, the issue with making it easier to share data and very, very personal data data of the most intimate kind in many circumstances is it is easier to once access by bad faith operators, it is easier for them to run riot and cause an awful lot of damage. It is also easier for inadvertent accessing to then be accidentally shared much more widely, much more easily, because the whole system is lubricated by the single patient record. So I do understand the health data charter, the reason for it, that the, uh.
New clause six is trying to, uh, the, the ills that it's trying to cure or the potential ills. And it says here, um, at new clause three, uh, new clause. Six three B and I quote include the primary goal of protecting people's privacy and their data from exploitation. Well, that's a fantastic goal. The goal we all support, of course, I don't respectfully agree that this is necessarily going to achieve that. And the added layer of bureaucracy, my good friend of Commander Horton has asked the rhetorical question that I hope will be answered by the front bench of the Liberal Democrats as to the bureaucracy issue and the effectiveness issue.
So I endorse that set of questions. So I minded not to support this proposal while agreeing with what it's trying to achieve. Perhaps the minister, if she doesn't support this proposal, this clause can explain how its aims and objectives are protecting people's privacy are nevertheless delivered by this bill, because there seems to be great scope for privacy being undermined. And abused, not only deliberately by bad faith actors, but inadvertently. Second issue here that I think the charter is trying to achieve.
Is this balance between security of personal data. But recognizing the value of the data that the NHS gathers in anonymized form for research and development because clearly data that is fully anonymized and cannot be unpicked through reverse engineering is of huge value. Commercially and also for the public good, commercially, in the public good are necessarily opposed to each other. In fact, very often they come together and. The NHS should be able to exploit is probably seen as a negative word, but exploit for the good.
The value of that anonymized data. But how do we balance that with people's right to privacy?And again, the possibility for inadvertently using data that where people can be identified for a wider public good, where it's intended to be anonymized?And I think this charter is trying to get to the heart of that issue as well. So I welcome, uh, indeed it does. I can see it quoted here, hold continuous oversight of all health data and oversee the trusted research environment.
So I welcome comments from the minister about how, if she doesn't agree with this clause, how the government's proposals balance the security of individuals personal data whilst simultaneously exploiting for the public good the value of the huge depth of anonymized data that the NHS holds and will hold, that can be used to drive so much innovative research development. Actually not only for the benefit of health delivery in this country, but across the world. And if something is that valuable as a commodity, it has commercial value and in fact can help to.
Deliver financial benefit to the NHS. And I think that's an area we can perhaps all agree. We haven't exploited to its best yet. And I think there's an opportunity to do it here with the single patient record. If done properly, with all the safeguards that are necessary.
11:45
11:46
Speaker 6
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Speaker 6
To discuss a new clause six. In the name of the honourable lady from North Shropshire. Um. And as my honourable friend has just said, this is essentially seeking to ensure that we have good data security and control, which with which I would agree, uh, that trust is important, that data security is important and that supporting research with anonymized data is also a good thing to do. So what does the new clause six do?Well, firstly, it establishes an independent body known as a sovereign health data trust.
And what is one of those?Essentially, it's a group of people put together. It doesn't say how big, I don't know. The honourable lady knows has in mind how large a group this would be, but it describes a group of people with a diverse range of backgrounds and health expert health data experts, clinicians and patient representatives. So are the first group intended to be laypeople rather than experts?And what does she mean by a diverse range of backgrounds?Um, is this in relation to protected characteristics or is she looking for a farmer from Northumberland and a lawyer from Islington to say they've got different backgrounds?It's not entirely clear what, um, what she means.
I'd be grateful if she could clarify that. Um, but this group, uh, however big it is, and however it's composed, who's going to choose who is on it?On what criteria will they decide who will be responsible?But having set up this, this group, this sovereign health data trust chair, um, this group. Will be charged with creating a health data charter, which led me to the second question, which is what is a health data charter?And essentially health data charter must is defined in.
This is setting out fundamental principles and responsibilities for assessing whether data sharing partnership is an interest to the public and the NHS. Masters is, my honourable friend has said, includes a primary goal of protecting people's privacy and their data from exploitation, while promoting trust in data systems and the handling of health data. And that is important because we've heard of several examples in the media chair of where data has been for sale or has been leaked, and the problems that were caused from that, um, must. Assure that patients have control of their data, including providing relevant opt outs.
And I'm glad to see the bit about relevant opt outs, because we've talked about the importance of the record not being shared as a whole necessarily, but being shared in pieces and things like, um, obstetric health or sexual health may want to be separately, um, consented. Um patients having control of the data is important, but I would again just ask the honourable lady who proposed the amendment how she would deal with safeguarding issues in terms of control of data, particularly in relation to, children's data. Um. Provide that all health data is held anonymously and access through a trusted research environment seems reasonable.
Um, set out ways to retain and protect the value of health data in England, including providing measures to invest a share of the income generated from new medicines or treatments developed with that health data to be invested back into the NHS. And the honourable gentleman from Lichfield and I discussed this earlier in the week and the important value of the NHS data. I think he said it was the most valuable data set in the world, and he and he he he may well be right. Um, indeed he may well be right.
I was a bit confused by this part of the clause though, because we were talking last week, earlier this week about the health HASSI. B um. Being able to sell time, training and sharing expertise, including to private sector organisations overseas. And we had. But they were the government had changed it in this bill so that there would only be able to retain costs and not to make any money back to the Treasury. And I noticed that when we put forward amendment 56 to a vote, the Liberal Democrats abstained.
And I don't know quite what the difference is between using NHS data for research and using the expertise for their training for overseas organisations. But be grateful to understand that. The charter must be designed in such a way to render it interoperable with the European Health data space. So the European Health Data Space Regulations, introduced in March 25th, which are in the transition period and will be implemented in 27 and 29. Um, and it should be interoperable in technical terms through the promotion of findable, accessible, interoperable and reusable, uh, data.
Principles. So what is the, um, European health data space?Essentially, it's a single patient record for Europe. Um, and it says in there in the instructions for, for it, member states may and underline may offer an opt out for the cross-border exchange of electronic data under the Aids. Again, I don't really understand the argument for that because they've made a strong argument in this as a whole and throughout the committee that data needs to be shared carefully. And there were some clauses that they advanced on ensuring data was held in the United Kingdom.
Uh, and that, um, we used um, British. Tech where possible, etc.. This would do would, would put us interoperable with the European system, which would presumably, uh, move us to. A European systems.
And what is one of those?Essentially, it's a group of people put together. It doesn't say how big, I don't know. The honourable lady knows has in mind how large a group this would be, but it describes a group of people with a diverse range of backgrounds and health expert health data experts, clinicians and patient representatives. So are the first group intended to be laypeople rather than experts?And what does she mean by a diverse range of backgrounds?Um, is this in relation to protected characteristics or is she looking for a farmer from Northumberland and a lawyer from Islington to say they've got different backgrounds?It's not entirely clear what, um, what she means.
I'd be grateful if she could clarify that. Um, but this group, uh, however big it is, and however it's composed, who's going to choose who is on it?On what criteria will they decide who will be responsible?But having set up this, this group, this sovereign health data trust chair, um, this group. Will be charged with creating a health data charter, which led me to the second question, which is what is a health data charter?And essentially health data charter must is defined in.
This is setting out fundamental principles and responsibilities for assessing whether data sharing partnership is an interest to the public and the NHS. Masters is, my honourable friend has said, includes a primary goal of protecting people's privacy and their data from exploitation, while promoting trust in data systems and the handling of health data. And that is important because we've heard of several examples in the media chair of where data has been for sale or has been leaked, and the problems that were caused from that, um, must. Assure that patients have control of their data, including providing relevant opt outs.
And I'm glad to see the bit about relevant opt outs, because we've talked about the importance of the record not being shared as a whole necessarily, but being shared in pieces and things like, um, obstetric health or sexual health may want to be separately, um, consented. Um patients having control of the data is important, but I would again just ask the honourable lady who proposed the amendment how she would deal with safeguarding issues in terms of control of data, particularly in relation to, children's data. Um. Provide that all health data is held anonymously and access through a trusted research environment seems reasonable.
Um, set out ways to retain and protect the value of health data in England, including providing measures to invest a share of the income generated from new medicines or treatments developed with that health data to be invested back into the NHS. And the honourable gentleman from Lichfield and I discussed this earlier in the week and the important value of the NHS data. I think he said it was the most valuable data set in the world, and he and he he he may well be right. Um, indeed he may well be right.
I was a bit confused by this part of the clause though, because we were talking last week, earlier this week about the health HASSI. B um. Being able to sell time, training and sharing expertise, including to private sector organisations overseas. And we had. But they were the government had changed it in this bill so that there would only be able to retain costs and not to make any money back to the Treasury. And I noticed that when we put forward amendment 56 to a vote, the Liberal Democrats abstained.
And I don't know quite what the difference is between using NHS data for research and using the expertise for their training for overseas organisations. But be grateful to understand that. The charter must be designed in such a way to render it interoperable with the European Health data space. So the European Health Data Space Regulations, introduced in March 25th, which are in the transition period and will be implemented in 27 and 29. Um, and it should be interoperable in technical terms through the promotion of findable, accessible, interoperable and reusable, uh, data.
Principles. So what is the, um, European health data space?Essentially, it's a single patient record for Europe. Um, and it says in there in the instructions for, for it, member states may and underline may offer an opt out for the cross-border exchange of electronic data under the Aids. Again, I don't really understand the argument for that because they've made a strong argument in this as a whole and throughout the committee that data needs to be shared carefully. And there were some clauses that they advanced on ensuring data was held in the United Kingdom.
Uh, and that, um, we used um, British. Tech where possible, etc.. This would do would, would put us interoperable with the European system, which would presumably, uh, move us to. A European systems.
11:51
Speaker 4
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Speaker 4
My friend give way on that point. Greg Stafford I don't mean this as a cheeky point, but is it not the case that clearly, as with everything the Liberal Democrats thinks that the European Union can do no wrong and therefore they don't see the same problems of data that they expressed in other clauses, because this is the European Union and they want to go back and rejoin it, and therefore they can see that it can have no possible harm to British subjects.
11:51
Speaker 6
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Speaker 6
In. It does seem it seems ironic to me when reading it, that the seem comfortable for data to be shared across the EU, but not across across our own country. It didn't say. It didn't make, um, didn't make complete sense to me. But again, the the honourable member may be able to in her summing up, be able to tell us more about that. And what else will the sovereign health Data Trust, data Trust Group do?Well, they'll have continued oversight for all health and data and trusted research environments.
All health data. Big job. And again, what sort of resources does the honourable lady think that will entail and what would she have in mind in terms of the cost and the bureaucracy of that. Would have the power to restrict and recall organisations access to data if they, as a group, had reason to believe the data is not being used for public or patient benefit. So, chair, what is the threshold for that?I mean, we're working in a commercial environment for lots of these.
If they receive a letter potentially from from a competitor saying there is a concern, is that does that meet the threshold?What would the threshold be?Having decided that they they believe their data might not be used for public benefit?Um, one investigatory powers, would you envisage that they have to establish whether that is the case or not. What about if they decide they they've received some some concerning correspondence. They do the investigation under the investigatory powers that they're given. And they decide that they don't think it's being used for public or patient benefit.
And they restrict the organisation's ability to access data. That's obviously got a significant financial penalty. Potentially. It may have an effect on patients access to healthcare. To um what right of appeal would the organisation have and to whom and how would that work?Um the other thing is the question about the wording because commercial activity may well benefit patients. And I think sometimes that is forgotten the. Next thing they have to do is ensure that all data sharing arrangements with the non NHS organisation are transparent with all health data contracts entered into by public body made publicly available.
Again just some more detail really on that. So um would that include um anonymous anonymously provided data. Um what effect would that have on the research environment and the integrity of um research being done under commercial. Arrangements. Um what about the costs. Would the costs only costs be shared and what effect would that have on future commercial negotiations when the government is trying to get the next, next organisation to look at the data and what level of detail are made publicly available in the contract, what level of detail would need to be provided?They need to publish minutes of their meetings, which seems reasonable.
They need to show that all health data collection and sharing initiatives are preceded by public consultation, involvement and awareness. As data collection, as well as data sharing initiatives. Do they really mean that all data collection has to be go through public consultation?So if, as we talked about yesterday in corridor relating to corridor care, the government decided now wants to know how many people have voted more than 24 hours in A&E. They have to do public consultation to, to, to, to um to collect that data.
It just seems a little bit, um, overly bureaucratic.
All health data. Big job. And again, what sort of resources does the honourable lady think that will entail and what would she have in mind in terms of the cost and the bureaucracy of that. Would have the power to restrict and recall organisations access to data if they, as a group, had reason to believe the data is not being used for public or patient benefit. So, chair, what is the threshold for that?I mean, we're working in a commercial environment for lots of these.
If they receive a letter potentially from from a competitor saying there is a concern, is that does that meet the threshold?What would the threshold be?Having decided that they they believe their data might not be used for public benefit?Um, one investigatory powers, would you envisage that they have to establish whether that is the case or not. What about if they decide they they've received some some concerning correspondence. They do the investigation under the investigatory powers that they're given. And they decide that they don't think it's being used for public or patient benefit.
And they restrict the organisation's ability to access data. That's obviously got a significant financial penalty. Potentially. It may have an effect on patients access to healthcare. To um what right of appeal would the organisation have and to whom and how would that work?Um the other thing is the question about the wording because commercial activity may well benefit patients. And I think sometimes that is forgotten the. Next thing they have to do is ensure that all data sharing arrangements with the non NHS organisation are transparent with all health data contracts entered into by public body made publicly available.
Again just some more detail really on that. So um would that include um anonymous anonymously provided data. Um what effect would that have on the research environment and the integrity of um research being done under commercial. Arrangements. Um what about the costs. Would the costs only costs be shared and what effect would that have on future commercial negotiations when the government is trying to get the next, next organisation to look at the data and what level of detail are made publicly available in the contract, what level of detail would need to be provided?They need to publish minutes of their meetings, which seems reasonable.
They need to show that all health data collection and sharing initiatives are preceded by public consultation, involvement and awareness. As data collection, as well as data sharing initiatives. Do they really mean that all data collection has to be go through public consultation?So if, as we talked about yesterday in corridor relating to corridor care, the government decided now wants to know how many people have voted more than 24 hours in A&E. They have to do public consultation to, to, to, to um to collect that data.
It just seems a little bit, um, overly bureaucratic.
11:55
11:56
Speaker 4
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Speaker 4
Isn't that part of the tension in the, the problem in the wording of this new clause is that it's not clear from the new clause. What is NHS data and what is the patient's data and who owns which bit of it. And the problem with the way the clause is written, as she's outlining, is that it appears to read that every single piece of data held by the NHS, whether it directly relates to a patient or not. And indeed, as she's outlining, if the government were to collect any other sort of data, even if it's on an aggregate basis, as she's describing, for how many how many people are waiting 24 hours, etc., that would then come under this, and that would obviously be totally unworkable and put an enormous burden of bureaucracy on, on the on the health service.
11:56
Speaker 6
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Speaker 6
My honourable friend is, as ever, correct. And I'd be interested if the honourable lady has made any estimates of the time, uh, person that personnel time or cost that this would entail. And so in summary, this clause creates an unelected committee. Removing democratic control of this thing. I mean, essentially what it's doing is it's asking the committee of unelected individuals to write the policy and implement the policy, um, which is the job of the minister. Um, and should be under ministerial control.
And if the minister disagrees or the elected individuals, government as a whole disagree with the policy in the um brought forward by this committee, I will, of course, show Robertson.
And if the minister disagrees or the elected individuals, government as a whole disagree with the policy in the um brought forward by this committee, I will, of course, show Robertson.
11:57
Speaker 5
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Speaker 5
I thank my hon. Friend for giving way. Does she agree there's an overarching issue here of public confidence in the safety of their data, which isn't about one company or another. It's about ensuring robust safeguards are there in place for everyone and for every provider of data. Record keeping system. Because if the public don't have confidence, then they will understandably withdraw consent for their data being held, and that will undermine the whole single patient record the whole way in which health can be delivered efficiently in the best interests of patients.
11:57
Speaker 6
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Speaker 6
Shadow Minister, I agree with my hon. Friend and of course, the purpose behind this clause, I'm sure, is to try and ensure that data is safe. But it it removes democratic accountability to, to an extent from from that process, the process of developing the policy, which may reduce the, um, people's. Confidence in it. Um, but I do agree with the, the underlying principles, I think much of it is quite cumbersome and as yet undefined. And so I think it's important that we get a little bit more detail and a bit more, more specificity within what is being proposed.
Thank you, Chair.
Thank you, Chair.
11:58
12:10
12:10
14:00
Speaker 2
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Speaker 2
Thank you, Miss Lou, and it's good to see you in the chair this afternoon. So I will address new clauses. 1256 and 84 together, starting with clause 84, tabled by the honourable member for Sleaford and North Hykeham. And I want to reconfirm that this government remains focused on reducing long waits by improving patient flow, increasing productivity and delivering better emergency care for patients. And we heard in the debate we had a very good discussion last night in the chamber on corridor care in particular.
Miss Lowell, I think all our comments are on the record. I won't deter the committee, delay the committee too much further by repeating all my points, but I will take some time to answer the questions as put forward. Um, this afternoon. This morning, and we were very clear that this government will end corridor care in this Parliament. It is completely unacceptable, and we know that longer waits for emergency care can be associated with poorer patient outcomes. And that is why, through the Urgent and emergency care plan in 2020 526, we are investing over £450 million to expand urgent and emergent care capacity, including new same day emergency care services, urgent treatment centres, additional mental health crisis provision and nearly 1000 replacement ambulances.
And alongside this, we are implementing new clinical standards and improving patient flow across hospitals, all to reduce the number of patients waiting more than 12 hours. And if I may, be, I will, of course.
Miss Lowell, I think all our comments are on the record. I won't deter the committee, delay the committee too much further by repeating all my points, but I will take some time to answer the questions as put forward. Um, this afternoon. This morning, and we were very clear that this government will end corridor care in this Parliament. It is completely unacceptable, and we know that longer waits for emergency care can be associated with poorer patient outcomes. And that is why, through the Urgent and emergency care plan in 2020 526, we are investing over £450 million to expand urgent and emergent care capacity, including new same day emergency care services, urgent treatment centres, additional mental health crisis provision and nearly 1000 replacement ambulances.
And alongside this, we are implementing new clinical standards and improving patient flow across hospitals, all to reduce the number of patients waiting more than 12 hours. And if I may, be, I will, of course.
14:01
14:01
Speaker 3
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Speaker 3
Um, thank you for the Minister for giving away. And I was really pleased with the debate yesterday in the chamber, and I was able to take part in that. And in that debate, I specifically talked about some examples from my own local hospital, where the hospital is expanding its same day, emergency care because of the funding we received from the Labour government. We also have a safe haven for mental health patients who may not need to go into the A&E. So there are lots of works happening in my own local hospital area, which is going to make a big improvement in the corridor care and wider emergency care pressures.
So would the minister agree that this is what we need to do, and this Labour Government is doing that?
So would the minister agree that this is what we need to do, and this Labour Government is doing that?
14:02
Speaker 2
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Speaker 2
Well, I thank my hon. Friend for Ashford for that innovation. And, you know, he has been such a strong campaigner. Um, there are a lot of problems in his health community as he well knows. And he's always there first, uh, challenging me, uh, this law about the challenges in his health care system and making sure the people of Ashford are duly represented in this area. And he's absolutely right. Some of those improvements on the ground are what will make a difference to patients.
And I think patients are already starting to feel I don't minimize how far there is to go, but patients are starting to feel that improvement. And in the debate last night, this law we heard not only from the member from Ashford about some great work that's happening there, but also the members in Rossendale and Darwen talked about what's happening in Blackburn. Again, a challenge system, challenged hospital, real improvements there. And one member for Watford and the, uh, our friend the member for Bury St Edmunds and Stowmarket talked about progress in West Suffolk and that is really encouraging to see.
Um, earlier on in the debate, Miss Lou, we did have some, uh, reference to some statistics that are raised, I think, by the member for North Shropshire and by others that are, um, you know, that are in the public domain about um deaths due to long waits and so on. Of course, that is completely unacceptable situation, but I just want to put on the record that those statistics aren't government statistics. I think we did have a bit of a debate about that from my hon. Friend the member for Bury St Edmunds and I.
Highlighted. How one can attribute um. Cause of death to certain provisions. It is a really important measure. We don't want anybody waiting. Full stop for that. Um, but the statistics aren't verified as government statistics. I just want to be clear about that. Um, and can I assure the committee that trusts are already held to account with reference to the amendment, trusts are already held to account on the number of patients waiting 12 hours from arrival in A&E to either admission, discharge or transfer, and the medium term planning Framework, published in October 2025, sets out the expectation that trusts reduced the percentage of patients waiting 12 hours or more year on year through through to 2020 829, as part of our overall ambition to meet the NHS constitutional standards, this government already produces comprehensive data on urgent emergency care performance, including waiting times and 12 hour waits, and these data provide transparency, support, oversight of NHS performance and enable independent analysis of patient outcomes.
And this government has been very keen to make sure those statistics are published. Another issue that was raised in the debate this morning was about this issue around beds and bed numbers, and we had a bit of a discussion about a bit of a historical throwback back into the 1990s, which I won't do now, and detain you further. Um, about, um, the movement and my friend from various evidence and Stone Mark talked about changes in clinical practice, mental health beds and so on and so forth. Um, and I, and again, I could talk for many hours as a junior manager coming into the health service, one of my first tasks was actually defining what a bed is.
That is not an easy thing to do. I know most people think they know what a bed is, but as the discussion we had earlier, for some people, defining that a trolley without wheels could be a bed. As I was discussing with colleagues earlier. So it sort of counting of beds and what they are and what their use is complicated business in health service. But I know you'll tell me not to differ from the amendment in front of us with that, but it is an important practice changes.
It's important that we keep up with the most effective and efficient use of NHS resources. That does mean changes to bed numbers and where those beds are and how we count them. But to be clear, June 2026 or on average, 13,618 adult patients in acute hospitals per day and they were waiting for delayed discharge, which is the point of what people were asking about. We have improved the data collection, so we've got a better sense of the scale of the problem and where it is crucially, because it's different in different places and we seek to improve that data.
But I also gently remind the committee that the NHS England website produces an awful lot of really good data, actually. So it is it is, you know, members of Parliament, our constituents are able to keep track of all that. But it is important. Um, as I said, and as my friend the member for Edmondson, Stowmarket made clear, we do need to keep up with best clinical practice as well as best use of resources. And we're very happy to share that information and keep it transparent.
So. I'll now turn to new clauses 12 and new clause 56, tabled by the honourable member for North Shropshire, and they are also right to raise the unacceptable rates of care for some patients. Experience in A&E after decision to admit them has been made, and this includes patients at times being treated and cared for in corridors due to lack of capacity in the hospitals to admit them. And again, as we discussed last night, to reiterate it, the government is clear corridor care is not an acceptable standard of care and must not be normalised.
We inherited an NHS under severe pressure, with long waits and increasing numbers of patients receiving care in non-designated clinical areas. And as we heard earlier, it is unacceptable. But I'm afraid it was allowed to again happen under the party opposite and we are committed to eradicating corridor care and have a plan to do so. So to improve transparency, we've already established that clear national definition of corridor care. Again, something they could have done in the last 14 years, but they chose not to.
So we've established that definition, introduced daily reporting arrangements, and strengthened the data quality processes, working hand in hand with stakeholders including the Royal College. And in addition, we have published national guidance to support safe care where such situations cannot be avoided, and we're working hard to tackle the causes of corridor care, not just report on the consequences. That's why we want to improve patient flow. And we had good discussions about patient flow. Both pre-admission and Post-discharge and indeed social care, primary and community care to support people, and leading care homes so that we don't have people, particularly frail elderly people, turning up at hospitals where it is better for them clinically to be treated, where they are improving patient flow to strengthen the discharge arrangements and invest in £215.5 million in new and expanded urgent care services across England.
We're also providing targeted support to the trusts facing the greatest challenges in relation to corridor care, so that improvements can be delivered where they are needed most. I'd also remind the honourable members that currently a patient and I think the honourable member for Sleaford and North Hykeham, obviously as a clinician, will be clear on, on, on some of this around admission to the of North Shropshire amendment. Um a patient will present at A&E and a clinician will decide if they need to be admitted to the hospital, provide treatment, transfer their care to another location or discharge them.
And under current reporting rules, the clock starts running on a patient's arrival in A and E, and this clock stops when one of these actions is taken. So as a result, no decision is made to admit to an A&E itself. Instead, if someone requires admission, that means they could be somewhere else in the hospital. So, Miss Lewis, I fully recognise the concerns that underpin these amendments. I don't believe that further statutory requirements are the right approach in this in in in this case.
But as I alluded to the debate last night, I think outlined in full the government's absolute commitment to addressing these issues, to improving the situation for all our constituents. And I hope I've suitably reassured the honourable members that these clauses are not required and they feel able to withdraw them.
And I think patients are already starting to feel I don't minimize how far there is to go, but patients are starting to feel that improvement. And in the debate last night, this law we heard not only from the member from Ashford about some great work that's happening there, but also the members in Rossendale and Darwen talked about what's happening in Blackburn. Again, a challenge system, challenged hospital, real improvements there. And one member for Watford and the, uh, our friend the member for Bury St Edmunds and Stowmarket talked about progress in West Suffolk and that is really encouraging to see.
Um, earlier on in the debate, Miss Lou, we did have some, uh, reference to some statistics that are raised, I think, by the member for North Shropshire and by others that are, um, you know, that are in the public domain about um deaths due to long waits and so on. Of course, that is completely unacceptable situation, but I just want to put on the record that those statistics aren't government statistics. I think we did have a bit of a debate about that from my hon. Friend the member for Bury St Edmunds and I.
Highlighted. How one can attribute um. Cause of death to certain provisions. It is a really important measure. We don't want anybody waiting. Full stop for that. Um, but the statistics aren't verified as government statistics. I just want to be clear about that. Um, and can I assure the committee that trusts are already held to account with reference to the amendment, trusts are already held to account on the number of patients waiting 12 hours from arrival in A&E to either admission, discharge or transfer, and the medium term planning Framework, published in October 2025, sets out the expectation that trusts reduced the percentage of patients waiting 12 hours or more year on year through through to 2020 829, as part of our overall ambition to meet the NHS constitutional standards, this government already produces comprehensive data on urgent emergency care performance, including waiting times and 12 hour waits, and these data provide transparency, support, oversight of NHS performance and enable independent analysis of patient outcomes.
And this government has been very keen to make sure those statistics are published. Another issue that was raised in the debate this morning was about this issue around beds and bed numbers, and we had a bit of a discussion about a bit of a historical throwback back into the 1990s, which I won't do now, and detain you further. Um, about, um, the movement and my friend from various evidence and Stone Mark talked about changes in clinical practice, mental health beds and so on and so forth. Um, and I, and again, I could talk for many hours as a junior manager coming into the health service, one of my first tasks was actually defining what a bed is.
That is not an easy thing to do. I know most people think they know what a bed is, but as the discussion we had earlier, for some people, defining that a trolley without wheels could be a bed. As I was discussing with colleagues earlier. So it sort of counting of beds and what they are and what their use is complicated business in health service. But I know you'll tell me not to differ from the amendment in front of us with that, but it is an important practice changes.
It's important that we keep up with the most effective and efficient use of NHS resources. That does mean changes to bed numbers and where those beds are and how we count them. But to be clear, June 2026 or on average, 13,618 adult patients in acute hospitals per day and they were waiting for delayed discharge, which is the point of what people were asking about. We have improved the data collection, so we've got a better sense of the scale of the problem and where it is crucially, because it's different in different places and we seek to improve that data.
But I also gently remind the committee that the NHS England website produces an awful lot of really good data, actually. So it is it is, you know, members of Parliament, our constituents are able to keep track of all that. But it is important. Um, as I said, and as my friend the member for Edmondson, Stowmarket made clear, we do need to keep up with best clinical practice as well as best use of resources. And we're very happy to share that information and keep it transparent.
So. I'll now turn to new clauses 12 and new clause 56, tabled by the honourable member for North Shropshire, and they are also right to raise the unacceptable rates of care for some patients. Experience in A&E after decision to admit them has been made, and this includes patients at times being treated and cared for in corridors due to lack of capacity in the hospitals to admit them. And again, as we discussed last night, to reiterate it, the government is clear corridor care is not an acceptable standard of care and must not be normalised.
We inherited an NHS under severe pressure, with long waits and increasing numbers of patients receiving care in non-designated clinical areas. And as we heard earlier, it is unacceptable. But I'm afraid it was allowed to again happen under the party opposite and we are committed to eradicating corridor care and have a plan to do so. So to improve transparency, we've already established that clear national definition of corridor care. Again, something they could have done in the last 14 years, but they chose not to.
So we've established that definition, introduced daily reporting arrangements, and strengthened the data quality processes, working hand in hand with stakeholders including the Royal College. And in addition, we have published national guidance to support safe care where such situations cannot be avoided, and we're working hard to tackle the causes of corridor care, not just report on the consequences. That's why we want to improve patient flow. And we had good discussions about patient flow. Both pre-admission and Post-discharge and indeed social care, primary and community care to support people, and leading care homes so that we don't have people, particularly frail elderly people, turning up at hospitals where it is better for them clinically to be treated, where they are improving patient flow to strengthen the discharge arrangements and invest in £215.5 million in new and expanded urgent care services across England.
We're also providing targeted support to the trusts facing the greatest challenges in relation to corridor care, so that improvements can be delivered where they are needed most. I'd also remind the honourable members that currently a patient and I think the honourable member for Sleaford and North Hykeham, obviously as a clinician, will be clear on, on, on some of this around admission to the of North Shropshire amendment. Um a patient will present at A&E and a clinician will decide if they need to be admitted to the hospital, provide treatment, transfer their care to another location or discharge them.
And under current reporting rules, the clock starts running on a patient's arrival in A and E, and this clock stops when one of these actions is taken. So as a result, no decision is made to admit to an A&E itself. Instead, if someone requires admission, that means they could be somewhere else in the hospital. So, Miss Lewis, I fully recognise the concerns that underpin these amendments. I don't believe that further statutory requirements are the right approach in this in in in this case.
But as I alluded to the debate last night, I think outlined in full the government's absolute commitment to addressing these issues, to improving the situation for all our constituents. And I hope I've suitably reassured the honourable members that these clauses are not required and they feel able to withdraw them.
14:09
14:09
14:10
Speaker 4
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Speaker 4
The shadow minister raised a question about the role of Healthwatch in selecting the panel that would, uh, interrogate the Secretary of State as we envisage a new clause, new clause 56, uh, which we've discussed and have quite a long debate over, in fact, this morning, um, I'm just going to cover off a couple of questions. Um. The shadow minister raised a question about the role of Healthwatch in selecting the panel that would, uh, interrogate the Secretary of State as we envisage a new clause, new clause 56, uh, which we've discussed and have quite a long debate over, in fact, this morning, um, I'm just going to cover off a couple of questions.
Um. The shadow minister raised a question about the role of Healthwatch in selecting the panel that would, uh, interrogate the Secretary of State as we envisaged in new clause 12. And the fact that Healthwatch had been, uh, abolished by the bill and also, uh, on the, um, the other new clause, which requires the Secretary of State to have due regard to the final reporting of Baroness Casey's report. But those were essentially inconsistent. And I would just draw the shadow ministers attention to the fact that as a suite of amendments that we put down, they were consistent.
So we oppose the abolition of Healthwatch. Had that been successful, Healthwatch would definitely have still been there. Um, and we have put down nuclear 60, which we'll get to at some point, which requires Baroness Casey's commission to report much more quickly. So that's why they're that apparent consistency, inconsistency exists. And um, I hope that sorted that out for her. Uh, just, just more generally, um, the right hon. Gentleman the former minister talked about capacity as a hole in the system and its impact on social care and on corridor care.
And his concern that if we focus on corridor care, we would end up with more people being treated in ambulances, have longer ambulance handover times and very long ambulance wait times. Now he will know because he was the responding minister to my first adjournment debate in this place. Um, that ambulance wait times have been a significant problem where I live and I'm pleased to say that they are becoming less and less of a problem over time. And that has been because the new management of the hospital have focused relentlessly on their A&E department and on ensuring that ambulance patients can be taken into the A&E department very quickly, or certainly much more quickly than they used to be.
So I recognise this concern, but I think that is a manageable concern. I will give way to them.
Um. The shadow minister raised a question about the role of Healthwatch in selecting the panel that would, uh, interrogate the Secretary of State as we envisaged in new clause 12. And the fact that Healthwatch had been, uh, abolished by the bill and also, uh, on the, um, the other new clause, which requires the Secretary of State to have due regard to the final reporting of Baroness Casey's report. But those were essentially inconsistent. And I would just draw the shadow ministers attention to the fact that as a suite of amendments that we put down, they were consistent.
So we oppose the abolition of Healthwatch. Had that been successful, Healthwatch would definitely have still been there. Um, and we have put down nuclear 60, which we'll get to at some point, which requires Baroness Casey's commission to report much more quickly. So that's why they're that apparent consistency, inconsistency exists. And um, I hope that sorted that out for her. Uh, just, just more generally, um, the right hon. Gentleman the former minister talked about capacity as a hole in the system and its impact on social care and on corridor care.
And his concern that if we focus on corridor care, we would end up with more people being treated in ambulances, have longer ambulance handover times and very long ambulance wait times. Now he will know because he was the responding minister to my first adjournment debate in this place. Um, that ambulance wait times have been a significant problem where I live and I'm pleased to say that they are becoming less and less of a problem over time. And that has been because the new management of the hospital have focused relentlessly on their A&E department and on ensuring that ambulance patients can be taken into the A&E department very quickly, or certainly much more quickly than they used to be.
So I recognise this concern, but I think that is a manageable concern. I will give way to them.
14:12
Speaker 5
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Speaker 5
I'm grateful to the Honourable lady for taking the intervention. Whilst it is true that a hospital management could could concentrate on dealing with the waits in A&E. It is surely the case that what the hospital management needs to do is to concentrate on the flow through the entire hospital, so every department within the hospital, every everybody that's involved in the hospital has to be thinking all the time about the way in which the flow through the entire hospital happens. And so, you know, that involves sorting out having a pharmacy, which is open at night.
It involves making sure that the social workers are there when they need to be. It involves all manner of things. So simply concentrating on a particular statistic within an A&E department won't actually deal with the problem.
It involves making sure that the social workers are there when they need to be. It involves all manner of things. So simply concentrating on a particular statistic within an A&E department won't actually deal with the problem.
14:13
Speaker 4
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Speaker 4
Well, I thank you for his intervention, and I think our amendment does address that. That point actually. So, um, just on a couple of things. So I mentioned that my own hospital, uh, Shrewsbury and Telford Hospital Trust, they have improved their ambulance wait issue simply by improving their flow through the hospital and addressing some of those issues. I recognise that our amendment doesn't deal with that particularly critical issue of pharmacy availability at weekends and overnight, which I know is an issue in many hospitals.
And I think when we get to report stage, we'll certainly tidy it up to ensure that it does. I take his point on board there, but I think my amendment, my new clause here, does actually address the system wide capacity issue that he has highlighted so, so carefully, both last night in the debate and today, because we need more capacity across the whole system, because otherwise we're just kind of trying to push a lump in a carpet to a different place. And it doesn't it's always going to be a lump somewhere.
And so our amendment seeks to provide 6000 more beds across the whole system to allow that flow through the system and to ensure that the waits don't back up in the ambulance service or in people on corridors in A&E, where they currently back up, or indeed on corridors outside wards. So, um, the amendment definitely seeks to address that. And critically, I think this point about NHS pledges and rights is one that we should address, because it's, in my view, a. The fact that the Constitution is broadly agnostic about the length of time that you will wait on a corridor, but isn't agnostic about the amount of time that you will take to get cancer treatment.
Is it inconsistency?And I think we should talk that inconsistency out because I think all of our constituents are. Would consider both of those things to be of equal importance. So I take the minister's point on new clause. Um, where are we. New clause 12. And I won't push that to a vote, but I would just say that trusts are held to account on their performance. But it does feel like the piece that's lacking is that the Secretary of state isn't.
Um and that's what this this amendment, this new clause seeks to address. So I wonder if you'd consider that when we get to report stage. Um, so I will not push new clause to, to vote, but when we get to clause 56 later on I will do. Thank you.
And I think when we get to report stage, we'll certainly tidy it up to ensure that it does. I take his point on board there, but I think my amendment, my new clause here, does actually address the system wide capacity issue that he has highlighted so, so carefully, both last night in the debate and today, because we need more capacity across the whole system, because otherwise we're just kind of trying to push a lump in a carpet to a different place. And it doesn't it's always going to be a lump somewhere.
And so our amendment seeks to provide 6000 more beds across the whole system to allow that flow through the system and to ensure that the waits don't back up in the ambulance service or in people on corridors in A&E, where they currently back up, or indeed on corridors outside wards. So, um, the amendment definitely seeks to address that. And critically, I think this point about NHS pledges and rights is one that we should address, because it's, in my view, a. The fact that the Constitution is broadly agnostic about the length of time that you will wait on a corridor, but isn't agnostic about the amount of time that you will take to get cancer treatment.
Is it inconsistency?And I think we should talk that inconsistency out because I think all of our constituents are. Would consider both of those things to be of equal importance. So I take the minister's point on new clause. Um, where are we. New clause 12. And I won't push that to a vote, but I would just say that trusts are held to account on their performance. But it does feel like the piece that's lacking is that the Secretary of state isn't.
Um and that's what this this amendment, this new clause seeks to address. So I wonder if you'd consider that when we get to report stage. Um, so I will not push new clause to, to vote, but when we get to clause 56 later on I will do. Thank you.
14:15
Speaker 1
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Speaker 1
Is everyone content for the new clause to be withdrawn?You caused by leave withdrawn. We now come to a new clause 13 which was debated with new clause one. Does the honourable member wish to push this to a vote?No. We now come to Group 56 in New Clause 14, with which we will debate New clause 79 and new clause 80. I call Helen Morgan to move the new clause. Oh, doctor Danny Chambers even.
14:16
Speaker 6
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Speaker 6
Thank you, Madam Chair. Clause 14 is about healthy life expectancy. So this would require the Secretary of State to make regulations to establish a statutory target for healthy life expectancy in Great Britain and publish a strategy every two years, setting out how this target will be achieved. A new clause 79 would establish a public health committee and health creation unit to promote public health and cross-government policy making, and New clause 80 would place a duty on all ministers to consider health outcomes and the promotion of public health when exercising their duty.
So I'll speak to all these three clauses together as a very closely related. So give me a bit of context. Over the last 100 years, life expectancy in the UK has been increasing for a variety of reasons, including vaccination and improved hygiene and medical advances. Um, but worryingly, it between 2022 and 2024, it decreased by 1.8 years for men and 2.5 years for women. This is the first time it's decreased in a while. Um, there's an 11.1 year gap that exists between the highest and lowest life expectancies.
And we know that the part of the reason for that gap existing is due to demographics and different socio economic, situations. The socio economic disparity is causing a very significant difference in life expectancy. So it's clear that we need wider whole government working to address the root cause and contributing factors to ill health. So if the DHS, the NHS and social care are dealt with too much in silos, but equally this is the same across the whole of government, there's too much siloed working.
So the whole government, all departments, should be working with at least one eye on the health of the nation. And so that's what these amendments are seeking to foster. So a healthy life expectancy target would provide the basic metric for this aspiration, forcing wider thinking around prevention and ill health rather than the current focus. As important as they are being very much focused on waiting lists and hospital performance. So. Would place a duty on all ministers to consider health outcomes and the promotion of public health and exercising their duties.
Again, this should aim to focus the minds of non government departments that have a central role to play in the promotion of good health and longevity, whether that be housing standards or environmental regulations. Um, we also included health protection as well as health promotion. So areas like clean water included, which are more in the space of health protection rather than say active travel, which is more promotional. And finally, new clause 79. This would create a public health committee and a health creation unit to support the work of these.
These committees, especially when it's between um departments. So this was an idea originally introduced under the coalition government designed to tackle obesity, alcohol abuse and other public health problems. Now, while we recognise it's not perfect, um namely the Tories lack of engagement and spotty attendance, the desire to foster cross-government thinking was was definitely the right one.
So I'll speak to all these three clauses together as a very closely related. So give me a bit of context. Over the last 100 years, life expectancy in the UK has been increasing for a variety of reasons, including vaccination and improved hygiene and medical advances. Um, but worryingly, it between 2022 and 2024, it decreased by 1.8 years for men and 2.5 years for women. This is the first time it's decreased in a while. Um, there's an 11.1 year gap that exists between the highest and lowest life expectancies.
And we know that the part of the reason for that gap existing is due to demographics and different socio economic, situations. The socio economic disparity is causing a very significant difference in life expectancy. So it's clear that we need wider whole government working to address the root cause and contributing factors to ill health. So if the DHS, the NHS and social care are dealt with too much in silos, but equally this is the same across the whole of government, there's too much siloed working.
So the whole government, all departments, should be working with at least one eye on the health of the nation. And so that's what these amendments are seeking to foster. So a healthy life expectancy target would provide the basic metric for this aspiration, forcing wider thinking around prevention and ill health rather than the current focus. As important as they are being very much focused on waiting lists and hospital performance. So. Would place a duty on all ministers to consider health outcomes and the promotion of public health and exercising their duties.
Again, this should aim to focus the minds of non government departments that have a central role to play in the promotion of good health and longevity, whether that be housing standards or environmental regulations. Um, we also included health protection as well as health promotion. So areas like clean water included, which are more in the space of health protection rather than say active travel, which is more promotional. And finally, new clause 79. This would create a public health committee and a health creation unit to support the work of these.
These committees, especially when it's between um departments. So this was an idea originally introduced under the coalition government designed to tackle obesity, alcohol abuse and other public health problems. Now, while we recognise it's not perfect, um namely the Tories lack of engagement and spotty attendance, the desire to foster cross-government thinking was was definitely the right one.
14:19
14:19
14:19
Speaker 5
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Speaker 5
I wonder whether he would comment on what I consider to be almost the most successful and most important bill that our new government has, in fact passed, which is the effective abolition of cigarette smoking, which will, I believe, save more lives as time goes by than anything else that we could possibly think of. Now, I do recognise that this was the initiative of the previous government, but. But I think that the fact that this new government has managed to get this over the line is a massive achievement, which I think is very much underappreciated and certainly not spoken about anything like enough.
We will never do anything as important as the abolition of cigarette smoking.
We will never do anything as important as the abolition of cigarette smoking.
14:19
Speaker 6
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Speaker 6
I think the other intervention and yes, actually sat on the tobacco Bill committee for six weeks, going line by line through legislation as well. And I think one of the most interesting impacts of that is not only that it's a single piece of legislation that will improve public health and life expectancy, but it's also one of the probably the single most impactful piece of legislation to actually improve inequality, um, especially socioeconomic health outcomes, because so many of the disparities between life expectancy, wealthy people and, and people, um, living in relative poverty tend to be due to smoking levels.
Not only that, but significant, that is a significant factor. So it's very good of him to highlight that, um. And so Beckham during the coalition, the Tories recognised it would send a powerful message that the public health is a responsibility. Responsibility of all government departments. And when it was then scrapped, the shadow health secretary at the time um now the the honourable member for Makerfield said we can only tackle Britain's looming obesity crisis if all government departments pull together, and we completely agree with that statement.
So our amendment tries to address some of these issues that occurred back then, including placing requirements on ministerial attendance and giving liaison committee oversight to drive accountability. So I just appreciate the minister. Um, I'm sure she would agree that greater cross-government working is needed. So what are the department's plans to support this?Because if we want to tackle the various public health crisis facing our country, we can't do this without proper cross-government working. And certainly in my professional life, I've, I, um, I used to I'm made an honorary lecturer at Bristol University Veterinary School in an area of one health, which was a recognition that animal health, human health and environmental health are completely interlinked.
It's very difficult to improve one without looking at factors that improve the other. And I think we need that kind of approach throughout all government departments.
Not only that, but significant, that is a significant factor. So it's very good of him to highlight that, um. And so Beckham during the coalition, the Tories recognised it would send a powerful message that the public health is a responsibility. Responsibility of all government departments. And when it was then scrapped, the shadow health secretary at the time um now the the honourable member for Makerfield said we can only tackle Britain's looming obesity crisis if all government departments pull together, and we completely agree with that statement.
So our amendment tries to address some of these issues that occurred back then, including placing requirements on ministerial attendance and giving liaison committee oversight to drive accountability. So I just appreciate the minister. Um, I'm sure she would agree that greater cross-government working is needed. So what are the department's plans to support this?Because if we want to tackle the various public health crisis facing our country, we can't do this without proper cross-government working. And certainly in my professional life, I've, I, um, I used to I'm made an honorary lecturer at Bristol University Veterinary School in an area of one health, which was a recognition that animal health, human health and environmental health are completely interlinked.
It's very difficult to improve one without looking at factors that improve the other. And I think we need that kind of approach throughout all government departments.
14:21
14:22
14:22
Speaker 3
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Speaker 3
Miss level, it's good to see you in the chair. Um. I strongly believe that public health is very important in our health system to, uh, focusing on prevention so that people don't end up in A&E or in our hospital beds. But unfortunately, what we have seen the opposite of that over the last ten, 15 years, if we are serious about improving the nation's health, then prevention must sit at the heart of every decision we make. Public health professionals bring a vital perspective, one that looks beyond treating illnesses to understanding and tackling its root causes.
They consider the wider determinants of health, from housing and education to inequality and environment, and they help us design services that keep people well, not just respond when they are unwell. Um, so what we need to do is influence or identify our priorities. Our resources need to be allocated appropriately and long term strategy. If I just talk to the clause 79, what we have seen here is this new clause is asking to create a new a new committee. Somebody who worked in the NHS for many, many years.
What I have seen is in NHS or in our health care system, there is no shortage of any committees or senior leaders or management or meetings. In fact, it is too many. I'm missing there is. We don't have people to work in the front line, and that's what we've seen in the last 14 years. That's including both Conservatives and Lib Dem was part of it. And one of the reasons I joined in the active politics was that the reason that the front line was struggling, and I would say I was a nurse working in the front line in the mental health services.
But what we were seeing is all money was diverted to create a more senior leadership, more groups of meetings and, and management. But we were missing the people who actually want to do more work in the front line. So this specific clause asking to create a health committee, we do have enough committees. We do have enough managers. In fact, by modernizing this bill, we're trying to get rid of some of the managers. That's that's the most important thing I identify from this bill.
And lots of these new clauses I have seen today. And in the last committee day was it was asking to create more and more committees, more directors. So, um. Mr.. Will, I think I think we're missing a point here. This committee got an opportunity to reform our health system. If you speak to a nurse or a doctor who works in the hospital or our health care system, they will say, we need more nurses. We need more health care assistants.
We need more doctors, not more managers, not more, not more, any more. Directors. So I think this is not just this clause in this field. We're talking about new many new clauses. And we really need to think about um, what we need is um, we need to empower the public health voice with an integrated care boards. I believe that strengthening integrated care boards ability to act early, reduce health inequalities and deliver care closer to home. I'm happy to give way.
They consider the wider determinants of health, from housing and education to inequality and environment, and they help us design services that keep people well, not just respond when they are unwell. Um, so what we need to do is influence or identify our priorities. Our resources need to be allocated appropriately and long term strategy. If I just talk to the clause 79, what we have seen here is this new clause is asking to create a new a new committee. Somebody who worked in the NHS for many, many years.
What I have seen is in NHS or in our health care system, there is no shortage of any committees or senior leaders or management or meetings. In fact, it is too many. I'm missing there is. We don't have people to work in the front line, and that's what we've seen in the last 14 years. That's including both Conservatives and Lib Dem was part of it. And one of the reasons I joined in the active politics was that the reason that the front line was struggling, and I would say I was a nurse working in the front line in the mental health services.
But what we were seeing is all money was diverted to create a more senior leadership, more groups of meetings and, and management. But we were missing the people who actually want to do more work in the front line. So this specific clause asking to create a health committee, we do have enough committees. We do have enough managers. In fact, by modernizing this bill, we're trying to get rid of some of the managers. That's that's the most important thing I identify from this bill.
And lots of these new clauses I have seen today. And in the last committee day was it was asking to create more and more committees, more directors. So, um. Mr.. Will, I think I think we're missing a point here. This committee got an opportunity to reform our health system. If you speak to a nurse or a doctor who works in the hospital or our health care system, they will say, we need more nurses. We need more health care assistants.
We need more doctors, not more managers, not more, not more, any more. Directors. So I think this is not just this clause in this field. We're talking about new many new clauses. And we really need to think about um, what we need is um, we need to empower the public health voice with an integrated care boards. I believe that strengthening integrated care boards ability to act early, reduce health inequalities and deliver care closer to home. I'm happy to give way.
14:26
Speaker 2
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Speaker 2
I thank the honourable member for giving way and for his powerful comments. I was just kind of struck by his, um, argument that we need to focus more on what we do in the community itself. And in my own community of Croydon East, where we've got a community diagnostic centre that's opened that in a community that has a ten year, um, health life expectancy versus people that are a mile down the road. Does he agree with me that those kind of real, tangible interventions on the, within our communities at the heart of communities that need the help the most is what we should be focusing on and kind of what this government is trying to do.
14:26
Speaker 3
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Speaker 3
Um, thank you for that intervention, and I absolutely agree with that point. And I can give an example. Last week, one of my GP practices as part of the ECB's new neighbourhood, um Independent Neighbourhood Health Centre, started to proactively go and see all um elderly patients. So this is not that they're seeing the patient giving the appointments to, to, for when they're falling ill. It is proactively going and seeing them. That's what we need. We need that kind of support to go in so we can prevent the illnesses, prevent people going to the hospital.
So I. Yeah, thank you.
So I. Yeah, thank you.
14:27
14:27
Speaker 2
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Speaker 2
Member for giving way. And will he agree with me that as well as the physical aspects of health and extending life expectancy, we need to look at preventative measures for mental health as well to ensure that people are able to live the fullest life that they can, and to have a good life and receive the treatment that they need. Does he see that as integral to any public health strategy?
14:27
Speaker 3
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Speaker 3
Um, thank you. Thank you for that intervention. And, um, my honourable friend, I'm making absolutely a sensible comment and I work very closely with my honourable friend in, in mental health areas. And it's absolutely right. And some of the policies that this government has introduced, like, for example, getting children an early access to a mental health professional is absolutely vital. So we can prevent that illnesses, they get unwell later on. And also the government is rolling out the new mental health prevention strategy is going to be that's going to be very important.
So I think what we need to focus on, we need to be more lean. We need to be more productive rather than be creating more, uh, managers and more, more committees.
So I think what we need to focus on, we need to be more lean. We need to be more productive rather than be creating more, uh, managers and more, more committees.
14:28
Speaker 8
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Speaker 8
So the honourable member briefly. Yeah. Thank you. I'm very grateful to him. Um, he will probably be aware of the King's Fund report from late last year, which highlighted and it only goes up to 2025. So it's 2010 to 2025, 15 years highlighted that the growth rate in managers has only been 5% during that time. But the growth rate among children's nurses was 94%. Doctors, a 55% increase and similar. And that we are seeing that investment and those workforce increases in the right areas.
But there is one challenge which I think is right, that we acknowledge, and I suspect he will recognise that one group where we haven't seen that same growth is community health visitors and community health workers, and that that group can equally play a role alongside the massive investment in increases in doctors in the past 15 years that that group also does deserve focus from whichever party is in government.
But there is one challenge which I think is right, that we acknowledge, and I suspect he will recognise that one group where we haven't seen that same growth is community health visitors and community health workers, and that that group can equally play a role alongside the massive investment in increases in doctors in the past 15 years that that group also does deserve focus from whichever party is in government.
14:29
Speaker 3
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Speaker 3
Thank you, honourable member, for that intervention. And I agree we need a more band. Five nurses who or a health care assistant who can go and take your blood pressure or check your blood sugar in the patient's home, or when somebody rings the GP surgery, they can meet a nurse or a health care worker to just to check some of the, uh, the basic checks rather than we delay and people not able to get to see somebody and a few weeks or months or a year later they end up in A&E.
So I think that's where the focus should be. So, um, I don't support this clause and I urge the committee to think about some of the new clauses we put there to creating more, uh, directors or more committees. And we need to focus on, um, we need to be more productive. Our health system needs to be more productive.
So I think that's where the focus should be. So, um, I don't support this clause and I urge the committee to think about some of the new clauses we put there to creating more, uh, directors or more committees. And we need to focus on, um, we need to be more productive. Our health system needs to be more productive.
14:30
14:30
Speaker 9
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Speaker 9
Thank you. Chair rise to speak to clauses 1479 and 80 from the Liberal Democrats. Um, new clause 14 requires the Secretary of State to, within six months, make a statutory target for healthy life expectancy in England and then to produce a strategy we need every two years to meet that target. Um, it isn't the first time the House has heard about life expectancy targets. The. I'm sure, um, chair, you will remember the the 2022 levelling up white paper.
The previous government that talks about narrowing the gap in healthy life expectancy between areas where it's highest and lowest. It also aim for healthy life expectancy to rise. Um, and as the honourable member for Winchester said, life expectancy over the last century has increased quite dramatically. But much of this a lot of this effect has come from improvements in child mortality over that time, which is which is a good thing. But then when we look at healthy life expectancy, it's also, um, worth.
Looking at how it's calculated, they use the Sullivan method, which basically starts by looking at mortality rates over a specific time frame for specific population. And then it takes data from a cross-sectional study where people are asked to rate their own health, sort of multiplies, um, them together and produces a figure for healthy life years. And essentially the, therefore, the main element that separates healthy life expectancy from unhealthy life expectancy is survey responses. It's not a clinical metric. If somebody's on a huge amount of medication and treatment feels healthy, then they're healthy.
And if someone on very minor treatment feels unhealthy, then they then they're unhealthy because it's a self-reported measure. The government's website says if, um, if mortality improves by 2%, then a healthy life expectancy increases a very small amount compared with if self-reported, um, healthy, um, feeling healthy goes up by 2%, then you get a much bigger increase in health life expectancy. So, um, I think it's a very important thing to do. We do want people not just to live longer, but to live well.
Um, but it's a case of how we measure it and how we ensure that there are no perverse incentives within it. Um, and that we can, we can look at it over time in the same individuals, because how do people feel when they get up in the winter and it's cold and it's dark and it's raining and it's icy. Sometimes the people may feel less healthy then than they do when England win the World Cup and the sun is shining and it's the weekend. So it's um, it's that sort of varying point.
Another question I wanted to ask the government is that the government's own figures show that musculoskeletal health is particularly important. So 17.2% of the population is a prevalence of such conditions. And people with those conditions are three times more likely to have self-reported poor health. So, um, we've asked before if the government will have a modern service framework on musculoskeletal disease, having scrapped our long term condition strategy. And I'd be grateful if the minister could say whether the government has given more consideration to that and is now willing to do an MSF in relation to musculoskeletal health.
And then moving on to New clause 79. Essentially what this does is it requires, um, the government to create a committee across government, including the Prime Minister, all cabinet members and one minister from each government department. And um, I think, I think the what's behind that, the idea that we need to work together is important. But I'd be grateful for the minister's comments on how feasible that would be and how practical that would be in terms of its effectivity as well. And then finally claw new clause 80.
Um, the duty to promote public health. Well, of course, the duty to produce. It is um the minister's duty to do, to do his or her job. And part of that is promoting public health. But I just wonder, um what minister thinks the practical effects of this clause will be on, on, on, on bureaucracy within departments.
The previous government that talks about narrowing the gap in healthy life expectancy between areas where it's highest and lowest. It also aim for healthy life expectancy to rise. Um, and as the honourable member for Winchester said, life expectancy over the last century has increased quite dramatically. But much of this a lot of this effect has come from improvements in child mortality over that time, which is which is a good thing. But then when we look at healthy life expectancy, it's also, um, worth.
Looking at how it's calculated, they use the Sullivan method, which basically starts by looking at mortality rates over a specific time frame for specific population. And then it takes data from a cross-sectional study where people are asked to rate their own health, sort of multiplies, um, them together and produces a figure for healthy life years. And essentially the, therefore, the main element that separates healthy life expectancy from unhealthy life expectancy is survey responses. It's not a clinical metric. If somebody's on a huge amount of medication and treatment feels healthy, then they're healthy.
And if someone on very minor treatment feels unhealthy, then they then they're unhealthy because it's a self-reported measure. The government's website says if, um, if mortality improves by 2%, then a healthy life expectancy increases a very small amount compared with if self-reported, um, healthy, um, feeling healthy goes up by 2%, then you get a much bigger increase in health life expectancy. So, um, I think it's a very important thing to do. We do want people not just to live longer, but to live well.
Um, but it's a case of how we measure it and how we ensure that there are no perverse incentives within it. Um, and that we can, we can look at it over time in the same individuals, because how do people feel when they get up in the winter and it's cold and it's dark and it's raining and it's icy. Sometimes the people may feel less healthy then than they do when England win the World Cup and the sun is shining and it's the weekend. So it's um, it's that sort of varying point.
Another question I wanted to ask the government is that the government's own figures show that musculoskeletal health is particularly important. So 17.2% of the population is a prevalence of such conditions. And people with those conditions are three times more likely to have self-reported poor health. So, um, we've asked before if the government will have a modern service framework on musculoskeletal disease, having scrapped our long term condition strategy. And I'd be grateful if the minister could say whether the government has given more consideration to that and is now willing to do an MSF in relation to musculoskeletal health.
And then moving on to New clause 79. Essentially what this does is it requires, um, the government to create a committee across government, including the Prime Minister, all cabinet members and one minister from each government department. And um, I think, I think the what's behind that, the idea that we need to work together is important. But I'd be grateful for the minister's comments on how feasible that would be and how practical that would be in terms of its effectivity as well. And then finally claw new clause 80.
Um, the duty to promote public health. Well, of course, the duty to produce. It is um the minister's duty to do, to do his or her job. And part of that is promoting public health. But I just wonder, um what minister thinks the practical effects of this clause will be on, on, on, on bureaucracy within departments.
14:34
14:34
Speaker 10
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Speaker 10
Thank you. Always a pleasure to see you in the chair again this afternoon. Um. I want to very briefly speak, if I may, about specifically clauses, a new clauses 79 and 80. Um I must say I really like the intent of these clauses, this idea of government working better and government working more together and public health being more of an agenda and trying to get people working together in that framework. I think every single member in this room, I'm pretty sure every single member in the House, um, would would agree with the idea that we're going to try and make public health more of an agenda, and we're going to try and get more cross-government working, more cross-departmental working is something I think we would all support.
I do, however, have some very serious concerns about the phrasing and the wording and how these are currently looking at. And if I can turn to new clause 79. Uh, in this new committee, which is which is proposed would include at least one minister from each government department in its membership and all cabinet ministers. I presume that's an addition. So it would be all cabinet members plus one other, which makes it seem like quite an unwieldy, um, committee. And there comes a point when if you've got a committee of 70 people, it ceases to be a committee, particularly because it's then going to be um, need to be chaired, need to be clerks can be, need to be various people in the room.
I have some concerns about the size of it, and I've also got some concerns about the frequency with which it would meet and the requirement that the, um, every single secretary of state must, or every single cabinet minister, I should say, must attend a minimum of three times a year, which is the implication of some of the wording there. I understand I will, of course.
I do, however, have some very serious concerns about the phrasing and the wording and how these are currently looking at. And if I can turn to new clause 79. Uh, in this new committee, which is which is proposed would include at least one minister from each government department in its membership and all cabinet ministers. I presume that's an addition. So it would be all cabinet members plus one other, which makes it seem like quite an unwieldy, um, committee. And there comes a point when if you've got a committee of 70 people, it ceases to be a committee, particularly because it's then going to be um, need to be chaired, need to be clerks can be, need to be various people in the room.
I have some concerns about the size of it, and I've also got some concerns about the frequency with which it would meet and the requirement that the, um, every single secretary of state must, or every single cabinet minister, I should say, must attend a minimum of three times a year, which is the implication of some of the wording there. I understand I will, of course.
14:35
Speaker 5
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Speaker 5
Thank you for taking intervention. I wonder whether the member. I thank you for taking intervention. Um, public health used to be very clearly something that was under the aegis of the National Health Service, and some years ago, what happened is the public health officers became employees of the local authorities. And and the thing became somewhat separated. Does the member agree with what I think, which is that we must try and join public health more closely to the activities of the National Health Service.
And of course, it is public health, which was at the very foundations of the of the National Health Service. I mean, I don't know whether other members like me may have read A.J. Cronin famous book called The Citadel, which describes the origins of the National Health Service. Um, it was, in fact, the book that I understand the original politicians had all read, but there's a marvellous description in there of, uh, an. Endemic of typhus, which had been caused by an infected drain which was running down the middle of the street in this little Welsh mining village.
And the doctors had been completely unable to get the, uh, any of the authorities to deal with this. And so one night, they were ex-military. They, they put a little dynamite in the drain, and they blew the whole thing up. And it's well described in this book. And it just shows how public health was absolutely integrated into the foundation principles of the National Health Service.
And of course, it is public health, which was at the very foundations of the of the National Health Service. I mean, I don't know whether other members like me may have read A.J. Cronin famous book called The Citadel, which describes the origins of the National Health Service. Um, it was, in fact, the book that I understand the original politicians had all read, but there's a marvellous description in there of, uh, an. Endemic of typhus, which had been caused by an infected drain which was running down the middle of the street in this little Welsh mining village.
And the doctors had been completely unable to get the, uh, any of the authorities to deal with this. And so one night, they were ex-military. They, they put a little dynamite in the drain, and they blew the whole thing up. And it's well described in this book. And it just shows how public health was absolutely integrated into the foundation principles of the National Health Service.
14:37
Speaker 10
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Speaker 10
I. I thank the honourable member for his intervention, and I think he raises a very important point about the centrality of public health to the founding of the NHS. I said earlier in this Bill committee that the NHS is the greatest gift that the Labour Party has ever given to the country, and I fundamentally believe it. And so he's he's he's absolutely right to mention the centrality of public health in that process. I also thank him for his recommendation of a book.
So read over recess. Always a pleasure. Um, um, returning back though to clause. Uh, sorry. New clause 79. I do want to just really focus on what we're asking when we say all cabinet members should attend this. That means the Secretary of State for defence. Now, I understand cross-government working. I understand the need for government departments to work closely together. I'm struggling and I'm scratching my head about what actions we expect.
The Secretary of State for defence to be taking to support public health, especially in a circumstance where they will be required to attend this committee minimum of three times a year. In addition, I think in my reading of the wording, in addition to another defence Minister, I would absolutely give my.
So read over recess. Always a pleasure. Um, um, returning back though to clause. Uh, sorry. New clause 79. I do want to just really focus on what we're asking when we say all cabinet members should attend this. That means the Secretary of State for defence. Now, I understand cross-government working. I understand the need for government departments to work closely together. I'm struggling and I'm scratching my head about what actions we expect.
The Secretary of State for defence to be taking to support public health, especially in a circumstance where they will be required to attend this committee minimum of three times a year. In addition, I think in my reading of the wording, in addition to another defence Minister, I would absolutely give my.
14:39
14:39
Speaker 10
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Speaker 10
I appreciate the intervention. Join him in thanking those those service personnel who've done so much good around the world. I just wonder whether it is appropriate to be asking the Secretary of State for defence to be focusing on public health. It's absolutely right that the Defence Department can maybe do things, but do they need to be that centrally involved with the committee?They will have to attend three times a year, in addition to another minister, a minimum of four times a year.
And you're absolutely right to say that, yes, a variety of government departments would be able to do that.
And you're absolutely right to say that, yes, a variety of government departments would be able to do that.
14:40
Speaker 6
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Speaker 6
I appreciate. Um, just to blow my own trumpet. But my greatest, my greatest academic achievement is getting correspondence published in nature on the impact of conflict on antimicrobial resistance and how and it might interest members to know that in Ukraine currently, um, 80% of wounds have bacteria, the novel bacteria that are displaying multi-drug resistance. And it's become a limiting factor in getting soldiers back onto the front line. And so what we're trying to do is get, uh, issues like antimicrobial resistance.
Re framed as national security issues and defence issues and not purely public health issues. Thank you.
Re framed as national security issues and defence issues and not purely public health issues. Thank you.
14:40
Speaker 10
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Speaker 10
Again, I very much appreciate the the intervention. I congratulate him on getting published in a in a very important journal. Um, I am not in any way saying that the Secretary of State shouldn't have any regard and shouldn't be considered. Now you've made a joke. I'm going to respond and say, I thought you looked like a trombonist rather than a trumpeter. Um, but. I do think there is a very important point to draw out here, that whilst government departments can be thinking about this, and whilst I'm sure many ministers will think about some of the public health impacts of of the work that they undertake, I'm not sure that this level of requirement for the for the Defence Department, who obviously have a very significant role, have a very serious role, need to be focused on this.
And if, again, I move to clause 80 and all ministers to have regard for public health. Again, I really appreciate and I value and I think it's a good conversation for us to have and a good debate for us to have. But do I want the Minister for investment?If they are in a situation where they have managed to secure an investor to save a large business, which is essential to the economy of an area, do I want them to be held up by being forced to demonstrate that the investment that they've been able to secure will secure public health?I'm not sure, because a lot of those decisions have to be made very quickly.
Do I want the um. You know, I'm not going to I'm not going to go through a long list of ministers. We'll all be here till next week. Um, but I just think that the, the phrasing, the, the, the wording of this is too broad. And in its current format, I'm not sure I can support it because it is too broad and it's going to replace too much of a requirement onto too many government departments to be focusing too much on areas which aren't their core responsibilities.
Thank you very much, Mr. Robertson.
And if, again, I move to clause 80 and all ministers to have regard for public health. Again, I really appreciate and I value and I think it's a good conversation for us to have and a good debate for us to have. But do I want the Minister for investment?If they are in a situation where they have managed to secure an investor to save a large business, which is essential to the economy of an area, do I want them to be held up by being forced to demonstrate that the investment that they've been able to secure will secure public health?I'm not sure, because a lot of those decisions have to be made very quickly.
Do I want the um. You know, I'm not going to I'm not going to go through a long list of ministers. We'll all be here till next week. Um, but I just think that the, the phrasing, the, the, the wording of this is too broad. And in its current format, I'm not sure I can support it because it is too broad and it's going to replace too much of a requirement onto too many government departments to be focusing too much on areas which aren't their core responsibilities.
Thank you very much, Mr. Robertson.
14:42
Speaker 11
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Speaker 11
Thank you, Mr. President. To serve with you in the chair. And I find myself unequal to the level analysis of analysis and detail that the honourable member for Lichfield gave to public health in the Department. Um, for defence. Can I just add my few brief thoughts?And that is to say that something that has good intention and that is to extend the life expectancy of people in this country, although my hon. Friend the minister, Shadow Minister, makes a good point that it's not just about living for a long time, but it's living.
Well. Those good intentions are not always best served by creating committees and additional duties and additional reports and additional responsibilities in legislation, the honourable member for Winchester made the argument that he would like all departments. I think I paraphrase it's a matter of record to have an eye on the health of the nation, and that sounds sensible. There are other things. I would hope that all ministers would have an eye on, like the wealth of the nation and inequality in everything they do.
But I wouldn't advocate for embedding all of these things that you would hope just come with good governance and good public duty and responsibility, enshrining them into legislation as a duty, a committee, a set of meetings and a report. Indeed, it's those things with good intention that lead to growing bureaucracy that slows down decision making, requires more people to be employed to discharge those duties. Growing costs on the public purse. It is something that Western democracies do rather all too well, and not always for the good.
And I wouldn't want this well intended set of new clauses to lead to that growing bureaucracy with maybe very little benefit, and the benefit that the honourable member wants to see, which I agree can be best dealt with and delivered in other ways.
Well. Those good intentions are not always best served by creating committees and additional duties and additional reports and additional responsibilities in legislation, the honourable member for Winchester made the argument that he would like all departments. I think I paraphrase it's a matter of record to have an eye on the health of the nation, and that sounds sensible. There are other things. I would hope that all ministers would have an eye on, like the wealth of the nation and inequality in everything they do.
But I wouldn't advocate for embedding all of these things that you would hope just come with good governance and good public duty and responsibility, enshrining them into legislation as a duty, a committee, a set of meetings and a report. Indeed, it's those things with good intention that lead to growing bureaucracy that slows down decision making, requires more people to be employed to discharge those duties. Growing costs on the public purse. It is something that Western democracies do rather all too well, and not always for the good.
And I wouldn't want this well intended set of new clauses to lead to that growing bureaucracy with maybe very little benefit, and the benefit that the honourable member wants to see, which I agree can be best dealt with and delivered in other ways.
14:44
14:44
Speaker 2
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Speaker 2
Excuse me, miss, I thought we were going to get more comments from other members opposite. So, um, I'm grateful for members bringing this discussion to the House. Um, the government is clearly committed to helping enable people to live longer. She's one of the successes of recent years that we are from the foundation of the health service. I think life expectancy was about average age of 60, 62, and now is obviously in its early to mid 80s. That is a massive change.
Um, in the last 80 years or so. So but as well as improving healthy life expectancy of the population, we are determined to address the stark inequalities that blight our nation's health. And we know that the most disadvantaged in society will often face the biggest health challenges, and that the current model of care works works least well for those who already experiencing disadvantage and are far more likely to have complex needs. In fact, my own, um, you know, entry into working for the health service in the 1990s was on the back of the black report, which some members might remember well from actually the then conservative government that.
SAT on for ages because it was so such an awful reflection on the first 35 years of the health service that health inequalities had not improved, that they sought to not publish it. But that struck me as something so shocking that it led me to want to pursue a life, to do something about it. And I see that in my own constituency where smoking, the legacy of the tobacco industry, which my hon. Friend the member for Stowmarket and various areas in Stowmarket mentioned, um, lead to very high levels of prevalence of smoking related disease.
And in some parts of my constituency, it's up to 34%. Quest. I thank the Minister for giving way. And, uh, can I point to examples like that of the north east of England, where the work on smoking has been incredibly effective and still continues and makes that real shift in change?And does she agree with me that actually it's those practical examples that we need to see and to support along the way?Well, I thank my hon. Friend from Blaydon concert at that point about prevalence in the North East.
Often the prevalence of the disease is also do with post industrial work that many people have had to do without concern or knowledge about about their health. And as my friend the member for Croydon East said about practical examples as well, the the opening, the building of things like community diagnostic centres, uh, in places that are accessible, open to public health. That's entirely the drive that we have services, um, where people are and where the greatest health need is and not expecting people to travel. And we talked in terms of smoking, obviously, one of the greatest legacies of the last Labour government was, of course, the ban on indoor smoking.
Um, my mother was a barmaid for all her adult life, the city hard to imagine that people are just standing there at your place of work, blowing, smoking whilst you're at work. I tell my children. Yes, we used to sit on aeroplanes and people were smoking, or some people sat on the way back from school, miss Little unbelievable smoking at the back of buses and so on and so forth. Um, you know, really quite shocking. And tobacco in Batesville, which we've also talked about in this bill, is a real, real testament to the work of this House.
But didn't it take a long time?And I paid tribute to the Right Honourable member, the member for Richmond, for pursuing that. Um, a great adversity in his own party at the time, not obviously by the members here present who all have a high concern about health, but by others, perhaps on those conservative benches in the House at the time. And then indeed in the Lords, who sought to thwart, uh, I say thwart. It's a strong word in these contexts. Obviously, they made their points, but to stop that going through at various stages, and some of my colleagues were coming back from the chamber at different times, and they said they were working on tobacco and vape.
And I said, what's still really as it's sort of not come through yet, showing really quite how hard it is when something is so well evidenced, um, so supported by the public health experts, so detrimental to people's public health, and particularly to people living in poorer communities such as the one I represent in Bristol South. But it still takes such a time to get going through. So I will absolutely give way on that point.
Um, in the last 80 years or so. So but as well as improving healthy life expectancy of the population, we are determined to address the stark inequalities that blight our nation's health. And we know that the most disadvantaged in society will often face the biggest health challenges, and that the current model of care works works least well for those who already experiencing disadvantage and are far more likely to have complex needs. In fact, my own, um, you know, entry into working for the health service in the 1990s was on the back of the black report, which some members might remember well from actually the then conservative government that.
SAT on for ages because it was so such an awful reflection on the first 35 years of the health service that health inequalities had not improved, that they sought to not publish it. But that struck me as something so shocking that it led me to want to pursue a life, to do something about it. And I see that in my own constituency where smoking, the legacy of the tobacco industry, which my hon. Friend the member for Stowmarket and various areas in Stowmarket mentioned, um, lead to very high levels of prevalence of smoking related disease.
And in some parts of my constituency, it's up to 34%. Quest. I thank the Minister for giving way. And, uh, can I point to examples like that of the north east of England, where the work on smoking has been incredibly effective and still continues and makes that real shift in change?And does she agree with me that actually it's those practical examples that we need to see and to support along the way?Well, I thank my hon. Friend from Blaydon concert at that point about prevalence in the North East.
Often the prevalence of the disease is also do with post industrial work that many people have had to do without concern or knowledge about about their health. And as my friend the member for Croydon East said about practical examples as well, the the opening, the building of things like community diagnostic centres, uh, in places that are accessible, open to public health. That's entirely the drive that we have services, um, where people are and where the greatest health need is and not expecting people to travel. And we talked in terms of smoking, obviously, one of the greatest legacies of the last Labour government was, of course, the ban on indoor smoking.
Um, my mother was a barmaid for all her adult life, the city hard to imagine that people are just standing there at your place of work, blowing, smoking whilst you're at work. I tell my children. Yes, we used to sit on aeroplanes and people were smoking, or some people sat on the way back from school, miss Little unbelievable smoking at the back of buses and so on and so forth. Um, you know, really quite shocking. And tobacco in Batesville, which we've also talked about in this bill, is a real, real testament to the work of this House.
But didn't it take a long time?And I paid tribute to the Right Honourable member, the member for Richmond, for pursuing that. Um, a great adversity in his own party at the time, not obviously by the members here present who all have a high concern about health, but by others, perhaps on those conservative benches in the House at the time. And then indeed in the Lords, who sought to thwart, uh, I say thwart. It's a strong word in these contexts. Obviously, they made their points, but to stop that going through at various stages, and some of my colleagues were coming back from the chamber at different times, and they said they were working on tobacco and vape.
And I said, what's still really as it's sort of not come through yet, showing really quite how hard it is when something is so well evidenced, um, so supported by the public health experts, so detrimental to people's public health, and particularly to people living in poorer communities such as the one I represent in Bristol South. But it still takes such a time to get going through. So I will absolutely give way on that point.
14:48
14:48
14:48
Speaker 9
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Speaker 9
Thank you, Minister, for giving way. She's very, very aware of my views and opinions on tobacco and vape, and particularly on the area of vaping and stopping vaping for children, in particular, the tobacco vapes bill, a bit like this bill left lots of opportunities for the government to regulate and provide regulations, and anyone who's been in a shop in the past few days will have seen the vapes behind the counter, still very visible, very colourful, very in lots of different flavours and such like. Can the Minister update, update the committee and therefore the House on when she expects the regulations that are provided for by the tobacco Bill to come into force so that we can actually apply the law as opposed to just have it out the statute Minister?
14:49
Speaker 2
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Speaker 2
Well, I thank her for her support. And as I said, I didn't expect that people here present who understand the impact of of that work to be the ones who were thwarting that, um, I don't have at the top of my head exactly on that bill when regulations are coming forward. But I'm sure we can furnish the honourable member with details as, as soon as possible, because we all want to see that happening and the work going on, particularly around high streets, prevention of force, force shops for all sorts of things, not only just vapes, obviously is high on the agenda, as some of my colleagues as well, because those places and those people are also blighting our high streets.
I would, of course.
I would, of course.
14:49
Speaker 5
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Speaker 5
I wonder whether I thank the Minister for allowing an intervention. So I sit on the, uh. Committee, Home Affairs Committee, and we have lately been discussing the matter of serious organised crime and vape shops in particular. And it turns out that many of the vape shops are in fact, not really shops. They're places for laundering money. And um, in particular, they launder money in relation to the drug businesses and the drug trade, which is another huge public health matter that I'm sure she will agree with me, need to be dealt with.
We were informed that about 10% of the adult population of this country are using illicit drugs, and that these are being delivered, for the most part now via the General Post Office. So will the minister agree with me that this is a massive public health issue that will also need to be urgently addressed, Minister?
We were informed that about 10% of the adult population of this country are using illicit drugs, and that these are being delivered, for the most part now via the General Post Office. So will the minister agree with me that this is a massive public health issue that will also need to be urgently addressed, Minister?
14:50
Speaker 2
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Speaker 2
Well, I thank my friend the member for very same Edmunds and Stowmarket or perhaps the other way around, Stowmarket, the very same, um for that and his expertise and that work on the Home Office, I think it shows again to the committee the wide range of work that does go on. And of course, many honourable members are campaigning and working hard. These are those are lots. There are lights in our communities. And as with other most illicit drug dealing, they happen to the most vulnerable on.
In places where they pick on the most vulnerable. And often they are in areas of high deprivation. And that is something we need to stop. And I commend all the communities and community leaders that work so hard to stop that happening in their areas. We absolutely must address it. Mr. Lewis, I return to new clause 14. I fully recognise and share the ambition that sits behind the amendment. I don't believe that placing a new statutory duty is the right way to achieve it.
Now, healthy life expectancy is a long term outcome shaped by a wide range of factors across society and across government, many of which cannot be meaningfully addressed through a rigid statutory timetable requiring the Secretary of State to set a statutory target within six months. Publish a refreshed cross-government strategy every two years and make formal statements to Parliament. Does risk creating a process heavy framework that prioritises reporting over delivery?What matters most is sustained practical action to improve prevention, tackle health inequalities, expand access to care and address those wider determinants of health.
Um, and that is why the government has already published our ten year health plan to improve the nation's health, of which healthy life expectancy is one measure that's very central to us in bringing forward the ten year plan and publishing a new strategy every two years would would be duplicative and not help deliver the plan that we already have in place. Now, work is already underway, and I'm sure this House will hold us to account for the progress we make. As you rightly, they should. But I believe we share the same aim that this amendment seeks.
But we do differ on the best means to get there.
In places where they pick on the most vulnerable. And often they are in areas of high deprivation. And that is something we need to stop. And I commend all the communities and community leaders that work so hard to stop that happening in their areas. We absolutely must address it. Mr. Lewis, I return to new clause 14. I fully recognise and share the ambition that sits behind the amendment. I don't believe that placing a new statutory duty is the right way to achieve it.
Now, healthy life expectancy is a long term outcome shaped by a wide range of factors across society and across government, many of which cannot be meaningfully addressed through a rigid statutory timetable requiring the Secretary of State to set a statutory target within six months. Publish a refreshed cross-government strategy every two years and make formal statements to Parliament. Does risk creating a process heavy framework that prioritises reporting over delivery?What matters most is sustained practical action to improve prevention, tackle health inequalities, expand access to care and address those wider determinants of health.
Um, and that is why the government has already published our ten year health plan to improve the nation's health, of which healthy life expectancy is one measure that's very central to us in bringing forward the ten year plan and publishing a new strategy every two years would would be duplicative and not help deliver the plan that we already have in place. Now, work is already underway, and I'm sure this House will hold us to account for the progress we make. As you rightly, they should. But I believe we share the same aim that this amendment seeks.
But we do differ on the best means to get there.
14:53
Speaker 12
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Speaker 12
Aims to improve health and reduce inequalities, ensuring that action on health is embedded across government. So, for example, through the Warm Homes Plan and rented sector reform, we're supporting healthier homes and reducing health harms associated with poor housing through the Keeping Britain Working Review. We're addressing the links between work, health and wellbeing through the Environment Improvement Plan. We're tackling the health harms of air pollution and in lifting hundreds of children out of poverty, we will transform their health and life chances. And these endeavours demonstrate that improving health outcomes is already embedded across government activity and does not depend on the creation of a new statutory committee.
And whilst I have considerable sympathy with the aim of this amendment, and I'm a strong, a strong supporter, as I hope I've assured the committee of those supporting those wider determinants of health. I'm not persuaded that placing detail internal government structures into primary legislation is either necessary or desirable, and I think we heard well from my my friend the honourable member, Litchfield, about some of the complications, unintended complications, I think about this. We are in this bill, as we've repeatedly said, not seeking to be unduly prescriptive or create unnecessary bureaucracy, which may risk slowing down delivery.
Indeed, we're aiming to reduce that democracy. And furthermore, the government must retain the flexibility to organise in a way that best supports delivery. As the context evolve, the government already brings departments together to advance shared goals and will continue to strengthen collaboration wherever it is needed. Turning now is loyal to New clause 80 and again. I'm not convinced that creating a new statutory duty on every minister is either necessary or the most effective means of achieving the honourable member's objective. The Secretary of State for Health and Social Care already has a statutory duty in relation to the protection of public health and powers to take the appropriate steps to improve the health of the people of England.
And as we've discussed in clause four, which reformulates the Secretary of State's duty on health inequalities. Um, sorry, we have already discussed clause four. These provide a clear duty statutory framework for improving health and addressing inequalities. Beyond this, the government does not operate in departmental silos. Ministers do consider the implications of decisions and work collectively in the public interest, including on health impacts where relevant, and that is particularly important to this government. The proof is in the action that we've started to take across government to improve health.
And whilst I agree entirely that health should be considered across government in imposing a broad new legal duty on every minister, does risk creating more unnecessary bureaucracy without meaningfully improving outcomes. As my friend from Litchfield I think highlighted, creating this new procedures and reporting requirements is not in the spirit of this bill, which has flexibility and focus on delivery as at its heart. And I think we also had those comments from the spokesperson opposite. Our focus is and must remain on delivering improvements in health outcomes, supporting prevention and tackling the causes of ill health rather than creating additional statutory red tape.
And the object of this amendment can be achieved without placing a new statutory requirement on every minister. The honourable Lady asked me about plans on. A modern service framework for MSK. We don't have plans currently to develop MSF, MSK the National Quality Board will be assessing all proposals for new Msf's against clear criteria. I think we highlighted this before ensuring that we prioritise the area where the. Where a framework will have the greatest impact for more patients. I will.
And whilst I have considerable sympathy with the aim of this amendment, and I'm a strong, a strong supporter, as I hope I've assured the committee of those supporting those wider determinants of health. I'm not persuaded that placing detail internal government structures into primary legislation is either necessary or desirable, and I think we heard well from my my friend the honourable member, Litchfield, about some of the complications, unintended complications, I think about this. We are in this bill, as we've repeatedly said, not seeking to be unduly prescriptive or create unnecessary bureaucracy, which may risk slowing down delivery.
Indeed, we're aiming to reduce that democracy. And furthermore, the government must retain the flexibility to organise in a way that best supports delivery. As the context evolve, the government already brings departments together to advance shared goals and will continue to strengthen collaboration wherever it is needed. Turning now is loyal to New clause 80 and again. I'm not convinced that creating a new statutory duty on every minister is either necessary or the most effective means of achieving the honourable member's objective. The Secretary of State for Health and Social Care already has a statutory duty in relation to the protection of public health and powers to take the appropriate steps to improve the health of the people of England.
And as we've discussed in clause four, which reformulates the Secretary of State's duty on health inequalities. Um, sorry, we have already discussed clause four. These provide a clear duty statutory framework for improving health and addressing inequalities. Beyond this, the government does not operate in departmental silos. Ministers do consider the implications of decisions and work collectively in the public interest, including on health impacts where relevant, and that is particularly important to this government. The proof is in the action that we've started to take across government to improve health.
And whilst I agree entirely that health should be considered across government in imposing a broad new legal duty on every minister, does risk creating more unnecessary bureaucracy without meaningfully improving outcomes. As my friend from Litchfield I think highlighted, creating this new procedures and reporting requirements is not in the spirit of this bill, which has flexibility and focus on delivery as at its heart. And I think we also had those comments from the spokesperson opposite. Our focus is and must remain on delivering improvements in health outcomes, supporting prevention and tackling the causes of ill health rather than creating additional statutory red tape.
And the object of this amendment can be achieved without placing a new statutory requirement on every minister. The honourable Lady asked me about plans on. A modern service framework for MSK. We don't have plans currently to develop MSF, MSK the National Quality Board will be assessing all proposals for new Msf's against clear criteria. I think we highlighted this before ensuring that we prioritise the area where the. Where a framework will have the greatest impact for more patients. I will.
14:56
14:56
14:57
14:57
Speaker 12
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Speaker 12
Well, I think there's a long priority list, having been left by the last government for MSF for different reasons. I think lots of things on MSK are indeed things. Things like as well as more diagnostic facilities, because, as she knows, 80% of people on the waiting list are waiting for diagnostics. That's why we are fast tracking and pushing more. As my friend from Cordani said, community diagnostic centres in places like Croydon East, in order to get those people through to the diagnostics they need, and also and some of the things that her party seems to continue to be opposing, which is advice and guidance for GPS, that particularly so that if there are other alternatives to deal with MSK of which of which most.
There is already a lot of evidence that they can indeed refer people to a more appropriate or faster access route in the meantime. So those actions are being taken because she's quite right. A trauma orthopaedics is a large part of the waiting list, but diagnostics, access to faster treatment use the independent sector where appropriate as well. All of those are determined as part of our electoral reform plan, to particularly target orthopaedic waiting lists. I will hopefully give way, Minister.
There is already a lot of evidence that they can indeed refer people to a more appropriate or faster access route in the meantime. So those actions are being taken because she's quite right. A trauma orthopaedics is a large part of the waiting list, but diagnostics, access to faster treatment use the independent sector where appropriate as well. All of those are determined as part of our electoral reform plan, to particularly target orthopaedic waiting lists. I will hopefully give way, Minister.
14:58
14:58
Speaker 12
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Speaker 12
Okay. Well, Miss Law, the member opposite is tempting me into diverting away from addressing the clear point, but I just will take that point fully on board. I'm glad that the party opposite are not opposing the principle advice and guidance, because it does. Evidence suggests that it is a good route to supporting patients to have care close to home and get faster treatment. And as she knows, because it's been clarified, if there was ever any doubt that there is no compulsion on GPS to do that.
The final point, just to raise, I think we were going to be coming back to it in Group 63, the new clause that the honourable gentleman, the member for Winchester, talked about his expertise in blowing his own trumpet with regard to Amr, and he just slightly about that. But he raises a really important point about Amr, and I'm sure we'll come back to talk about that more in his amendment later down in this list. But he's absolutely right. It is an important public health issue, and it does cross many divides.
And I look forward to discussing that later when his new clause comes through in Group 63.
The final point, just to raise, I think we were going to be coming back to it in Group 63, the new clause that the honourable gentleman, the member for Winchester, talked about his expertise in blowing his own trumpet with regard to Amr, and he just slightly about that. But he raises a really important point about Amr, and I'm sure we'll come back to talk about that more in his amendment later down in this list. But he's absolutely right. It is an important public health issue, and it does cross many divides.
And I look forward to discussing that later when his new clause comes through in Group 63.
14:59
14:59
Speaker 8
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Speaker 8
Thank you, Madam Chair, and thank you to all members for their contributions and discussions. Um, I just say to the member for Lichfield, he made a very good point about a committee of 70 people potentially not being that efficient. Um, you should come to Lib Dem parliamentary party meetings. And. Be efficient. It's a really insightful discussion and it's what makes us such an effective force. So, so I wouldn't knock a committee of 70 people. Um, but I really appreciate, um, the minister um.
Acknowledging how important it is to have cross party work on public cross department work and public health. And we won't be pushing this to a vote.
Acknowledging how important it is to have cross party work on public cross department work and public health. And we won't be pushing this to a vote.
15:00
15:00
Speaker 8
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Speaker 8
So I speak to the. Dean and 76. Um so this would require a new trade negotiation which would require NHS spending or funding to exceeding £100 million to be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure. And new clause 76 would require the arrangement between the United States of America and the United Kingdom and pharmaceutical pricing to be brought before the House for a vote. So the IFS has indicated the deal would cost as much as 9 billion by 2036.
That's 9 billion. Could be transformative for so much of the NHS. This could be money that could be put towards ending Covid care. We've been discussing today. We could hire thousands more staff, countless radio radiotherapy machines, or actually start to deliver high quality care and help for people at home, the elderly and disabled. Um, to make matters worse, Trump's ambassador. The head of nice, the expert independent body that looks for value for money. The NHS to rebuke him over his opposition to the deal.
Now it's utterly outrageous that a British public servant has been dressed down by a foreign regime for putting the interests of British patients first, and indeed for. For putting the interests of the British taxpayer first as well. Um. It is crazy that billions of pounds in NHS funding is being spent to placate Trump at the expense of patients well-being. Now we want to support the British life sciences sector, and this should be a domestic matter for the UK government to serve holistically through negotiations with the sector.
It should not be dictated from Washington. So hiking payments for medicine is the wrong approach for patients who badly need investment in frontline staff, hospitals and equipment. This lack of transparency over the full cost has already created a great deal of uncertainty in the sector, and it's astonishing that this major decision is being made without any say for the British people or a vote in Parliament. The government has refused to even publish an assessment of the impact of this deal. Um, this raises suspicion.
And some people think that something is being hidden. Um, this House and the voters who elected us decide on matters of national importance, not the white House. And it's why we've tabled this amendment to allow this deal to come before the House for a proper vote. Thank you.
That's 9 billion. Could be transformative for so much of the NHS. This could be money that could be put towards ending Covid care. We've been discussing today. We could hire thousands more staff, countless radio radiotherapy machines, or actually start to deliver high quality care and help for people at home, the elderly and disabled. Um, to make matters worse, Trump's ambassador. The head of nice, the expert independent body that looks for value for money. The NHS to rebuke him over his opposition to the deal.
Now it's utterly outrageous that a British public servant has been dressed down by a foreign regime for putting the interests of British patients first, and indeed for. For putting the interests of the British taxpayer first as well. Um. It is crazy that billions of pounds in NHS funding is being spent to placate Trump at the expense of patients well-being. Now we want to support the British life sciences sector, and this should be a domestic matter for the UK government to serve holistically through negotiations with the sector.
It should not be dictated from Washington. So hiking payments for medicine is the wrong approach for patients who badly need investment in frontline staff, hospitals and equipment. This lack of transparency over the full cost has already created a great deal of uncertainty in the sector, and it's astonishing that this major decision is being made without any say for the British people or a vote in Parliament. The government has refused to even publish an assessment of the impact of this deal. Um, this raises suspicion.
And some people think that something is being hidden. Um, this House and the voters who elected us decide on matters of national importance, not the white House. And it's why we've tabled this amendment to allow this deal to come before the House for a proper vote. Thank you.
15:03
15:03
15:03
Speaker 11
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Speaker 11
Thank you. Chair rise to discuss new clause 15 and 76. And I'll be relatively brief. Um new clause 15 would require trade negotiation requiring NHS spending of funding to exceed £100 million to be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure. A new clause 76 would require the arrangement between the United States of America and the United Kingdom on pharmaceutical pricing to be bought for the House to vote. I think one of the key concerns I would like to ask the minister about is costing.
So there have been various estimates of the cost of additional cost of medicines, and the former Secretary of State said that he would not be changing the NHS budget, cutting the NHS budgets to pay for those for that increased cost of medicines. So the question for the minister is how much is the extra cost of medicines estimated to be?And where is the money coming from if it's not coming from Dscs budget?
So there have been various estimates of the cost of additional cost of medicines, and the former Secretary of State said that he would not be changing the NHS budget, cutting the NHS budgets to pay for those for that increased cost of medicines. So the question for the minister is how much is the extra cost of medicines estimated to be?And where is the money coming from if it's not coming from Dscs budget?
15:04
Speaker 8
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Speaker 8
Thank you very much, Miss Loyal, and it's a pleasure to serve under your chairmanship this afternoon. And again, I like the Shadow Minister. I'm going to be relatively brief. Um the there was there was quite was that a noise of appreciation or disappointment from the minister. It wasn't, it wasn't clear. Um I'll take it. I'll take everything that I say that she was receives with the same, same same noise and grace. But going back to this, the trade, the trade deals, um, I should declare that yesterday the Secretary of State appeared before the Health Select Committee, on which I and my hon.
Friend for um the Isle of Wight East, uh, also sit and he was questioned at some length on the issue of the UK US trade deal by the chairman of the committee, the honourable member for Oxford West and Abingdon, and it was striking that the Secretary of State appeared not to be able to answer the basic question, which is, could a um a. A an impact assessment be presented to the Committee under whatever terms of, of, of secrecy or confidentiality that the Department wanted to place on it, um, to, to allow the committee to be able to assess what were both the costs.
As the honourable member for Winchester has outlined. But also one would hope the benefits and the Secretary of State was very clear that there were benefits. Um but he was unable to outline what those benefits were. And he cited things like commercial confidentiality, which I do understand. There will be commercial confidentiality elements to this. But what was really striking was that even under whatever terms, the committee was very happy to receive this information under whatever any strictures that he wanted to put on them so that we as a committee would be able to scrutinise that.
And I think that does raise serious cause for concern, um, focusing specifically now on, on the on the new clauses. 15 and 76 as tabled by the honourable member for Winchester, Miss Winchester, was it?Yes. Yes. No, no. North Shropshire. I understand again what he's trying to achieve here. But I think there are some problems with the drafting, because I do think that there will be commercial confidentiality elements to this. And so laying it in front of the house as he I think he's trying to do in new clause 15 in essentially an unredacted complaint way might have real problems.
And likewise on new clause 76 where um he is essentially focusing specifically on the. Well, I assume the intention is specifically on the UK US trade deal as currently, uh, formulated.
Friend for um the Isle of Wight East, uh, also sit and he was questioned at some length on the issue of the UK US trade deal by the chairman of the committee, the honourable member for Oxford West and Abingdon, and it was striking that the Secretary of State appeared not to be able to answer the basic question, which is, could a um a. A an impact assessment be presented to the Committee under whatever terms of, of, of secrecy or confidentiality that the Department wanted to place on it, um, to, to allow the committee to be able to assess what were both the costs.
As the honourable member for Winchester has outlined. But also one would hope the benefits and the Secretary of State was very clear that there were benefits. Um but he was unable to outline what those benefits were. And he cited things like commercial confidentiality, which I do understand. There will be commercial confidentiality elements to this. But what was really striking was that even under whatever terms, the committee was very happy to receive this information under whatever any strictures that he wanted to put on them so that we as a committee would be able to scrutinise that.
And I think that does raise serious cause for concern, um, focusing specifically now on, on the on the new clauses. 15 and 76 as tabled by the honourable member for Winchester, Miss Winchester, was it?Yes. Yes. No, no. North Shropshire. I understand again what he's trying to achieve here. But I think there are some problems with the drafting, because I do think that there will be commercial confidentiality elements to this. And so laying it in front of the house as he I think he's trying to do in new clause 15 in essentially an unredacted complaint way might have real problems.
And likewise on new clause 76 where um he is essentially focusing specifically on the. Well, I assume the intention is specifically on the UK US trade deal as currently, uh, formulated.
15:06
15:07
15:07
Speaker 7
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Speaker 7
Be Grenfell his permission to. Take an intervention. Um so much of the conversation around these trade deals relates to pharmaceuticals and pharmaceuticals, which come from the United States. And it must be the case that our patients should be able to access the best available treatments. Whatever deals you cook up. What do you not recognise that we need to be able to support very innovative research based within our own country, in particular to support clinical trials for new medicines in this country, and that in order to do that, we need to support clinical academics, the clinical academics, these are the doctors who work within universities and organized research.
And I wonder whether he will recognise that during the period of the last conservative administration, the number of clinical academics fell. And we have a situation in which most clinical academics are now getting to be very senior, and we're not effectively recruiting replacements for them. And so we need to look after our home pharmaceutical industries in order that we don't need to do these trade deals with.
And I wonder whether he will recognise that during the period of the last conservative administration, the number of clinical academics fell. And we have a situation in which most clinical academics are now getting to be very senior, and we're not effectively recruiting replacements for them. And so we need to look after our home pharmaceutical industries in order that we don't need to do these trade deals with.
15:08
Speaker 8
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Speaker 8
Uh, well, I certainly I certainly agree with his latter point, whether his penultimate point, which is we need to support homegrown clinical academics, we need to support the life sciences industry in this country. And I, because he's drawn me down this line, I ought to declare that my wife works in the life sciences industry at the moment in the UK. Um, but um, so I, so I entirely agree with him on that point. I don't think I agree with him if he's saying, and therefore the corollary of that is that we shouldn't do deals and trade deals with other countries for pharmaceuticals, because our patients in the UK need to have the best medicines wherever they come from.
If he wasn't saying that, and I'm putting words into your mouth, I apologise. But that sounded like what he was saying to me, so I agree. Support, support home grown. Obviously we need to have access to worldwide. And that does bring me on to the concerns that I have with new clause 76, which is, it seems I understand why he's doing it, but the because of the way it's written, it means that any trade deal ever. Whilst the life of this bill goes forward with America would presumably have to come follow that strictures.
And it seems odd. Whilst I accept he doesn't like the current deal, and whilst I accept he doesn't like the current incumbent in the white House, um, it does seem odd that we're singling out in statute one country over every other one to put this stricture on it, rather than any other, and I think it might have been a more acceptable amendment. I probably still would have voted for it, but it might have been a more acceptable amendment if he had said that any trade deal with any country or even a group of countries, I know he's a big fan of one group of countries.
Um, but I will in a second. That might have made it difficult. I think it is really, really dangerous to put essentially a stricture on a trade deal with one specific country, especially one is what probably our strongest ally in this bill. And I think that sits very badly.
If he wasn't saying that, and I'm putting words into your mouth, I apologise. But that sounded like what he was saying to me, so I agree. Support, support home grown. Obviously we need to have access to worldwide. And that does bring me on to the concerns that I have with new clause 76, which is, it seems I understand why he's doing it, but the because of the way it's written, it means that any trade deal ever. Whilst the life of this bill goes forward with America would presumably have to come follow that strictures.
And it seems odd. Whilst I accept he doesn't like the current deal, and whilst I accept he doesn't like the current incumbent in the white House, um, it does seem odd that we're singling out in statute one country over every other one to put this stricture on it, rather than any other, and I think it might have been a more acceptable amendment. I probably still would have voted for it, but it might have been a more acceptable amendment if he had said that any trade deal with any country or even a group of countries, I know he's a big fan of one group of countries.
Um, but I will in a second. That might have made it difficult. I think it is really, really dangerous to put essentially a stricture on a trade deal with one specific country, especially one is what probably our strongest ally in this bill. And I think that sits very badly.
15:09
Speaker 5
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Speaker 5
Um, thank you for the honourable member giving away. The member agree that the existing constitutional arrangements already provide mechanisms and ministerial accountability and parliamentary scrutiny. So singling out one country is politicising and will have a long term consequences into our relationships.
15:09
Speaker 8
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Speaker 8
Yes, I entirely agree with him on that point. And I think it is a very slippery slope, especially writing it into legislation. So I understand the often as I do, I understand the motivation of the of the of the honourable members on the Liberal Democrat benches, but I don't think the drafting is appropriate in this context, and I think I therefore. In conclusion, as I could not support nuclear. 76.
15:10
Speaker 3
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Speaker 3
Thank you, Mr. Leal. As my honourable friend for Farnham and Bordon says, we. Select Committee heard from the Secretary of State yesterday, and although this set a new clauses were obviously drafted in advance, the timing is rather a good one because we had our opportunity to ask the person, the minister, the Secretary of State that sits right at the top, some fairly basic questions about the deal that will see the NHS apparently pay 25% more for US drugs than it currently pays. Basic questions like how much is it going to cost?Um, the chair of the Select committee, the honourable member for Aberdeen West or Abingdon and Oxford West skewered the Secretary of State within minutes, and I had an opportunity a few.
A short while later, the Secretary of State, having had the chance to reflect on those questions, I had the opportunity to come back for some even more basic questions like does a figure exist?Not. What is it?And has any analysis been done?We ended up going backwards where we still don't know. And this is the the public and parliamentarians still don't know some basic questions. Even though a deal has been done. Do we know how much it's going to cost?Does a figure exist?Hasn't that analysis been done?Uh, are we talking about a figure or a bracket?On what basis was the deal?Agreed.
And to all those questions we had absolutely no answers at all. So I posed fairly obvious conclusion. Question how on earth can a deal be done to pay 25% more money for drugs than we already get, without knowing how much it will cost?And that answer wasn't given either. So it's no wonder that this sits in the middle. This. The fundamental questions are set effectively. Sit in the middle of a bill. It's not the place for them.
But in absence of the basic answers not being forthcoming, I can see why. Um, the the honourable member for Winchester and others have raised it. So I asked the question to the minister of her boss. Can't answer them. Perhaps she can. The Department, having had 24 hours to reflect how much is the deal with the US going to cost?Is there even a figure, even if the government doesn't want to disclose it, what sort of impact assessment exists?Even if the government doesn't want to disclose it?If the government can confirm a figure exists or a bracket exists and it's not going to disclose it, why?If the government can confirm that some sort of impact assessment has been done and it's not going to disclose it, why or when and until we get these answers.
It's a fairly. UN un unappealing way of going, about talking about securing investment for life sciences. If people cannot see even the fundamental decisions, considerations on which the government made its decisions. Now, the Secretary of State talked about benefits of this deal. I'm sure there are benefits. I don't disagree with the principle about paying some more for drugs. If there are benefits that come out of it for research and development, I get that. I support the principle, but I want to be able to see what the intended benefits are in some form of document and some form of analysis, not just bare statements.
That research and development is good. We all know that. And I want to see what the cost is. And in here, the new clause, I think, refers to um if the intended cost is more than a certain threshold, I'll be 100, 100 million. Is it um of course the government aren't in a position to confirm whether this current deal would qualify under that new clause. If it existed in law. Um so I do accept that that clause would at least force the government's hand if it existed or had existed prior to today.
And I suspect it's far higher. I suspect it's into the billions. But again, we don't know because all we're left to do is sit and speculate. Despite having the Secretary of State in front of the Health and Social Care Committee, he's got to have expected that question was going to come, and he was flanked by the permanent secretary of the department, and he was flanked by the chief executive of NHS England. You had all the people in the room, by the way.
He was a Treasury minister prior to becoming the Secretary of State just two months ago. You had all the key people in the room to give some sort of indication as to cost and benefit, and none was forthcoming. So while I can't back this because I don't think this is the right place to ask those questions in statute, I completely understand why this new clause is being proposed. And I wonder whether the minister, of course, you won't agree to this new clause, can at least point to some of the answers that parliamentarians and the public are asking.
A short while later, the Secretary of State, having had the chance to reflect on those questions, I had the opportunity to come back for some even more basic questions like does a figure exist?Not. What is it?And has any analysis been done?We ended up going backwards where we still don't know. And this is the the public and parliamentarians still don't know some basic questions. Even though a deal has been done. Do we know how much it's going to cost?Does a figure exist?Hasn't that analysis been done?Uh, are we talking about a figure or a bracket?On what basis was the deal?Agreed.
And to all those questions we had absolutely no answers at all. So I posed fairly obvious conclusion. Question how on earth can a deal be done to pay 25% more money for drugs than we already get, without knowing how much it will cost?And that answer wasn't given either. So it's no wonder that this sits in the middle. This. The fundamental questions are set effectively. Sit in the middle of a bill. It's not the place for them.
But in absence of the basic answers not being forthcoming, I can see why. Um, the the honourable member for Winchester and others have raised it. So I asked the question to the minister of her boss. Can't answer them. Perhaps she can. The Department, having had 24 hours to reflect how much is the deal with the US going to cost?Is there even a figure, even if the government doesn't want to disclose it, what sort of impact assessment exists?Even if the government doesn't want to disclose it?If the government can confirm a figure exists or a bracket exists and it's not going to disclose it, why?If the government can confirm that some sort of impact assessment has been done and it's not going to disclose it, why or when and until we get these answers.
It's a fairly. UN un unappealing way of going, about talking about securing investment for life sciences. If people cannot see even the fundamental decisions, considerations on which the government made its decisions. Now, the Secretary of State talked about benefits of this deal. I'm sure there are benefits. I don't disagree with the principle about paying some more for drugs. If there are benefits that come out of it for research and development, I get that. I support the principle, but I want to be able to see what the intended benefits are in some form of document and some form of analysis, not just bare statements.
That research and development is good. We all know that. And I want to see what the cost is. And in here, the new clause, I think, refers to um if the intended cost is more than a certain threshold, I'll be 100, 100 million. Is it um of course the government aren't in a position to confirm whether this current deal would qualify under that new clause. If it existed in law. Um so I do accept that that clause would at least force the government's hand if it existed or had existed prior to today.
And I suspect it's far higher. I suspect it's into the billions. But again, we don't know because all we're left to do is sit and speculate. Despite having the Secretary of State in front of the Health and Social Care Committee, he's got to have expected that question was going to come, and he was flanked by the permanent secretary of the department, and he was flanked by the chief executive of NHS England. You had all the people in the room, by the way.
He was a Treasury minister prior to becoming the Secretary of State just two months ago. You had all the key people in the room to give some sort of indication as to cost and benefit, and none was forthcoming. So while I can't back this because I don't think this is the right place to ask those questions in statute, I completely understand why this new clause is being proposed. And I wonder whether the minister, of course, you won't agree to this new clause, can at least point to some of the answers that parliamentarians and the public are asking.
15:16
15:16
Speaker 12
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Speaker 12
Thank you, Miss Lill. Um, and I'm happy to talk about the amendments in relation to the impact of trade arrangements on NHS spending and how arrangements are scrutinised by Parliament and grateful to bring these new clauses. And more generally, um I think, you know, this is yet another area, isn't it, our relationship with industry, with life sciences, with the pharmaceutical sector, as my hon. Friend and for Bury St Edmunds and Stowmarket said is so crucial not only to our patients and people we represent, but also to growth in our country and across.
Many honourable members will have companies, large companies and um for my friend for Aylesbury Line and for smaller companies, but really important local companies doing great work innovation, bringing together great people to work on behalf of the life science sector and our country more generally, and yet again, make us proud to be on the international stage as a leading country in this entire area. And it's yet another moment, if I can play credit to my right hon. Friend the member for Holborn and St Pancras, for the leadership that he has provided in leading this government on the international stage with regard to putting this country back in its rightful place.
Yet another part of our international reputation, trashed by the party opposite. So if I can move, started it. If you want to start moving now to new clause 15. Parliamentary scrutiny is crucial in ensuring that trade deals negotiated by this government are in the best interests of UK, and that is why this government is committed to transparency and enabling effective scrutiny of its trade agenda. And nowhere is scrutiny more important than in considering the potential impact of trade agreements on public services such as the NHS.
And because of this, the government has a clear framework in place for scrutiny of the trade agreements it has negotiated, and this process strikes the right balance between ensuring the appropriate accountability can take place, while preserving our ability to effectively negotiate these agreements, and this is important in ensuring that the UK negotiate and communicate credibly with its partners to secure positive outcomes for the public and British businesses in trade deals, whilst still upholding and protecting the role of Parliament. New clause 15 I will.
Many honourable members will have companies, large companies and um for my friend for Aylesbury Line and for smaller companies, but really important local companies doing great work innovation, bringing together great people to work on behalf of the life science sector and our country more generally, and yet again, make us proud to be on the international stage as a leading country in this entire area. And it's yet another moment, if I can play credit to my right hon. Friend the member for Holborn and St Pancras, for the leadership that he has provided in leading this government on the international stage with regard to putting this country back in its rightful place.
Yet another part of our international reputation, trashed by the party opposite. So if I can move, started it. If you want to start moving now to new clause 15. Parliamentary scrutiny is crucial in ensuring that trade deals negotiated by this government are in the best interests of UK, and that is why this government is committed to transparency and enabling effective scrutiny of its trade agenda. And nowhere is scrutiny more important than in considering the potential impact of trade agreements on public services such as the NHS.
And because of this, the government has a clear framework in place for scrutiny of the trade agreements it has negotiated, and this process strikes the right balance between ensuring the appropriate accountability can take place, while preserving our ability to effectively negotiate these agreements, and this is important in ensuring that the UK negotiate and communicate credibly with its partners to secure positive outcomes for the public and British businesses in trade deals, whilst still upholding and protecting the role of Parliament. New clause 15 I will.
15:18
15:18
Speaker 6
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Speaker 6
Thank you for giving way. I just wanted to put on the record where the disquiet about this deal comes from. The sums involved are huge, possibly £9 billion a year, possibly more, based on discussions with big companies in the sector and, uh, towards towards the back of the ten year period. Um, and the Abpi weren't involved in the negotiation of this deal. This is a deal that has been negotiated with the US. So while we are fully supportive of the life sciences sector in this country, and we understand there's a complex debate to be had about access to novel medicines for people with unusual and rare diseases, which is an important point to consider.
And also balancing that with everybody else's access to volume services on the front line. That's an important discussion. We think it's one that should be had by Parliament and the British people, and not one that should be had between a trade negotiator and Donald Trump's White House. That's where I comes from. And that's why we put these amendments on the on the bill.
And also balancing that with everybody else's access to volume services on the front line. That's an important discussion. We think it's one that should be had by Parliament and the British people, and not one that should be had between a trade negotiator and Donald Trump's White House. That's where I comes from. And that's why we put these amendments on the on the bill.
15:19
Speaker 12
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Speaker 12
I thank the honourable member for North Shropshire, and I understand her intent and her commitment to parliamentary scrutiny, and indeed, her friend, the chair of the select committee, and I hope some of my points will address that. Um, so new clause 15 proposed by the honourable member does duplicate existing processes and creates responsibilities for Secretary of State for health, which would cut across these important procedures for scrutiny. I want to be clear that no trade agreement can by itself change UK domestic law or require new public expenditure without the usual domestic process has been followed and any changes to legislation necessary to implement a trade agreement would be subject to parliamentary scrutiny in the usual way, and it's right that this government should be held to account to ensure trade deals deliver for the country.
However, these processes are already in place and are working. New clause 76. I heard lots of points there of the honourable gentleman.
However, these processes are already in place and are working. New clause 76. I heard lots of points there of the honourable gentleman.
15:20
15:20
Speaker 12
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Speaker 12
Thank you. I'm not a party to negotiations. He's attributing, um, you know, above my pay grade in terms of the conversations, uh, that he's alluded to yesterday. So if I get back to him, if there's any outstanding questions, obviously department will be getting back to the select committee or any other sorts of details.
15:20
15:20
Speaker 2
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Speaker 2
Don't worry, my friend, for giving way. And I'd just like to bring in a quote from the Precision Health Technologies Accelerator at the University of Birmingham, very close to my Lichfield constituency, and the leadership around the. To have been very supportive of the removal of tariffs um from um pharmaceuticals, saying that the removal of those tariffs, um sorry, the introduction of those tariffs could lead to supply chains collapsing and patients suffering. That is an enormous growth opportunity for the West Midlands Combined Authority, for Birmingham and actually for the wider region.
And I think, you know, there's been a lot of discussions about that. But bringing in the views of those organisations which are going to be very, very, very, very benefited by this is something I did want to make sure we put on the record, because it's going to be so beneficial for my region Minister.
And I think, you know, there's been a lot of discussions about that. But bringing in the views of those organisations which are going to be very, very, very, very benefited by this is something I did want to make sure we put on the record, because it's going to be so beneficial for my region Minister.
15:21
Speaker 12
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Speaker 12
I thank my friend the member for Lichfield again for that, and he highlights really clearly the advantages for his constituents and the importance, particularly to the university and universities across the country. Um, from these outward facing, uh, arrangements that do benefit constituencies in so many ways, both in terms of employment, but also in terms of the benefits of, um, of. Maceuticals, etc., and medical devices that help all our constituents on new clause 76. Um, which specifically references the trade arrangement between the United States and the United Kingdom.
This landmark partnership with the United States government on pharmaceuticals pricing and tariffs is in the best interest of UK patients supporting the NHS and the economy. And as a result of the changes to UK's medicines pricing, NHS patients will get improved access to life saving treatments, with new medicines already recommended under the updated approach, including a brain cancer drug available to patients as young as 12 and a last resort treatment for a rare, aggressive stomach cancer something I think the entire House and committee would support.
This landmark partnership with the United States government on pharmaceuticals pricing and tariffs is in the best interest of UK patients supporting the NHS and the economy. And as a result of the changes to UK's medicines pricing, NHS patients will get improved access to life saving treatments, with new medicines already recommended under the updated approach, including a brain cancer drug available to patients as young as 12 and a last resort treatment for a rare, aggressive stomach cancer something I think the entire House and committee would support.
15:22
Speaker 4
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Speaker 4
Minister for giving way, and I just wanted to emphasize the point that has actually already been made about the impact, the positive impact of this agreement for people with rare and undiagnosed conditions. And as the minister will know, I work with a number of these organisations, and certainly there is an opportunity for those innovative treatments to be funded as they may not have been before. So I thank the Minister for making. Can I thank.
15:22
Speaker 12
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Speaker 12
My friend the member for Blaydon and Consett again, this is an area of work that she has led that I have seen for many years in this place. Often. Many others aren't around to support and Miss Lowell. Uh, and with so many organisations and charities lobbying on behalf of so many people that are really desperate for particularly rare diseases to be highlighted, those diseases that affect a small number of people, many of them children and in small numbers, but are so crucial. And her work in leading this work is is exemplary in this place.
And that's exactly where we aim to get with working with our partners in difficult circumstances, trade deals and negotiations are necessarily difficult, otherwise they'd be easy. But yielding results to people is the result of some of that hard work. And as I said, the outward approach that this government has taken with regard to working with our partners and with the industry, we have already taken steps towards the commitments made, most notably increasing the Nice cost effectiveness threshold. The government has previously updated Parliament through two ministerial statements, and MPs do have the opportunity to, of course, to continue to table parliamentary questions.
As is quite right, officials should be able to produce a confidential advice for ministers to inform trade or other negotiations, and we must maintain this confidentiality in this case, as this impact assessment contains commercially sensitive assumptions as scenario based and remains linked to live policy development. And it's on that basis, I ask the honourable member to withdraw their amendments.
And that's exactly where we aim to get with working with our partners in difficult circumstances, trade deals and negotiations are necessarily difficult, otherwise they'd be easy. But yielding results to people is the result of some of that hard work. And as I said, the outward approach that this government has taken with regard to working with our partners and with the industry, we have already taken steps towards the commitments made, most notably increasing the Nice cost effectiveness threshold. The government has previously updated Parliament through two ministerial statements, and MPs do have the opportunity to, of course, to continue to table parliamentary questions.
As is quite right, officials should be able to produce a confidential advice for ministers to inform trade or other negotiations, and we must maintain this confidentiality in this case, as this impact assessment contains commercially sensitive assumptions as scenario based and remains linked to live policy development. And it's on that basis, I ask the honourable member to withdraw their amendments.
15:24
15:24
Speaker 13
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Speaker 13
Thank you, Madam Chair, and I thank the Minister for comments as well. It's really good to see the cross-party recognition, how important the life sciences sector is in the UK. Universities, businesses, knowledge transfer partnerships. Um, this is a huge opportunity to not only improve the health and of the nation and treatments available, but, it's, you know, boosting the economy. Um, when it comes to, we will withdraw um, new clause 15. Um, but I thought the member for the Isle of Wight spoke extremely well, um about the, the concerns with this trade deal.
And just to reassure the member for um a founding member board and. That this is um if you look at the wording. Um. It. This is.
And just to reassure the member for um a founding member board and. That this is um if you look at the wording. Um. It. This is.
15:25
15:25
15:25
Speaker 13
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Speaker 13
We very much appreciate that. Just to reiterate, this is the arrangement between the United States of America, this specific one. We're not writing to statute. Every single trade deal. And you can completely accept that this, you know, entering into primary legislation isn't potentially the way to to scrutinise a trade deal. But, you know, given the the lack of options at the moment, um, you sometimes you have to use every political mechanism available to, to, to create transparency. And so transparency.
Well, yes, of course.
Well, yes, of course.
15:26
Speaker 11
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Speaker 11
I thank the honourable member for bringing forward this amendment. Um, this government has came to power saying it would be more transparent, but actually it has not been transparent. And it took us months to get the numbers out, of out of the government and the Chagos Islanders as well. Did he not?
15:26
15:26
15:27
15:27
Speaker 13
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Speaker 13
Thank you, Madam Chair. Um 16, 17 and 18. Um. Um I'll speak to all these together. Um. It's regarding the duty of integrated care boards to promote the health and wellbeing of carers. Um and certainly as mental health spokesperson, we've got particular interest in is the mental health of carers and having been a carer, like many people in this room would have been as well. Sometimes that is um we forget that it's not only the patient that needs caring for the carers need a huge amount of support.
It can be hugely draining. So unpaid carers are essential to the sustainability of NHS and social care system. Yet carers consistently experienced poorer physical and mental health outcomes and carers and frequently struggle to access support for their own health needs. There are approximately 4.7 million unpaid carers in England. Providing support valued at an estimated £152 billion annually. That's the equivalent to the annual NHS budget being provided by all these people. Um, but evidence consistently shows unpaid carers experience worse health outcomes than carers.
The GP Patient Survey 2020 showed that 72% of carers report a long term condition of disability, compared to 60% of non carers. The office for National Statistics reports that 1 in 4 adults who are providing unpaid care reported being in not good health, compared to 1 in 5 adults who are not providing any unpaid care. The probability of reporting being in not good health was higher for people providing more hours of unpaid care, and 49% of unpaid carers reported at least one health, one adverse health effect from providing the unpaid care and low mental wellbeing was common among unpaid carers, about 20%, and those not providing unpaid carers, with 15% and.
A study analysing GP patient survey data found that for those caring for more than 50 hours a week, the health impact of being a carer is equivalent to losing 18 days of full health every year. Another academic study analysing GP survey data found that for those caring. Oh sorry, wait two seconds. Yeah, the carers are having to cancel medical treatments and appointments because nobody is available to step into their caring role, or that they cannot find an appointment at a time that they could attend due to their caring responsibilities.
So more targeted approaches to support unpaid carers could help prevent the onset and deterioration of carers own health and wellbeing as a result of their caring role. Although icbs have broad duties relating to population health and inequalities, there's currently no explicit statutory duty requiring icbs to improve the health and wellbeing of unpaid carers, specifically. Now our new clause 16 would place such a duty on icbs, as well as requiring carers to be included with joint forward plans. This would strengthen the prevention of ill health with an unpaid carers, as well as improving accountability for carers outcomes within the NHS.
Now, with an ageing population and growing numbers of people with long term disabilities, the need for unpaid carers will only grow. And analysis by the Ippr found that the number of unpaid carers is up by 70% just in the last two decades, so local authorities already have duties in relation to identifying unpaid carers. No equivalent duty exists for integrated care boards which um which commission?The vast majority of health services. So unpaid carers are more likely to come into contact with health services earlier than they come into contact with local authorities.
Unpaid carers can take years to identify themselves. Each early identification of unpaid carers helps to ensure that they can be assessed, and then offered appropriate support for their caring role. Now there's a gap in our numbers. Only 1.4% of patients were coded as unpaid carers in GP systems, compared with the census estimates, which suggest a true prevalence of approximately 8.8%. So identify identification of carers in the NHS as a gateway to many of the services and support offered, including advice on financial support, referral to local authority support and inclusion in hospital discharge planning, identification of more unpaid carers would also mean that local areas have more accurate data, which would enable them to do better local planning of services.
Our new clause 17 would fill this gap and create a duty for Icbs to identify unpaid carers. Given the potential opportunities of a single patient record, this could be revolutionary for the whole system to support unpaid carers and the support they receive. We've also tabled a new clause 18, which would introduce a national respite scheme. Supplying respite care would alleviate the burden on carers and prevent hospital admissions due to carers becoming too exhausted to look after their loved ones. A dedicated carers support service was implemented in Kingston by the Liberal Democrat leader following following his campaigning, and it now supports over 1000 carers equally, Scotland has introduced a statutory right for unpaid carers to access breaks from caring responsibilities under the Care Act 2014.
Unpaid carers in England are entitled to a carer's assessment and local authorities are required to meet eligible needs identified through that assessment, statutory guidance recognises that support for carers may include replacement care to allow the carer to have a break. However, carers breaks are not explicitly defined or guaranteed in legislation, so in practice many carers report that following a carer's assessment, they receive only information, advice or signposting rather than meaningful respite support. Even where eligible needs are identified, support is often delayed or not provided. As a result, many unpaid carers are left unable to take regular or meaningful breaks from caring, with serious consequences for their health and wellbeing, employment and family life.
Many carers describe the severe impacts on the lives and wellbeing, including burnout, exhaustion, social isolation, inability to maintain employment and deterioration in mental health. Supporting carers to take regular breaks as a preventative policy that helps carers remain well sustained employment and education maintain relationships and continue caring safely where they wish to do so. It also reduces the risk of crisis situations and carer breakdown, which can place additional pressures on health and social care services. One of the most significant wins we had since I have been elected was keeping a day care centre open and adult day care centre that Hampshire County Council are trying to close, and we had dozens of people coming forward saying that if that centre shut, they because they were carers themselves, they would struggle to continue in their caring role if they didn't get respite care.
And so we're very pleased that that has been kept open. And the amount of gratitude we've had from people who are carers saying that they they can now carry on caring for their loved ones because they can have a regular respite care once a week. This is completely life changing to them. Thank you.
It can be hugely draining. So unpaid carers are essential to the sustainability of NHS and social care system. Yet carers consistently experienced poorer physical and mental health outcomes and carers and frequently struggle to access support for their own health needs. There are approximately 4.7 million unpaid carers in England. Providing support valued at an estimated £152 billion annually. That's the equivalent to the annual NHS budget being provided by all these people. Um, but evidence consistently shows unpaid carers experience worse health outcomes than carers.
The GP Patient Survey 2020 showed that 72% of carers report a long term condition of disability, compared to 60% of non carers. The office for National Statistics reports that 1 in 4 adults who are providing unpaid care reported being in not good health, compared to 1 in 5 adults who are not providing any unpaid care. The probability of reporting being in not good health was higher for people providing more hours of unpaid care, and 49% of unpaid carers reported at least one health, one adverse health effect from providing the unpaid care and low mental wellbeing was common among unpaid carers, about 20%, and those not providing unpaid carers, with 15% and.
A study analysing GP patient survey data found that for those caring for more than 50 hours a week, the health impact of being a carer is equivalent to losing 18 days of full health every year. Another academic study analysing GP survey data found that for those caring. Oh sorry, wait two seconds. Yeah, the carers are having to cancel medical treatments and appointments because nobody is available to step into their caring role, or that they cannot find an appointment at a time that they could attend due to their caring responsibilities.
So more targeted approaches to support unpaid carers could help prevent the onset and deterioration of carers own health and wellbeing as a result of their caring role. Although icbs have broad duties relating to population health and inequalities, there's currently no explicit statutory duty requiring icbs to improve the health and wellbeing of unpaid carers, specifically. Now our new clause 16 would place such a duty on icbs, as well as requiring carers to be included with joint forward plans. This would strengthen the prevention of ill health with an unpaid carers, as well as improving accountability for carers outcomes within the NHS.
Now, with an ageing population and growing numbers of people with long term disabilities, the need for unpaid carers will only grow. And analysis by the Ippr found that the number of unpaid carers is up by 70% just in the last two decades, so local authorities already have duties in relation to identifying unpaid carers. No equivalent duty exists for integrated care boards which um which commission?The vast majority of health services. So unpaid carers are more likely to come into contact with health services earlier than they come into contact with local authorities.
Unpaid carers can take years to identify themselves. Each early identification of unpaid carers helps to ensure that they can be assessed, and then offered appropriate support for their caring role. Now there's a gap in our numbers. Only 1.4% of patients were coded as unpaid carers in GP systems, compared with the census estimates, which suggest a true prevalence of approximately 8.8%. So identify identification of carers in the NHS as a gateway to many of the services and support offered, including advice on financial support, referral to local authority support and inclusion in hospital discharge planning, identification of more unpaid carers would also mean that local areas have more accurate data, which would enable them to do better local planning of services.
Our new clause 17 would fill this gap and create a duty for Icbs to identify unpaid carers. Given the potential opportunities of a single patient record, this could be revolutionary for the whole system to support unpaid carers and the support they receive. We've also tabled a new clause 18, which would introduce a national respite scheme. Supplying respite care would alleviate the burden on carers and prevent hospital admissions due to carers becoming too exhausted to look after their loved ones. A dedicated carers support service was implemented in Kingston by the Liberal Democrat leader following following his campaigning, and it now supports over 1000 carers equally, Scotland has introduced a statutory right for unpaid carers to access breaks from caring responsibilities under the Care Act 2014.
Unpaid carers in England are entitled to a carer's assessment and local authorities are required to meet eligible needs identified through that assessment, statutory guidance recognises that support for carers may include replacement care to allow the carer to have a break. However, carers breaks are not explicitly defined or guaranteed in legislation, so in practice many carers report that following a carer's assessment, they receive only information, advice or signposting rather than meaningful respite support. Even where eligible needs are identified, support is often delayed or not provided. As a result, many unpaid carers are left unable to take regular or meaningful breaks from caring, with serious consequences for their health and wellbeing, employment and family life.
Many carers describe the severe impacts on the lives and wellbeing, including burnout, exhaustion, social isolation, inability to maintain employment and deterioration in mental health. Supporting carers to take regular breaks as a preventative policy that helps carers remain well sustained employment and education maintain relationships and continue caring safely where they wish to do so. It also reduces the risk of crisis situations and carer breakdown, which can place additional pressures on health and social care services. One of the most significant wins we had since I have been elected was keeping a day care centre open and adult day care centre that Hampshire County Council are trying to close, and we had dozens of people coming forward saying that if that centre shut, they because they were carers themselves, they would struggle to continue in their caring role if they didn't get respite care.
And so we're very pleased that that has been kept open. And the amount of gratitude we've had from people who are carers saying that they they can now carry on caring for their loved ones because they can have a regular respite care once a week. This is completely life changing to them. Thank you.
15:34
15:34
15:34
Speaker 4
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Speaker 4
Thank you. Uh, Miss Lovell, it's a pleasure to serve you as chair, and I listened with great interest to, um. The honourable member proposing his amendments, which of course have a great deal of similarity to new laws, 89 which is in the name of the member for Shipley. Uh, we all know that it's absolutely vital that we look after our carers. They do a huge amount of work to, um, to support us and make sure that people are kept at home and are cared for.
And it's right that we, uh, look at that our new clause 89, uh, has its main point as, uh, having creating a duty of health bodies to provide information and advice to carers and refers to a number of issues, uh, here. And the main point being, as we have heard, uh, is to create a duty to provide information and advice to unpaid carers and, uh, and ask the Secretary of State to provide test. The Secretary of State, I should say, to provide such a service. Now, there are a number of clauses in, in um, uh, new clause 89, uh, asking for um.
First of all, information about um medicine and medicine records, which we talked about earlier in this debate a few days ago. But beyond that, it looks at information about services support. Um, and, and available from the NHS to help in the role that they have, uh, for information about support for their own needs, which are hugely important and to look after their health. Uh, and, uh, provide information about the support that's available to them and how to get more advice in their roles as unpaid carers.
And we've heard, and I won't go over all the arguments again, uh, the, uh, survey done by carers UK about the state of caring in 20 2520. 9% of carers saying they need more information and advice about caring, such as support with clinical tasks or managing someone's condition. So many of them, uh, provide support with medication and and administering medication. Uh, many of them monitor blood pressure or sugar levels or dress wounds or use equipment and what, um, what the discussion is, I think in all these amendments about carers is how we can best support carers in that role.
Uh, they have a vital role. I know the government recognises the importance of that role in contributing to healthcare. Uh, so, um, I think that it's important that we consider that issue here. You.
And it's right that we, uh, look at that our new clause 89, uh, has its main point as, uh, having creating a duty of health bodies to provide information and advice to carers and refers to a number of issues, uh, here. And the main point being, as we have heard, uh, is to create a duty to provide information and advice to unpaid carers and, uh, and ask the Secretary of State to provide test. The Secretary of State, I should say, to provide such a service. Now, there are a number of clauses in, in um, uh, new clause 89, uh, asking for um.
First of all, information about um medicine and medicine records, which we talked about earlier in this debate a few days ago. But beyond that, it looks at information about services support. Um, and, and available from the NHS to help in the role that they have, uh, for information about support for their own needs, which are hugely important and to look after their health. Uh, and, uh, provide information about the support that's available to them and how to get more advice in their roles as unpaid carers.
And we've heard, and I won't go over all the arguments again, uh, the, uh, survey done by carers UK about the state of caring in 20 2520. 9% of carers saying they need more information and advice about caring, such as support with clinical tasks or managing someone's condition. So many of them, uh, provide support with medication and and administering medication. Uh, many of them monitor blood pressure or sugar levels or dress wounds or use equipment and what, um, what the discussion is, I think in all these amendments about carers is how we can best support carers in that role.
Uh, they have a vital role. I know the government recognises the importance of that role in contributing to healthcare. Uh, so, um, I think that it's important that we consider that issue here. You.
15:37
Speaker 11
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Speaker 11
Thank you chair. This group is essentially about carers and how we look after carers who do so much work for so many people across the country, looking after their loved ones. And many of them indeed are not necessarily in full good health themselves. And some of them are even children, a chair. Um, so I think it's, it's the intention behind these amendments to, to try and improve carers lives and make sure they're recognised is, is, is a positive intention. And I want to congratulate the member for Winchester on his success in keeping open his respite care centre, and perhaps he could share notes with me, because at the moment, the Reform County Council in Lincolnshire are trying to close Swallow Lodge, a respite care centre that provides for um people of working age who have severe disabilities.
And it wants to it wants to close it. And they are devastated by that suggestion. And we had a public meeting in which many people came and they they hadn't been consulted at this point. I think they'd been an assumption made that they weren't able to communicate. But many of them are able to communicate with support, and that hadn't been done. Um, and. The fear that it's caused people, the worries of, you know, where will they go instead?Will it be suitable?What about the people that they've made friendships with at the centre?And many of them have elderly parents, very elderly parents in the 80s in some cases.
Um and so I think it's economically short sighted too, because it may end up with people going into full time care, which ultimately will cost the council more as well. So, um, the council have now been persuaded to do a full consultation. So that will be going on over the next few months. But if anything that he can share with me that was successful for him, that could help me to keep Swallow Lodge open against this Reform County Council changes, I think would be I'd be very grateful for.
Thank you Jeff.
And it wants to it wants to close it. And they are devastated by that suggestion. And we had a public meeting in which many people came and they they hadn't been consulted at this point. I think they'd been an assumption made that they weren't able to communicate. But many of them are able to communicate with support, and that hadn't been done. Um, and. The fear that it's caused people, the worries of, you know, where will they go instead?Will it be suitable?What about the people that they've made friendships with at the centre?And many of them have elderly parents, very elderly parents in the 80s in some cases.
Um and so I think it's economically short sighted too, because it may end up with people going into full time care, which ultimately will cost the council more as well. So, um, the council have now been persuaded to do a full consultation. So that will be going on over the next few months. But if anything that he can share with me that was successful for him, that could help me to keep Swallow Lodge open against this Reform County Council changes, I think would be I'd be very grateful for.
Thank you Jeff.
15:40
15:40
Speaker 5
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Speaker 5
Thank you, miss. As the chair of all party parliamentary group on adult social care, I want to pay tribute to unpaid carers for the enormous contribution they make to their families, communities and wider society. And I do often have meetings with these carers. And also, as part of my previous job, before I became an MP, I had a. While working in the NHS, I had numerous contact with carers and I have seen so many vulnerable patients. Benefit from this enormous work these carers do and some of the services like in the mental health services, there's already provision to identify carers and carers, assessment and support for carers in their um they provide extraordinary support, often great personal sacrifice.
Um while the intention to make this a statutory duty, what we need to be very careful that we, we should not put any, any, um a statutory responsibility on NHS and create more administrative burdens on NHS. So I would appreciate when the minister, when respond or the government could consider um something. To support the carers. Uh while we're not putting any administrative burden on NHS where we are focusing on providing more support in the frontline. Um the first two clauses in this group would impose new obligations on integrated care boards to promote carers wellbeing and to identify and record unpaid carers whenever they come into contact with NHS services.
Um, so that's why I just want to, to, to make it clear that we should not create any more administrative burden on NHS frontline services. Um, while identifying and supporting carers is important, this requirement would add to the administrative burden on NHS organisations at a time when they should be focusing on delivering frontline care. Um, we should be cautious about creating new statutory duties that may divert resources and staff time away from patients. Um, the proposal for a national respite care scheme is similarly well-intentioned, but it was imposing a centralised, one size fits all model across a system that already has local authorities and health bodies responsible for assessing local needs and delivering support.
So again, while we need more support going into carers, I think we should note we should be careful that we're not duplicating any of the services that is already available. Some of the charities do a brilliant job supporting carers as well. So, uh, it is something this clauses need to be looked into. Uh, but I think we need to be very cautious that we're not creating more burden on our existing systems. Thank you.
Um while the intention to make this a statutory duty, what we need to be very careful that we, we should not put any, any, um a statutory responsibility on NHS and create more administrative burdens on NHS. So I would appreciate when the minister, when respond or the government could consider um something. To support the carers. Uh while we're not putting any administrative burden on NHS where we are focusing on providing more support in the frontline. Um the first two clauses in this group would impose new obligations on integrated care boards to promote carers wellbeing and to identify and record unpaid carers whenever they come into contact with NHS services.
Um, so that's why I just want to, to, to make it clear that we should not create any more administrative burden on NHS frontline services. Um, while identifying and supporting carers is important, this requirement would add to the administrative burden on NHS organisations at a time when they should be focusing on delivering frontline care. Um, we should be cautious about creating new statutory duties that may divert resources and staff time away from patients. Um, the proposal for a national respite care scheme is similarly well-intentioned, but it was imposing a centralised, one size fits all model across a system that already has local authorities and health bodies responsible for assessing local needs and delivering support.
So again, while we need more support going into carers, I think we should note we should be careful that we're not duplicating any of the services that is already available. Some of the charities do a brilliant job supporting carers as well. So, uh, it is something this clauses need to be looked into. Uh, but I think we need to be very cautious that we're not creating more burden on our existing systems. Thank you.
15:42
Speaker 3
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Speaker 3
Thank you, Mr.. Um, I, I'm grateful to the honourable member for, uh, introducing. These new clauses, not least for the debate that it is allowing us to have here, um, unpaid carers are too often a silent and fundamentally unappreciated part of not only the system, but part of society. The system wouldn't cope without that is family members who are thrown into a role looking after their loved ones that they didn't expect to have to do, most of whom have no formal qualifications in which to do it.
But through love and family ties, they do unpaid support, which in many cases has a negative effect on the financial well-being of the household, as well as the huge emotional toil it plays and the crisis in social care in this country, an issue that has lasted for decades under different governments and different governments have struggled to tackle with. It is putting a direct and increasing pressure on family carers, many of whom actually don't see themselves as a carer. They see themselves as a husband or a wife or a daughter or a son or a friend.
But it is they who provide the millions of hours of care and support year in, year out. In my former role working for a national nursing charity seeking to support families of those living with dementia, I saw for myself how much can be achieved in relieving the pressure and unnecessary suffering by that wraparound care not for the person living with dementia, or it doesn't have to be someone with dementia, but it was in my previous experience. But someone living with long term frailty and conditions such that they need support in providing the wraparound care, not just for them, but for their family and their carer too.
And actually, very often the biggest need of the person. In my experience, living with dementia, their biggest care need was the biggest need. Their family carer had. If you could sort the family carers biggest pressure or need, they could go on and deliver and do so much more for the person they love. So I welcome and thank the honourable member for Winchester for allowing us to have this debate, and I would urge the government, if it's not going to adopt these new clauses, to do all it can to try and relieve the pressure and provide support to unpaid carers up and down the country.
But through love and family ties, they do unpaid support, which in many cases has a negative effect on the financial well-being of the household, as well as the huge emotional toil it plays and the crisis in social care in this country, an issue that has lasted for decades under different governments and different governments have struggled to tackle with. It is putting a direct and increasing pressure on family carers, many of whom actually don't see themselves as a carer. They see themselves as a husband or a wife or a daughter or a son or a friend.
But it is they who provide the millions of hours of care and support year in, year out. In my former role working for a national nursing charity seeking to support families of those living with dementia, I saw for myself how much can be achieved in relieving the pressure and unnecessary suffering by that wraparound care not for the person living with dementia, or it doesn't have to be someone with dementia, but it was in my previous experience. But someone living with long term frailty and conditions such that they need support in providing the wraparound care, not just for them, but for their family and their carer too.
And actually, very often the biggest need of the person. In my experience, living with dementia, their biggest care need was the biggest need. Their family carer had. If you could sort the family carers biggest pressure or need, they could go on and deliver and do so much more for the person they love. So I welcome and thank the honourable member for Winchester for allowing us to have this debate, and I would urge the government, if it's not going to adopt these new clauses, to do all it can to try and relieve the pressure and provide support to unpaid carers up and down the country.
15:45
Speaker 12
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Speaker 12
Thank you. Mr.. And, like the Honourable Isle of Wight, I'm grateful to the Honourable Winchester for bringing this discussion before the committee and I recognise, as has been said, that and I think all members across the House and this Committee are committed to ensure that carers receive the care and support they need, and because and the government also recognises that because we do recognise that unpaid carers do play a vital role and sustain the health and wellbeing of millions of people across their country, across our country.
And I'd like to take this opportunity to pay tribute to them and recognise all the work that they've contributed to, and to also thank and note the work of the Honourable Ashford, of his work on the Appg, working with people across the House, and I think the honourable member for Winchester highlighted, as we heard in our evidence session, the the shocking impact on people who are caring on their own physical and mental health. Um, and it does raise an important issue. I think particularly it is good that we can now talk more about the mental health of carers.
And as he rightly said, many of us are carers. It's not an easy thing to do. And I also pay tribute to them for the Isle of Wight East for his comments, particularly about wraparound care and the importance that that provides to people who often don't want to leave the one they care for, but to recognise that that respite care is important. And I wish the honourable member for Hykeham and and North Hykeham, um, good luck with her campaign in her constituency with Reform Council.
I will if.
And I'd like to take this opportunity to pay tribute to them and recognise all the work that they've contributed to, and to also thank and note the work of the Honourable Ashford, of his work on the Appg, working with people across the House, and I think the honourable member for Winchester highlighted, as we heard in our evidence session, the the shocking impact on people who are caring on their own physical and mental health. Um, and it does raise an important issue. I think particularly it is good that we can now talk more about the mental health of carers.
And as he rightly said, many of us are carers. It's not an easy thing to do. And I also pay tribute to them for the Isle of Wight East for his comments, particularly about wraparound care and the importance that that provides to people who often don't want to leave the one they care for, but to recognise that that respite care is important. And I wish the honourable member for Hykeham and and North Hykeham, um, good luck with her campaign in her constituency with Reform Council.
I will if.
15:47
Speaker 11
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Speaker 11
I thank the Minister for her well wishes on this, because they've not just proposed to close Swallow Lodge, but they've also recently closed the memory service and listening to what my hon. The services for people with dementia. This is another area where people will be suffering, um, because of the. Closures of their vital services.
15:47
Speaker 12
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Speaker 12
I thank you for that intervention, which is obviously not on the record. I'm sure she'll be, um, campaigning heavily that when she gets back to her constituents in behalf of her constituents, um on new clause 16, I mean, we are fully supportive of the need to support the health and wellbeing carers, but we don't think this amendment is necessary because the existing legal framework already requires the system to support carers. And this amendment, duplicate existing duties and risk adding complexity rather than improving support in practice, carers are explicitly referenced in the NHS Constitution, which establishes the principles and values of the NHS in England to improve the health and wellbeing of the population, and the Secretary of State for health.
All NHS bodies, private and voluntary sector providers supplying NHS services and local authorities in the exercise of their public health functions, are required by law to take account of this constitution in their decisions and actions. Local authorities and NHS bodies also have a duty of cooperation in respect of their functions relating to carers. And finally, under this Bill, the Secretary of State will take on NHS England's role in promoting the involvement of each patient in decisions relating to their illness, care or treatment, and this duty includes the involvement of carers and representatives.
However, beyond the legislative framework, our focus is. Liz Twist.
All NHS bodies, private and voluntary sector providers supplying NHS services and local authorities in the exercise of their public health functions, are required by law to take account of this constitution in their decisions and actions. Local authorities and NHS bodies also have a duty of cooperation in respect of their functions relating to carers. And finally, under this Bill, the Secretary of State will take on NHS England's role in promoting the involvement of each patient in decisions relating to their illness, care or treatment, and this duty includes the involvement of carers and representatives.
However, beyond the legislative framework, our focus is. Liz Twist.
15:48
Speaker 4
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Speaker 4
I thank the Minister for giving way and as she says, many people in this room will have had their own experiences of being a carer for a family member. Um and, uh, I just wonder she set out absolutely that there is already a legal framework for this, but clearly carers are saying we need a bit more. And I just wonder how the government can make sure that it's not just words and legal documents. It's actually helping on the ground.
15:49
Speaker 12
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Speaker 12
Yes, she I thank her for her intervention. I'm just moving on to talk about some of the work beyond the legislative framework. As she rightly says. Um, because beyond that legislative framework, our focus is on delivering practical improvements. Because as my friend from Blaydon says, that's absolutely what people want to see. And we are committed to ensuring carers have the support they need through measures. In the ten year health plan, we are already equipping and supporting carers by making them more visible, empowering their voices in care, planning, joining up services and streamlining their care tasks by introducing a new My Carer section to the NHS app.
We're also working with ministers from the DWP, DBT and the Department of Education to consider how best to recognise and support unpaid carers, and this government is preparing a cross-government action plan for unpaid carers to be published this year. And I will, of course.
We're also working with ministers from the DWP, DBT and the Department of Education to consider how best to recognise and support unpaid carers, and this government is preparing a cross-government action plan for unpaid carers to be published this year. And I will, of course.
15:50
15:50
Speaker 12
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Speaker 12
And that's exactly the sort of thing um that we wanted to do that we have done. Uh, and it does start to, to make visible carers practical measures to support. And that's exactly the sort of and across government that we absolutely have sought to bring, as my friend said, practical. Thing, um, that we wanted to do that we have done, uh, and it does start to recognise the work that people do, turning to new clauses. 17 and um, my honourable friends and concert talked about new clause 89 as a member of my hon.
Friend for Shipley, whose expertise and commitment in this area is well known across the house. Um, that looks at the identification of unpaid carers and the provision of information to them. And I do agree on the importance of ensuring that carers are properly recorded and identified in the system and provided with relevant information and advice, so they can be better supported and involved in care decisions. However, we do not believe we do not believe that explicit requirements on identifying and recording particular patient and carer groups are appropriate for legislation.
We have made clear commitments in the NHS ten year health plan and are taking practical steps to improve identification and support carers and involve them in care planning. If we need to mandate compliance. This is best done through including requirements within the national NHS contracts or in statutory guidance or directions where we can provide more detail and directly address barriers. Information about unpaid carers will be captured systematically to ensure their responsibilities are recognised and supported, and developments such as the single patient record which we've discussed in this committee earlier, will make this easier in the future.
I think that is a really important step forward. We're also looking to support general practice in better identifying and recording which of their parents are unpaid carers to help ensure these carers can get the support they need in the community. NHS England has recently published guidance to support this, and there's ongoing work to ensure more consistent coding of unpaid carers by general practitioners.
Friend for Shipley, whose expertise and commitment in this area is well known across the house. Um, that looks at the identification of unpaid carers and the provision of information to them. And I do agree on the importance of ensuring that carers are properly recorded and identified in the system and provided with relevant information and advice, so they can be better supported and involved in care decisions. However, we do not believe we do not believe that explicit requirements on identifying and recording particular patient and carer groups are appropriate for legislation.
We have made clear commitments in the NHS ten year health plan and are taking practical steps to improve identification and support carers and involve them in care planning. If we need to mandate compliance. This is best done through including requirements within the national NHS contracts or in statutory guidance or directions where we can provide more detail and directly address barriers. Information about unpaid carers will be captured systematically to ensure their responsibilities are recognised and supported, and developments such as the single patient record which we've discussed in this committee earlier, will make this easier in the future.
I think that is a really important step forward. We're also looking to support general practice in better identifying and recording which of their parents are unpaid carers to help ensure these carers can get the support they need in the community. NHS England has recently published guidance to support this, and there's ongoing work to ensure more consistent coding of unpaid carers by general practitioners.
15:52
Speaker 11
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Speaker 11
I'm grateful to the Minister for allowing me to mention. I have visited a number of schools in my constituency since I've been an MP, and I've always been struck by the number of children who are carers and I think this is a very under-recognised group of people who actually whose lives are completely dominated by the fact that they are carers for their parents.
15:52
Speaker 4
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Speaker 4
Well, I think my friend from Edmonton and Stomach and I heard a voice, audible voices of approval for that point, because I think when any of us know or encounter children, whether it be in our own circle or when we visit, schools in our constituency are very much struck by children who are themselves at school and caring. I think most schools do a tremendous job where they recognise, because often children, like adults, don't want to inform their school or local people that that's what they're doing. And very proud.
And perhaps the person they're caring for doesn't doesn't know how to do that. Um, I certainly seen it in my constituency where schools start to recognise and, and support in a, in a, in a dignified and respecting of privacy way, the needs of, of that particular child. And I did allude to some of the work that we're doing across government and with Department of Education. Um, to recognise and to find ways to support those young people who many of them do want to support their loved ones and, but ways to support them.
And I think we've all seen great ways, and I certainly know that I am always conscious when we are addressing children, to think about the circumstances in which we are talking to young children in our classrooms. And indeed, a lot of teenage teenage carers as well. So he's absolutely right to highlight that. Um. I think I'd got to um the, my carers were broadly. Apart from data sharing and addressing those barriers more broadly, the My Carer section of the NHS app will allow people to securely prove that they are providing care and for carers this will streamline their care responsibilities significantly.
Again, that can be done without having to sort of confront things in public. Um, if that's what people want while giving them a means to seek advice or reassurance directly from a range of professionals when they need it. I'm also not convinced that the challenge in providing effective support would be solved by adding an additional legal duty to the existing legal framework already requires the system to support carers, including with the provision of information and advice. What is needed is practical steps as we've discussed, and progress is being made locally through issuing practical toolkits to help hospitals implement the legal duties they already have around the Health and Care Act of 2022.
This year, we will also commission the Better Care Fund Support Programme, led by the Local Government Association, to work with the NHS and social care partners to strengthen their approach to involving unpaid carers and discharge planning. I think we have heard of new calls 18 so if I can just briefly address that, the request on a national respite care scheme, this amendment, um again, we feel is not necessary since the legal framework already provides rights for carers to access support. And this can include respite services under the Care Act of 2014, local authorities are required to carry out carers assessments, where a carer appears to have needs for support.
These consider both current and future needs where carers have eligible needs, local authorities are under duties and powers in respect of meeting those needs. This establishes a framework where needs assessment and subsequent care planning focus on the individual and their circumstances, rather than providing prescribing a particular service or solution. In other words, respite care is already considered as one of the many forms of care and support that might be offered as part of this process, where it is appropriate to meet the individual carers, needs, funding and mechanisms are in place to support local areas to deliver support for carers.
The Better Care Fund is an over £9 billion framework for integrated care boards and local authorities to make joint plans and pool budgets for the purposes of delivering better joined up care and in developing the better care fund plans. Icbs and local authorities should consider how pooled funding can help the NHS and local authorities meet those duties in relation to unpaid carers, include any short breaks and respite services. The government is also making over £4.6 billion of additional funding available for adult social care in 2829, compared to 2526 to support the sector in making improvements and local areas determine how the money is best used to support carers, depending on local need and with reference to their statutory responsibilities.
And for these reasons, I ask the honourable members to withdraw their amendments.
And perhaps the person they're caring for doesn't doesn't know how to do that. Um, I certainly seen it in my constituency where schools start to recognise and, and support in a, in a, in a dignified and respecting of privacy way, the needs of, of that particular child. And I did allude to some of the work that we're doing across government and with Department of Education. Um, to recognise and to find ways to support those young people who many of them do want to support their loved ones and, but ways to support them.
And I think we've all seen great ways, and I certainly know that I am always conscious when we are addressing children, to think about the circumstances in which we are talking to young children in our classrooms. And indeed, a lot of teenage teenage carers as well. So he's absolutely right to highlight that. Um. I think I'd got to um the, my carers were broadly. Apart from data sharing and addressing those barriers more broadly, the My Carer section of the NHS app will allow people to securely prove that they are providing care and for carers this will streamline their care responsibilities significantly.
Again, that can be done without having to sort of confront things in public. Um, if that's what people want while giving them a means to seek advice or reassurance directly from a range of professionals when they need it. I'm also not convinced that the challenge in providing effective support would be solved by adding an additional legal duty to the existing legal framework already requires the system to support carers, including with the provision of information and advice. What is needed is practical steps as we've discussed, and progress is being made locally through issuing practical toolkits to help hospitals implement the legal duties they already have around the Health and Care Act of 2022.
This year, we will also commission the Better Care Fund Support Programme, led by the Local Government Association, to work with the NHS and social care partners to strengthen their approach to involving unpaid carers and discharge planning. I think we have heard of new calls 18 so if I can just briefly address that, the request on a national respite care scheme, this amendment, um again, we feel is not necessary since the legal framework already provides rights for carers to access support. And this can include respite services under the Care Act of 2014, local authorities are required to carry out carers assessments, where a carer appears to have needs for support.
These consider both current and future needs where carers have eligible needs, local authorities are under duties and powers in respect of meeting those needs. This establishes a framework where needs assessment and subsequent care planning focus on the individual and their circumstances, rather than providing prescribing a particular service or solution. In other words, respite care is already considered as one of the many forms of care and support that might be offered as part of this process, where it is appropriate to meet the individual carers, needs, funding and mechanisms are in place to support local areas to deliver support for carers.
The Better Care Fund is an over £9 billion framework for integrated care boards and local authorities to make joint plans and pool budgets for the purposes of delivering better joined up care and in developing the better care fund plans. Icbs and local authorities should consider how pooled funding can help the NHS and local authorities meet those duties in relation to unpaid carers, include any short breaks and respite services. The government is also making over £4.6 billion of additional funding available for adult social care in 2829, compared to 2526 to support the sector in making improvements and local areas determine how the money is best used to support carers, depending on local need and with reference to their statutory responsibilities.
And for these reasons, I ask the honourable members to withdraw their amendments.
15:56
15:56
Speaker 5
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Speaker 5
Thank you, Madam Chair. Thank you to the whole committee for their contributions. Particularly members of the Isle of Wight, I thought spoke particularly well. Um, I know he worked the dementia UK. But. Emotively on that subject I um the member worked for dementia UK before entering and certainly my mother was a carer for my father dementia and she's my sister. Um and I used to give her quite a bit of respite care. Probably not enough actually.
And I know that there's many members here will have been in similar situations. It's a very, very common, uh, common disease. And it's increasingly more common. Um, thank you. Thank you to the minister for her, um, comments and. Reassurance and these things and, and to the point on um, the. Member for Bury St Edmunds made about children carers. One result of a bill committee last year, the Mental health bill committee that I sat on, it shows how impactful it can be.
We really appreciated the government's um engaging with on this was that um, that it's now a requirement, an obligation to identify whether mental health patients have children who are carers, um, because there wasn't before. And there's often teenagers who are caring, um, for an adult with, um, with severe mental health issues and it can be, and they're not even identified. They weren't even identified. So they couldn't be given the support that was required. Whereas that's changed now. And it's fantastic to see that we can make a difference through these committees that make a tangible difference to people's lives.
Um, I will withdraw new clause 16 and 17. Um, we do think that the National Respite Care Scheme establishing one would be a really sensible and impactful thing to do. Um, and so I'd like to go through provision in that. Thank you.
And I know that there's many members here will have been in similar situations. It's a very, very common, uh, common disease. And it's increasingly more common. Um, thank you. Thank you to the minister for her, um, comments and. Reassurance and these things and, and to the point on um, the. Member for Bury St Edmunds made about children carers. One result of a bill committee last year, the Mental health bill committee that I sat on, it shows how impactful it can be.
We really appreciated the government's um engaging with on this was that um, that it's now a requirement, an obligation to identify whether mental health patients have children who are carers, um, because there wasn't before. And there's often teenagers who are caring, um, for an adult with, um, with severe mental health issues and it can be, and they're not even identified. They weren't even identified. So they couldn't be given the support that was required. Whereas that's changed now. And it's fantastic to see that we can make a difference through these committees that make a tangible difference to people's lives.
Um, I will withdraw new clause 16 and 17. Um, we do think that the National Respite Care Scheme establishing one would be a really sensible and impactful thing to do. Um, and so I'd like to go through provision in that. Thank you.
15:59
15:59
15:59
16:00
16:00
16:00
16:00
16:02
16:02
16:02
Speaker 1
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Speaker 1
The eyes were worn and the nose were seven. So the nose have it. The nose have it unlock. We now come to new clause 19 in the name of Doctor Alison Gardner, which was debated in Group two. Does any member of the committee wish to move the new clause for a division?Sir?No. We now come to New Clause 24 in the name of Doctor Betty Cooper, which was debated with new clause 11. Does any member of the committee wish to move the new clause for a division?We now come to Group 59 in new clause 25, tabled in the name of Iqbal Muhammad, with which we will debate new clauses 62 to 64.
Does any member wish to move the new clause?Johnson.
Does any member wish to move the new clause?Johnson.
16:03
Speaker 3
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Speaker 3
Thank you, chair and the honourable. Asked me to speak to this amendment briefly, which I will do very briefly. It's a very serious issue, chair. Critically ill children are infants, children and adolescents with life threatening illness or injury, often requiring intensive, continuous care to survive conditions from leukaemia to meningococcal disease, traumatic brain injuries and post surgery like major surgery, like spinal surgery. And I should say that I am a consultant paediatrician, but I have worked in paediatric intensive care as a junior.
Now would be called resident doctor. Um. The the bill is the the the the the. Amendment is a new clause is drafted. Um I think doesn't do what I think the honourable member is aiming for when I, when I, when I read it through, I think the honourable member is looking at cases like the tragic case of little Charlie Gard, who we all remember died of Encephalomyopathic mitochondrial DNA depletion syndrome, known as MDS. It's incredibly rare and tragic.
Case highlights the potential for disputes between parents and doctors, which thankfully is an unusual circumstance. The the drafting at the moment talks of parents of critically ill children, communication, involvement in decision making. Now of course, of course, parents should be involved in decision making about their children. Of course they should. Um, but the um, I think when we talk about critically ill children, it's worth noting that the average time, the median time that children spent in ICU is two days and most of them get better.
Thankfully, very few of them don't. Um, the measures in the um, clause talk about teachers being involved, which is unnecessary and impractical in most cases. And many children may be admitted on a Friday, discharged from ICU by the um by the Monday and therefore the schools, the schools are closed. But there's no necessarily practical reason in the majority of cases for teachers to be involved. Um, parents being part of every meeting. Again, I can see the desire of that.
But sometimes clinicians need to be able to talk frankly about the cases. Sometimes they'll have multidisciplinary meetings where they're talking about a plethora of different cases, or they may compare one case to another in terms of what they've seen. And so, um, in terms of finding those scans and the like. And so it's not possible to have parents in every single meeting, although they're being aware of the discussions is of course desirable. The. There are other, there are other parts of it which, which seem reasonable, you know, make provision for parents to, to know, to know about everything and to set out how many communication and language needs may be met.
Um. They do also talk about um independent mediation where there is disagreement, which is a beneficial, uh, beneficial way to go about things. What we mustn't do is legislate in a way that gets in the way of urgent care, because most children who are critically ill in intensive care have urgent care needs that need dealing with now, not in a weeks time, and forming ethics committees to make decisions takes a long time, and that would get in the way of urgent care. So I think what the honourable member means is when he's talking, I think what he's aiming for is legislation that relates to chronically mechanically ventilated children, um, with with significant medical conditions rather than acute critically ill children.
Um, but I said I would raise it and I have, and I think what he's trying to do is to provide better care for some of the sickest children. And that is a desirable, desirable aim. And I know he cares deeply about this. Um, but I think the legislation is drafted, doesn't do what, what, what it says, what, what I think he's aiming for. And I think it could get in the way of paediatricians and others managing some of the children in the country.
So I won't be moving it to a vote.
Now would be called resident doctor. Um. The the bill is the the the the the. Amendment is a new clause is drafted. Um I think doesn't do what I think the honourable member is aiming for when I, when I, when I read it through, I think the honourable member is looking at cases like the tragic case of little Charlie Gard, who we all remember died of Encephalomyopathic mitochondrial DNA depletion syndrome, known as MDS. It's incredibly rare and tragic.
Case highlights the potential for disputes between parents and doctors, which thankfully is an unusual circumstance. The the drafting at the moment talks of parents of critically ill children, communication, involvement in decision making. Now of course, of course, parents should be involved in decision making about their children. Of course they should. Um, but the um, I think when we talk about critically ill children, it's worth noting that the average time, the median time that children spent in ICU is two days and most of them get better.
Thankfully, very few of them don't. Um, the measures in the um, clause talk about teachers being involved, which is unnecessary and impractical in most cases. And many children may be admitted on a Friday, discharged from ICU by the um by the Monday and therefore the schools, the schools are closed. But there's no necessarily practical reason in the majority of cases for teachers to be involved. Um, parents being part of every meeting. Again, I can see the desire of that.
But sometimes clinicians need to be able to talk frankly about the cases. Sometimes they'll have multidisciplinary meetings where they're talking about a plethora of different cases, or they may compare one case to another in terms of what they've seen. And so, um, in terms of finding those scans and the like. And so it's not possible to have parents in every single meeting, although they're being aware of the discussions is of course desirable. The. There are other, there are other parts of it which, which seem reasonable, you know, make provision for parents to, to know, to know about everything and to set out how many communication and language needs may be met.
Um. They do also talk about um independent mediation where there is disagreement, which is a beneficial, uh, beneficial way to go about things. What we mustn't do is legislate in a way that gets in the way of urgent care, because most children who are critically ill in intensive care have urgent care needs that need dealing with now, not in a weeks time, and forming ethics committees to make decisions takes a long time, and that would get in the way of urgent care. So I think what the honourable member means is when he's talking, I think what he's aiming for is legislation that relates to chronically mechanically ventilated children, um, with with significant medical conditions rather than acute critically ill children.
Um, but I said I would raise it and I have, and I think what he's trying to do is to provide better care for some of the sickest children. And that is a desirable, desirable aim. And I know he cares deeply about this. Um, but I think the legislation is drafted, doesn't do what, what, what it says, what, what I think he's aiming for. And I think it could get in the way of paediatricians and others managing some of the children in the country.
So I won't be moving it to a vote.
16:07
16:07
Speaker 4
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Speaker 4
Thank you, Miss Lou. And, um, I'm grateful to the honourable member for um. The new. Causes I think, uh, new clause 25 is what we are addressing now on um, and grateful to the member for Cleveland North Hykeham, uh, for. Um. Raising those comments and it is a genuine pleasure to hear an expertise that clinicians such as herself working in the field of children, which I know she's very obviously very passionate about, to be able to bring her expertise and her commitment to these, particularly looking after children and critically ill children, of course.
Um, and, you know, I do want to begin by recognising the profound impact that receiving a diagnosis for a life threatening condition has on a child and their wider family, such an overwhelming time in their lives. It's vital that families feel supported, informed, and able to navigate the care and services available to them. And we also recognise that families can also face huge variation in the support available, and they need to navigate complex systems at a particularly difficult time. And I know many honourable members, of course, support many families, constituents of ours in in these times, in these circumstances.
So as a government, we are committed to ensuring that families have access to the support they need in the most straightforward way as possible. So on new Clause 25, this seeks to place a duty on the Secretary of State to issue guidance to integrated care boards on communications with parents of critically ill children and parents, involvement in decision making in respect of the treatment or care of their child. And we heard from the opposition spokesperson about some of the um, the operational issues around some of the tax provisions in that course, but not absolutely above the intent.
Of course, parents should be involved and have good decision making at this particular time. Um, decisions about the care of a critically ill child can of course be distressing. We need to ensure that we get the process right from the beginning. And this starts with good communication, sensitive handling and ensuring best practice across the system. Healthcare professionals should always act in the best interests of their parents and the views of parents are of course very important. But it is the child's best interests that are paramount and we should not do anything that undermines that crucial principle.
It is important that families and medical professionals communicate and, where possible, reach an agreement on the care and treatment that is in the best interest of the child. To support this, there are many excellent examples of guidance and best practice across the health system and the Royal College of Paediatrics and Child Health is currently updating their framework for clinical practice on navigating decisions to provide, limit or withdraw treatment towards the end of a child's life. And this framework will include communication principles, legal and ethical principles, clinical and practical considerations, including the role of clinical ethics services.
It will also include guidance on navigating disagreements with professionals, children and young people and their families. An e-learning platform is available to staff working at all levels in children's healthcare. The training programme provides professionals with a suite of resources to enhance knowledge, skills and confidence. It supports healthcare providers to recognise, manage and de-escalate conflict between families and health care providers. Where that occurs, and signposts to both professional resources and resources for families. And the actions I've outlined will continue to help and support that existing best practice, training and.
Um, and, you know, I do want to begin by recognising the profound impact that receiving a diagnosis for a life threatening condition has on a child and their wider family, such an overwhelming time in their lives. It's vital that families feel supported, informed, and able to navigate the care and services available to them. And we also recognise that families can also face huge variation in the support available, and they need to navigate complex systems at a particularly difficult time. And I know many honourable members, of course, support many families, constituents of ours in in these times, in these circumstances.
So as a government, we are committed to ensuring that families have access to the support they need in the most straightforward way as possible. So on new Clause 25, this seeks to place a duty on the Secretary of State to issue guidance to integrated care boards on communications with parents of critically ill children and parents, involvement in decision making in respect of the treatment or care of their child. And we heard from the opposition spokesperson about some of the um, the operational issues around some of the tax provisions in that course, but not absolutely above the intent.
Of course, parents should be involved and have good decision making at this particular time. Um, decisions about the care of a critically ill child can of course be distressing. We need to ensure that we get the process right from the beginning. And this starts with good communication, sensitive handling and ensuring best practice across the system. Healthcare professionals should always act in the best interests of their parents and the views of parents are of course very important. But it is the child's best interests that are paramount and we should not do anything that undermines that crucial principle.
It is important that families and medical professionals communicate and, where possible, reach an agreement on the care and treatment that is in the best interest of the child. To support this, there are many excellent examples of guidance and best practice across the health system and the Royal College of Paediatrics and Child Health is currently updating their framework for clinical practice on navigating decisions to provide, limit or withdraw treatment towards the end of a child's life. And this framework will include communication principles, legal and ethical principles, clinical and practical considerations, including the role of clinical ethics services.
It will also include guidance on navigating disagreements with professionals, children and young people and their families. An e-learning platform is available to staff working at all levels in children's healthcare. The training programme provides professionals with a suite of resources to enhance knowledge, skills and confidence. It supports healthcare providers to recognise, manage and de-escalate conflict between families and health care providers. Where that occurs, and signposts to both professional resources and resources for families. And the actions I've outlined will continue to help and support that existing best practice, training and.
16:10
16:10
Speaker 3
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Speaker 3
Thank the minister who's setting out the important guidance that can be provided to clinicians who are managing the care of children who are seriously unwell. And I just wanted to add that I'm a member of the Royal College of Paediatrics and Child Health that is producing that guidance. Just for the records. Chair, I'm grateful to the Minister for laying out the importance. These are very difficult decisions. This is the end of life care. Decisions are very difficult.
They need to be taken in conjunction with families. But the minister is absolutely right. They must be done in the best interests of the child in all cases.
They need to be taken in conjunction with families. But the minister is absolutely right. They must be done in the best interests of the child in all cases.
16:11
16:11
Speaker 4
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Speaker 4
I thank her for that intervention, and I'm sure that the college will make sure the best use of both her clinical expertise and her expertise as a legislator as well, to to get that right. And obviously, we work with all colleges to ensure that we do get that best clinical evidence right into guidelines. Um, I hope the actions I've outlined will continue to help and support that existing best practice and training and guidance on shared decision making and dispute resolution so that that is embedded across the system.
There are a number of other important contributions in this group which haven't been moved, but I just wanted to say that, you know, alongside some of the things I've outlined, we are wanting to progress system wide reforms to improve how children and young people and their families are supported across many conditions. And, um, I think we are working to bring forward, uh, a modern service framework for children and young people that will set out how we will improve quality for children and young people's services in, in the longer term, as part of our ten year health plan.
There are a number of other important contributions in this group which haven't been moved, but I just wanted to say that, you know, alongside some of the things I've outlined, we are wanting to progress system wide reforms to improve how children and young people and their families are supported across many conditions. And, um, I think we are working to bring forward, uh, a modern service framework for children and young people that will set out how we will improve quality for children and young people's services in, in the longer term, as part of our ten year health plan.
16:11
16:11
16:11
Speaker 1
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Speaker 1
That's correct. Okay. Is everyone content for the new clause to be withdrawn?New clause by leave. Come to new clauses 26 and 27. In the name. In the name of Layla Moran, which have already been debated. Does any member of the committee wish to move either new clause for a division. We now come to Group 60 and new clause 28, tabled in the name of Layla Moran, who is not a member of the committee.
Does any member wish to move the new clause?Doctor Danny Chambers.
Does any member wish to move the new clause?Doctor Danny Chambers.
16:12
Speaker 5
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Speaker 5
Thank you, Madam Chair. Sir Nicholas, 28, tabled in the name of honourable friend, the chair of the Health Select Committee, extends the powers of the first tier tribunal so that when it is determined an appeal, it may be ordered that education, health and care plans must include health and social care needs provision, rather than just making recommendations on these matters. And I'm sure all members probably in a similar situation where I think. In the various forms, uh, one of the main reasons we get contacted by constituents certainly fills up my inbox.
Um, so following the Education committee's report, solving the Send crisis, which identified significant gaps in accountability and engagement from the DHS and by health services in the special educational needs and disabilities. Send system, the Health and Social Care Committee held off a held a one off evidence session to build on its findings. Looking at the delivery of health aspects of CPS. The committee followed up a recommendation that the Education Committee had made that the powers of the Send Tribunal service should be extended to allow it to issue binding recommendations to health services, not just education providers.
Sen tribunals are independent national tribunals, which decide appeals against local authority decisions about the special educational needs of children and young people, including decisions made about any HCP. They can make binding recommendations in relation to education provision, but not in relation to health and social care needs. So the Education Committee argued that this would ensure that when there is a failure to deliver a health provision specified in a health. Bodies are legally obligated to take corrective action. When the committee raised it with witnesses at the evidence session, several were supportive of.
Supportive of placing this duty in legislation, although they noted it would require other reforms to workforce and commissioning arrangements to be successful. This amendment would provide a level playing field between education bodies and icbs, so that icbs are also under a legal obligation to comply with recommendations from tribunals.
Um, so following the Education committee's report, solving the Send crisis, which identified significant gaps in accountability and engagement from the DHS and by health services in the special educational needs and disabilities. Send system, the Health and Social Care Committee held off a held a one off evidence session to build on its findings. Looking at the delivery of health aspects of CPS. The committee followed up a recommendation that the Education Committee had made that the powers of the Send Tribunal service should be extended to allow it to issue binding recommendations to health services, not just education providers.
Sen tribunals are independent national tribunals, which decide appeals against local authority decisions about the special educational needs of children and young people, including decisions made about any HCP. They can make binding recommendations in relation to education provision, but not in relation to health and social care needs. So the Education Committee argued that this would ensure that when there is a failure to deliver a health provision specified in a health. Bodies are legally obligated to take corrective action. When the committee raised it with witnesses at the evidence session, several were supportive of.
Supportive of placing this duty in legislation, although they noted it would require other reforms to workforce and commissioning arrangements to be successful. This amendment would provide a level playing field between education bodies and icbs, so that icbs are also under a legal obligation to comply with recommendations from tribunals.
16:14
16:14
16:14
Speaker 3
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Speaker 3
Thank you. Chair. Um, and I should say that I'm a member of the Education Committee. Um the new clause 28 would is the honourable gentleman says extend the powers of the first tier tribunal to. When determining appeal, it may order that E s must include health and social care needs and provision, rather than just making recommendations on these matters. Um, I think it's, it's clearly important that children with special educational needs get what they get, get what they need and the support that they need.
And we are aware, very aware at the moment of all of us from our inboxes, that that's not always the case. Um, I don't know whether putting it into legislation would make it happen or whether it would need much more work than one clause in legislation. But clearly, it's a very important aim that I support the principle of, and I'd be grateful for the Minister's comments on how she thinks it could work in practice, and whether the legislation is what's required, whether it's more of a widespread plan that they could they would need to do.
And we are aware, very aware at the moment of all of us from our inboxes, that that's not always the case. Um, I don't know whether putting it into legislation would make it happen or whether it would need much more work than one clause in legislation. But clearly, it's a very important aim that I support the principle of, and I'd be grateful for the Minister's comments on how she thinks it could work in practice, and whether the legislation is what's required, whether it's more of a widespread plan that they could they would need to do.
16:15
16:15
Speaker 12
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Speaker 12
Thank you very much. Mr. Lowell and I rise very briefly to speak on this as well. And I should note that I am the vice chairman of the all party parliamentary group on Special Educational Needs and Disabilities, so I wanted to put that on the record as well. And the honourable member for Winchester, on behalf of the honourable member for Oxford West and Abingdon, I think, makes the case very strongly as a member of the Health and Social Care Select Committee, we took evidence, as he described, and the impact that, um, the lack of statutory obligation that is currently within the Ehcp CHP process.
On ECP process is, is, is a real fundamental problem. And we do need to ensure that the health elements of it are put on the same footing as the, um, as the social care elements of it. Um, rightly because as I'm sure is the same in every hon. Right. Honourable member's constituency inbox, the number of children who are receiving or require support with their special educational needs and disabilities, and the frustrating process that at both a local and at a national level, we as parliamentarians and policy makers need to get a grip on.
I think there is a lot to merit this new clause, and as my hon. Friend the member for Sleaford and North Hykeham said, it would be very interesting to hear the Minister's thoughts on this. Um, obviously this needs to be done in collaboration with the Department for education, and I think it's quite right. And I think the Select Committee acknowledged that it was right that other changes would be needed to support this as well, including changes to workforce increases in workforce changes. The way things were commissioned.
But I don't think, um, that should therefore prevent us from seriously considering this new clause. Um, I want to pay tribute to all the parents and carers in my constituency of Farnham and Bordon, who are really struggling with dealing with the a process and doing their best for their children under really difficult circumstances.
On ECP process is, is, is a real fundamental problem. And we do need to ensure that the health elements of it are put on the same footing as the, um, as the social care elements of it. Um, rightly because as I'm sure is the same in every hon. Right. Honourable member's constituency inbox, the number of children who are receiving or require support with their special educational needs and disabilities, and the frustrating process that at both a local and at a national level, we as parliamentarians and policy makers need to get a grip on.
I think there is a lot to merit this new clause, and as my hon. Friend the member for Sleaford and North Hykeham said, it would be very interesting to hear the Minister's thoughts on this. Um, obviously this needs to be done in collaboration with the Department for education, and I think it's quite right. And I think the Select Committee acknowledged that it was right that other changes would be needed to support this as well, including changes to workforce increases in workforce changes. The way things were commissioned.
But I don't think, um, that should therefore prevent us from seriously considering this new clause. Um, I want to pay tribute to all the parents and carers in my constituency of Farnham and Bordon, who are really struggling with dealing with the a process and doing their best for their children under really difficult circumstances.
16:17
Speaker 4
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Speaker 4
Thank you, Miss Llewellyn. Can I, um, add my comments to the member for. And to those families in Bristol South also are struggling um with care of one's child is obviously one of the most difficult and most important things you can do. And, and that child is in distress and not supported by the system. It's a very hard place for a parent to be. And as has been said by, I think, all honourable members, it's an issue that, um, you know, arises a lot in our inboxes, in our emails and in our constituency surgeries.
Um, and it's been a difficult thing to address, but can I commend my friend, the education Secretary and her team of ministers for the work that they, they have done in bringing this. I will, of course, bringing this work forward and starting to tackle the issue. And I will, of course.
Um, and it's been a difficult thing to address, but can I commend my friend, the education Secretary and her team of ministers for the work that they, they have done in bringing this. I will, of course, bringing this work forward and starting to tackle the issue. And I will, of course.
16:17
Speaker 11
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Speaker 11
I'm very grateful to the Minister for taking an intervention. So my wife's an educational psychologist, and I've lived this by in a sort of vicarious fashion for the last 30 years or more. And I understand how the system for special educational needs has evolved, and in particular, the role of the psychological services and how children are supported. And what actually happened is, as a result of a series of reforms, and in particular during the years of austerity, the services that were provided by the local authorities into the schools, particularly the school psychological service, became, um.
Much more of a service which consisted of psychologists providing reports, reports, which were then used to inform the distribution of resources and much less in the way of, uh. Educational and school psychologists actually in schools actually supporting the children. And what I would like to see is I'd like to see a change such that we got the educational psychologist and the educational psychology expertise back in the schools, in the classrooms, supporting the teachers. And this is what I've heard time and time again when I have been to visit schools.
They said, let's get the educational psychology support back in the schools. And I think this is something my wife would support.
Much more of a service which consisted of psychologists providing reports, reports, which were then used to inform the distribution of resources and much less in the way of, uh. Educational and school psychologists actually in schools actually supporting the children. And what I would like to see is I'd like to see a change such that we got the educational psychologist and the educational psychology expertise back in the schools, in the classrooms, supporting the teachers. And this is what I've heard time and time again when I have been to visit schools.
They said, let's get the educational psychology support back in the schools. And I think this is something my wife would support.
16:18
16:19
Speaker 4
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Speaker 4
Well, I thank my friend, the honourable member. For. Stowmarket for that. And can I put on record my. Thanks. Our thanks to his wife for her work in this area and for making him so aware of of the of the issues, because he's absolutely right. It is a long, a long, long gestation, I guess, issue that some of us have watched sadly, over recent years get worse in our constituency. For children that go and you only get one chance, don't you, as a parent and as a child to come through this system.
And that's why people feel it. Quite, absolutely so passionately. And that's why the government I will.
And that's why people feel it. Quite, absolutely so passionately. And that's why the government I will.
16:20
Speaker 9
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Speaker 9
Thank you for the minister giving away. And I just want to pay tribute to all the parents and school teachers who had engaged with me, uh, in during the last summer and following the white paper about consultation. It's been a huge problem in Kent. Um, the Kent has been in a can can county council under the conservative administration for the last 25 years. And the recent years, they were on special measures because of this and provisions and parents and really struggle like me get my inbox is filled with these issues.
And we know that 98% of the tribunals, these people go to these provision. We will, um, um, turn into the parents favour. Uh, so there's been a long wait. So would the minister, um, just confirm that this provision, whether we accept this amendment or not, this needs to be looked into how the NHS and the local authorities can work together to make it easier for children, families and schools to get a proper, proper provision in place.
And we know that 98% of the tribunals, these people go to these provision. We will, um, um, turn into the parents favour. Uh, so there's been a long wait. So would the minister, um, just confirm that this provision, whether we accept this amendment or not, this needs to be looked into how the NHS and the local authorities can work together to make it easier for children, families and schools to get a proper, proper provision in place.
16:20
Speaker 4
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Speaker 4
Well, I thank my friend for Ashford and for his description of that. What's happened in Kent under the conservative administration for so long?Um, and he's absolutely right. I think the White paper and the work that's been done by my hon. Friend the Secretary of State and the ministerial team has, and the hard work they've done across the country, regardless of the political administration, uh, locally, has been exemplary in making it transparent. And I will come on to talk about some of the tribunals in my comments on this particular group, because what the government's end reforms aim to do is transform those outcomes for children and young people with Send and their families, ensuring that the right support is available at the right time and preventing needs from escalating or reaching crisis in the first place.
And that's why the reforms aim to build a system that parents can trust with collective responsibility in local areas, and strong partnership working across education, health and care. That's what parents expect us to be doing. I will, of course.
And that's why the reforms aim to build a system that parents can trust with collective responsibility in local areas, and strong partnership working across education, health and care. That's what parents expect us to be doing. I will, of course.
16:21
16:21
Speaker 8
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Speaker 8
I thank the Minister for giving way. I recently held consultation meetings, um, on the proposed reforms in both Blaydon and Consett, and the message was clear from both from parents that they wanted to see greater integration of health into PS so. I welcome the government's commitment to asking Icbs to work more closely with local authorities to develop reform plans and to start to tackle this issue. Would she agree that that's a really important thing for Icbs to take on board?
16:22
Speaker 4
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Speaker 4
Well, again, I thank my friend the member for Blaydon and Concert for that work and her work in going directly to her constituents in Blaydon and set to hear from them directly. And she's right. It's a fairly consistent message. I know when myself and the Member of Parliament for Bristol East and for Bristol North West um met last year with our own ICB and our local. We played a pivotal role in bringing them together as local members of Parliament. And that's as a result of our experience with parents and constituents.
And again, it's an area in which members of Parliament across the piece, I think, from no party political point made are there and can bring parents together highlighting how this issue is and then using that parliamentary power to bring, um, organisations that sometimes don't listen and don't and sometimes don't know the best way to communicate. And I think our role in that has been really pivotal. And I think that's what my friend Secretary of State for education has taken forward, is that learning and that lessons across the country, and that's why we're taking the steps to deliver the programme, and why Icbs have been asked to work with local authorities to develop local reform plans, because the plans they're working together will lay the foundation for long term reform, enabling ongoing monitoring of progress and draw on the knowledge, skills and lived experience held locally.
Now, this work builds on work underway to improve accountability and set expectations of joint working, which is frankly what parents and families expected to happen but was not happening. So each ICB is expected to have an executive lead on send the NHS medium term planning framework for the next three years made clear that Icbs and providers must meet their statutory duties and support delivery of the reforms. Furthermore, Ofsted and the Care Quality Commission will continue to check how local services, including health, work together for children and young people and hold them accountable.
We will also update the send code of practice and publish new guidance. So local partnerships have clearer expectations to work to, and that is why we have not progressed. Changes to health and social care appeals to the Send tribunal, including that these decisions should be binding. This reflects the need for Icbs and NHS providers to retain the flexibility to plan services across their wider populations and prioritise support according to clinical and population need. This aligns with our commitment in the ten year health plan to create a new NHS operating model, where Icbs are the strategic commissioners of local health care services.
It's also worth noting that whilst tribunal decisions on health and care are non-binding, local authorities and icbs are expected to follow them and in most cases they do. If they do not follow recommendations, they must send a response, setting out the next the steps they have decided to take and why. Now?There's no doubt that health and social care have crucial roles. As I've said, to play in these reforms, with those shared ambitions across education, health and care for earlier intervention and support.
And I want to reassure the committee that we are exploring further opportunities to strengthen accountability. As stated in the consultation document, we are considering responses to the consultation, which closed on the 18th of May, and we will set out our steps in due course. It's for these reasons that I ask the honourable member to withdraw the amendments in this group.
And again, it's an area in which members of Parliament across the piece, I think, from no party political point made are there and can bring parents together highlighting how this issue is and then using that parliamentary power to bring, um, organisations that sometimes don't listen and don't and sometimes don't know the best way to communicate. And I think our role in that has been really pivotal. And I think that's what my friend Secretary of State for education has taken forward, is that learning and that lessons across the country, and that's why we're taking the steps to deliver the programme, and why Icbs have been asked to work with local authorities to develop local reform plans, because the plans they're working together will lay the foundation for long term reform, enabling ongoing monitoring of progress and draw on the knowledge, skills and lived experience held locally.
Now, this work builds on work underway to improve accountability and set expectations of joint working, which is frankly what parents and families expected to happen but was not happening. So each ICB is expected to have an executive lead on send the NHS medium term planning framework for the next three years made clear that Icbs and providers must meet their statutory duties and support delivery of the reforms. Furthermore, Ofsted and the Care Quality Commission will continue to check how local services, including health, work together for children and young people and hold them accountable.
We will also update the send code of practice and publish new guidance. So local partnerships have clearer expectations to work to, and that is why we have not progressed. Changes to health and social care appeals to the Send tribunal, including that these decisions should be binding. This reflects the need for Icbs and NHS providers to retain the flexibility to plan services across their wider populations and prioritise support according to clinical and population need. This aligns with our commitment in the ten year health plan to create a new NHS operating model, where Icbs are the strategic commissioners of local health care services.
It's also worth noting that whilst tribunal decisions on health and care are non-binding, local authorities and icbs are expected to follow them and in most cases they do. If they do not follow recommendations, they must send a response, setting out the next the steps they have decided to take and why. Now?There's no doubt that health and social care have crucial roles. As I've said, to play in these reforms, with those shared ambitions across education, health and care for earlier intervention and support.
And I want to reassure the committee that we are exploring further opportunities to strengthen accountability. As stated in the consultation document, we are considering responses to the consultation, which closed on the 18th of May, and we will set out our steps in due course. It's for these reasons that I ask the honourable member to withdraw the amendments in this group.
16:24
16:24
Speaker 5
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Speaker 5
I thank the Minister and for their comments. How might you possibly missing all day?Tailgate people. Um. I think. It's um. And given that the um. The. The waiting for the response to the report that we will withdraw this amendment. Um, but thank you for reassurances on the seriousness of this issue.
16:25