Health Bill

Thursday 16th July 2026

(began 2 months, 1 week ago)

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None Portrait Speaker 4
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The minister.
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ECG screenings.
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None Portrait Speaker 4
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Thank you, doctor Hook. And especially to serve under your chairmanship this morning. And the honourable gentleman the Winchester raises a really important discussion because cardiac issues are serious and too often people lose their lives as a result of unidentified cardiac conditions. And as we know, ECGs are used significantly across the whole of health care, from accident emergency to new community diagnostic centres and beyond. They are important for investigating palpitations or unexpected syncope, and evaluating pacemaker function. An extremely useful diagnostic tool.

However, and as my honourable friend the member for Stowmarket and Bury St Edmunds in Stowmarket raised, I think there is currently no clear evidence that Non-symptomatic population screening using standard ECGs would yield any useful health data or improve population outcomes. Clearly, the loss of life, and particularly I think, as the honourable gentleman mentioned, um. Cllr constituents case and I think we've all seen or sadly experienced the loss of particularly a young life is, is, is an awful tragedy for those concerned. But we do need to rely on the evidence.

And the UK National Screening Committee, who are an independent scientific advisory body, are advising all four nations are considering this issue. They launched a three month public consultation on the 8th of June, looking at evidence on screening for sudden cardiac death, and their draft recommendations against screening because an ECG, as well as other tests, are unreliable tools for reliably identifying significant cardiac issues in asymmetric individuals. We know these are useful tools in the diagnosis of symptomatic patients, and the UK's National Screening Committee is in the process of reviewing their use for asymmetric individuals, and it's for these reasons, I ask the honourable member to withdraw their amendment.
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None Portrait Speaker 2
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Thank you, Madam Chair. So this new clause would require the Secretary of State to conduct and publish a review into the number of yearly deaths in the UK, which are related to antimicrobial resistant infections, and I declare an interest in the Secretary of the Appg on on antimicrobial resistance, Amr. Um. This is a major threat to public health globally and domestically, and it's already contributing towards an estimated 35,200 deaths every year in the UK. Now, this is often Amr is a bit like a silent pandemic that gets very little media attention.

But when we think that by 2040, it's predicted that 39 million people have died of Amr worldwide, it's certainly something that will eventually be pushed right up. The political agenda. And one reason for that, it's not simply a matter of dying from infections that couldn't be treated. It means that nearly all the advances in modern medicine over the last 50, 60, 70 years are null and void because it would be too risky to have something like a hip replacement, because the risk of getting an infection that could kill you.

Um, wouldn't you may as well. You'd be better off dealing and living with a painful arthritic hip than taking a risk of dying of sepsis. Same with things like heart disease. Um, you know, giving birth once again would become one of the most dangerous things a woman can do. If we lose the impact and effectiveness effectiveness of antibiotics. So the government has invested more than £560 million in AML programmes between 2020 and 2024. So it's reasonable that Parliament should receive an annual assessment of Amr related deaths to ensure the significant public investment is delivering results.

It represents value for money and is being targeted where they can have the greatest impact. We cannot effectively tackle what we do not measure. An annual review of deaths linked to Amr would provide a clear, consistent picture of the scale of the problem and enable Parliament and the public to track where the policies are working. But better data leads to better targeted interventions, and we know that rapid diagnostic tests and different types of decontamination are going to be hugely important in tackling Amr, along with potential future technologies like phage technology.

Um surveillance has already identified significant variations by age deprivation and geography. Um Amr threatens the effectiveness of modern medicine, including surgery, cancer treatments, and routine health care, and an annual review of Amr related deaths would ensure this growing public health threat receive the attention and urgency it deserves. And the reason I'm determined to push this up the agenda is that the national Cancer Plan doesn't specifically mention Amr or infection, um, and that is the second biggest cause of death of cancer patients. So at the moment, it's something that really isn't pushed up the political agenda enough.
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None Portrait Speaker 1
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Chambers.
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Edward.
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Abstain.
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None Portrait Speaker 6
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This new clause would introduce a mandatory individual duty for members of NHS and Foundation Trust boards to escalate evidence of systemic medical malpractice to the CQC. The Department of Health and Social Care and SIB. It also imposes a collective duty on the board to formally refer the trust to regulators. If staff raise concerns regarding malpractice and the related clause. The new clause 37 requires the Secretary of State to create a standardised framework for them to formally refer suspected health system failings, including systemic issues, directly to the police, the CQC, the Department of Health and Social Care and HSB with the duty on coroners to participate.

It provides legal protection for those making such referrals and it is tabled in the light of the Ockenden review, which came out a couple of weeks ago into failings at Nottingham Health Trust and other reviews, including that into mid-staffordshire some time ago now, where it's been shown that hospital management have failed to spot and, more importantly, deal with systemic issues. Staff have been dismissed, failures have been hidden from regulators and and patients and their families haven't been listened to. Uh, we heard in the case of Nottingham that the board.

Commissioned a number of independent reports into the maternity services. And then when they didn't see the answer that they liked, they just commissioned another one. We feel very strongly that that should have been referred onwards as soon as those issues were known about, um the amendment would do as I say, would introduce this mandatory duty and create a standard standardised framework within which those concerns could be raised just on coroners. Often coroners and medical examiners spot trends or worrying failures in care that they think might hint at something systemic.

But their main power is a regulation 28 order. So that goes back to hospital boards who investigate and report back that everything is fine. We've dealt with this problem and there's nothing to see here. Coroners are often overworked, trying to get the huge court backlogs often don't have sufficient capacity to push back on this. Even when they question the the diligence of the internal review. So we want to give them more powers and standardise routes for them to escalate concerns to the police.

The CQC, DHS or where they see fit, because we need as many eyes on this as possible, because we've seen a defensive and cover up culture too many times. Um, we've tabled a similar amendment to the Health Hillsborough bill to. To achieve the same outcome. We understand that the NHS is under strain and overworked. We all know that. But trust management need to be more transparent, more open and more receptive to staff concerns. And while I don't intend to push this to a vote Doctor Hook, I would be interested to hear the Minister's response as to as to what the government is planning to do to ensure that concerns are acted on more quickly.
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None Portrait Speaker 4
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Thank you, Doctor Hook. And I thank the honourable member for North Shropshire. She she raises issues around patient safety diligently on behalf of her constituents and the wider system, and I will take the time to answer some of those points as to where the government is, because, of course, um, the government obviously supports the member in prioritising patient safety, which along with service quality and experience, is of the utmost importance. Um, and I'll discuss the clauses in turn. So firstly with new clause 36.

So trusts are already subject to regulatory and contractual requirements to report medical malpractice. And that's why we don't think the amendment is necessary. So for example, CQC regulations for safe care and treatment and good governance are central to trust. Accountability for system systemic malpractice. They require trusts to have effective systems to identify patterns of harm, manage risks and deliver system wide improvements. Trusts are required to identify and report incidents leading to significant harm through to learn from patient safety events service ensuring CQC is informed and enabling NHS England to identify trends and support learning and improvement.

This information can be shared with and accessed by HCP and in the future could be shared with and accessed by the investigations arm of the CQC. The CQC regulation for Duty of candour reinforces transparency through truthful accounts of what happened when something goes wrong, including where harm reflects systemic issues under the Patient Safety Incident Response Framework, trusts must undertake patient safety learning investigations into certain incidents to support learning and improvement. In parallel, the NHS provider licence requires NHS trust boards to maintain clear accountability for quality of care and reporting of safety information through effective governance systems, where failures of governance occur.

NHS England has the powers to intervene and these powers will transfer to the Secretary of State as part of this bill. It is clear, then that this amendment does duplicate current processes together. The mechanisms already help trusts identify and address systemic issues locally while enabling national aggregation to support system wide learning. If I move to new clause 37, um, this seeks to require the creation of a standardised framework for coroners and medical examiners to report health system failings, and I'm going to use the opportunity to reassure the honourable member that regulations already require medical examiners to report any serious concerns identified in respect of clinical governance, patient safety or public health surveillance in accordance with local reporting arrangements, existing regulations also require current coroners in the context of an investigation to issue a report to a person or organisation, local authority or government department or agency where the coroner believes they may have power to take relevant action to prevent future deaths.

So in September 2024, the Department of Health and Social Care introduced death certification reforms, putting in place regulations to provide greater safeguards for the public by ensuring independent scrutiny by medical examiners of all deaths not investigated by a coroner. These reforms, as set out in the Medical Certificate of Cause of Death Regulations 24, which require an independent review to be carried out for all deaths in England. Introducing a system whereby all deaths are subject to either medical examiner's independent scrutiny or coroner's investigation. Should the medical examiner detect concerns about care, they will refer such cases to establish clinical governance, review processes and bodies and notify the coroner or, if necessary, the police, the Notification of Deaths Regulations 2019 require all doctors, including medical examiners, to refer a death to a coroner if they believe deficiency of care whilst undergoing treatment have contributed to the death, making the death unnatural.

Under the Coroners and Justice Act 2009, a coroner has the statutory duty to report on issues to the appropriate bodies, where they believe that action could be taken to mitigate or prevent the risk of future deaths. And both the report and responses to it are published by the Chief Coroner. It is important when incidents and errors occur, resulting in death or serious injury. We learn any lessons and the government is committed to ensuring that the prevention of future deaths reports are taken seriously and lead to meaningful action.

The department is working across government and with the Chief Coroner to identify ways to strengthen oversight and to ensure the right organisations are consistently notified of concerns, respond to them in a timely manner and drive appropriate action. Under the Medical Act 1983, the General Medical Council ensures that all doctors, including a medical examiner's report, suspected health failings, health system failings by making speaking up and mandatory professional obligation linked to a doctor's licence to practise embedding this whistleblowing requirement to its core regulatory and fitness to practice frameworks. And the GMC also enforces a professional duty of candour, requiring all doctors to be open and honest with patients and official bodies when things go wrong and actively report adverse incidents, so systematic lessons can be learned.

In summary, both these amendments duplicate requirements that are already existing regulations, systems and processes that are already in place to report suspected health system failings to the appropriate bodies. And it's for this reason I ask the honourable member to withdraw the amendment.
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None Portrait Speaker 1
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Helen Morgan.
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Is everyone content that the new clause to be withdrawn, new clause by leave withdrawn?We now come to clause 37, which was debated with new clause 36 in Group 64. Does Helen Morgan wish to move the new clause formally?No. Okay. Moving on. We now come to Group 66 in new clause 38. I call Doctor Caroline Johnson to move new clause 38. Thank you chair. I wish to speak to new clause 38, which I have tabled.

And it's a very straightforward clause. The Secretary of State will be required to ensure that a single sex changing rooms, toilets and washing facilities for NHS staff, awards for NHS patients and toilet and washing facilities for NHS patients that are single sex should be quite straightforward. The UK Supreme Court unanimously, unanimously ruled that a woman is defined by biological sex in 2025, when the minister herself said we are completely committed to single sex spaces. But it appeared that the Minister for Women and Equalities did not get that memo.

And despite being apparently started on her desk since September, the new draft code from the Equality and Human Rights Commission was not laid for Parliament until the 21st of May and then one week before this guidance was published, a female NHS England employee in Leeds when her claims of indirect sex discrimination and harassment over a policy to allow transgender colleagues to use toilets and changing rooms that correspond to their gender identity rather than biological sex. And after it was laid on the 28th of June, it was reported that West London NHS trust has told patients that they can use single sex facilities based on gender instead.

I know it's taken the current secretary of state some time, but I do understand that he's changed his mind on the issue and come to the same conclusion as others that a woman is, in fact a woman, and that toilets and changing facilities must be protected. So will the minister follow the Health Secretary's lead and protect single sex spaces in NHS trusts?To sum up, chair, the Supreme Court has ruled that a woman is defined by a biological sex. My party knows that the minister claims her party knows that too.

Now it's time for her to show it and pull the levers that only she can to ensure that patients and staff are protected right across our health service. Anyone?
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None Portrait Speaker 4
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Um, she is right that following the Supreme Court rule in April 2025, the For Women Scotland case and the recent laying on the 21st of May of the Equality and Human Rights updated Code of practice, public functions and associations ensuring the provision of single sex facilities for patients and staff is a prominent issue. And obviously the government welcomed the clarity provided by the Supreme Court judgment. The Ehrc Code of Practice sets out how service providers may lawfully apply sex based distinctions following the Supreme Court judgment, and this guidance is applicable for services, public functions and associations, and includes, but is not limited to the services provided in the NHS.

Following this, NHS England has drafted the revised guidance privacy, dignity and safety and hospital accommodation which will align with the legal position and the code of practice and replace existing guidance. I know many colleagues are impatient to see the existing guidance replaced on the Supreme Court ruling. It was important to wait for the HRC Code of Practice to be published, so this can be considered in any guidance, and that code of practice was published on the 21st of May. Following the publication, NHS England has reviewed the guidance to ensure it's in line with the code.

The code was subject to a 40 day laying period before Parliament, which ended on the 9th of July. The government expects the code to come into force in early August, and the guidance for the NHS will be published shortly afterwards. NHS England is also developing guidance on staff facilities including changing rooms, toilets and washing facilities that should be used by trusts and icbs. The provision of physical single sex facilities for NHS staff is for NHS organisations to individually manage, in line with their legal obligations.

There's already legislation covering this issue, particularly the workplace Health and Safety and Welfare regulations from 1992. Organisations should already be conducting assessment of their own estate and the needs of their workforce to decide what changes they need to make to comply with all legislative requirements. With regard to a mixed sex accommodation and breaches to breaches to patients. This is a long standing policy of same sex accommodation accommodation individuals should not have to share sleeping accommodation with patients of the opposite sex unless appropriate. In practice, the proposed amendment does not allow scope for mixed sex accommodation where clinically appropriate.

For example, an intensive care unit, facilities or where it is necessary for patient safety. And it's for these reasons that I ask the honourable member to withdraw the amendment.
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None Portrait Speaker 4
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No.
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Lock the doors.
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No.
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None Portrait Speaker 1
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The eyes were for the nose were nine. So the nose habit. The nose habit unlocked. We now come to group 67. A new clause 40. I call Doctor Caroline Johnson to move. New clause 40. Thank you. A new clause 40 requires the Secretary of State to publish a report detailing the business case for the use of public private partnerships for neighborhood health centres. And this goes back to the use of PFI.

In the past, um particularly during the last Labour government, when ministers were attracted by the prospect of off balance sheet financing. But while the idea looked good on paper, it proved a disaster in practice before the 2008 financial crisis. Private Finance Initiative interest rates were 2.5% to 4.4% higher than public sector borrowing rates. But after the crisis, PFI projects increased their rates by 20 to 30%. I won't rehash the story in the interest of time that I told earlier in the committee about the problems with simple things like putting a whiteboard up, but it did create operational problems to now, quite rightly, the previous government called time on PFI announcing the 2018 budget.

It wouldn't be used for future projects, which is why this government's plans are so peculiar. Labour ministers have taken a trip to the graveyard of bad ideas, resurrected PFI and adorned with new clothes. It's now p p p. The government have tried to reassure the public this is not a rehash of PFI, but the facts suggest otherwise. The funding of neighborhood health centres is to be 80% through p p, the minister told the BBC. We'll be working with the private sector, particularly around construction and maintenance and many of these new centres.

So how is P different from PFI?Mr. has previously told this House that the new scheme will draw on lessons learned in the past, so could you please say what those lessons are and if there have been learned, why did 53 academics write a letter urging the government to abandon its proposal?If lessons have been learned, why did dozens of Labour MPs signed an early day motion expressing grave concerns?And if lessons had been learned, why have the Treasury Select Committee, the Public Accounts Committee, the National Audit Office, the PDR and the IEA all cast doubt over the value of money for such schemes?Madam chair, no matter how ministers dress things up, I am concerned when the government needs to publish a business case for these proposals to show how it will, how it will work in practice and demonstrate they have learned lessons in the past and if they have, their members have no good reason to object to this amendment.

It only asks ministers to show their workings out in full view of the House, openly and transparently.
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None Portrait Speaker 4
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Well, Doctor Hook, what was the disaster?Was the Tories management of the capitalist state pre 1997 and post 2010. If the honourable lady wants to talk about disasters on capital planning. Now I can talk about this for a very long time. But in the interest I know the committee is keen to move forward. Today I address some of these issues. A previous amendment, but I'm very proud of, for example, Southmead Hospital in Bristol, one of the finest examples of a hospital in the country built under a PFI scheme, uh, which I've received treatment a couple of years ago in facilities that are good for the staff to work for and patients to be treated in, replacing a falling down, shocking hospital.

Despite the best efforts of staff across the country, we can see that clear. It is clear that under the Tories management and some of those early PFI schemes under the last Labour government, they were poorly negotiated. They had issues around management, for example, with inflation. Those are some of the lessons we've learned, some of the contracts the honourable lady talked about, I think it was her whiteboard that wasn't working. We know what those lessons are, and that's exactly what good government does.

That's what government does. When they take charge, they change it. In the 14 years they were in power, at any point, they could have started negotiating differently on some of these contracts. But they chose not to. They chose to let the estate atrophy and fall down. That is bad for patients, bad for the public. And that's why I was very proud last week to launch the government's capital plan building, building for the future. Looking forward, giving nine years of certainty for estates across all our constituencies.

With I will defer.
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Peter Brinsley.
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Well, I.
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Well, I.
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None Portrait Speaker 4
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Thank my hon. Friend for Bury St Edmunds and Stowmarket and, of course, across the east of England, where we now have so many Labour MPs, have been first out of the traps. I mean, others have been also, should I say, everyone's first out of the traps to try and rectify the mismanagement that local people have seen, particularly around the capital estate. But I will not detain on one of my favourite subjects, capital estate for very long. So the honourable member is aware that the decision was announced to use a.

On neighborhood health centres was announced in the autumn. The decision making process was supported by Business Case to examine the feasibility of developing a new model. Learning the lessons of the past of public private partnerships specifically to build neighbourhood health centres as part of our ten year plan. This informed the decision to proceed. The business case was a strategic outline case, the purpose of which was to scope and identify the preferred way forward for a new potential model, in line with HMM Treasury's five case model.

We're now working with the National Infrastructure and Service Transformation Authority to develop this further, and we expect a further round of market engagement in the autumn. I recognise that the interest in making this business case available to both houses. However, this must be balanced with the need to develop an effective policy publication while policy development is ongoing, would limit full, candid and proper deliberation, civil servants and subject experts need to be able to engage in frank discussion of policy options to expose their merits, demerits and possible implications, and their candour in doing so will be affected by their assessment of whether the context of such discussions will be disclosed.

Um, Doctor Huck, we are committed to building these neighbourhood health centres across the country. That's what patients and the public deserve. We will obviously be mindful of public money. We will obviously be part of the usual process of this House with regard to public Accounts Committee. We will learn those lessons. We are in full discussion with Mr.. And for those reasons, we are committed to developing good estate across our country. That's what our constituents deserve.

And I ask the honourable member to withdraw the amendment.
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Shadow Minister.
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Division.
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On that one.
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No.
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Dave. Robertson.
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No.
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None Portrait Speaker 4
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Thank you Doctor Huck. Again, I'm grateful, the honourable member for bringing this discussion before the committee. This amendment would require the Secretary of State to make regulations about how the NHS uses private provision to support access to treatment and reduce the list. Now, I understand the point she's making, but I'm sure that this is an unnecessary amendment. Icbs already can and do use private health care providers to offer patients treatment in their area, and to boost capacity to reduce those lists.

Our approach here is pragmatic. It's not ideological. In the ten year health plan, the government committed to continuing to use the private sector capacity where it is available. This is not because we favour the private sector, but because we are committed to using capacity wherever it is available, because our priority is treating patients in a timely manner, not not favouring one form provider over another. And under existing legislation, patients must be offered a choice of provider for their first outpatient appointment, where the duty is to choice applies if a person's needs are not met by local services or waiting times are high, they can use this choice to see an appropriately qualified provider.

However, the. We must also resist the temptation to apply a one size fits all approach here. Icbs are responsible for financial sustainability, planning and strategic commissioning of services for their local population, so they are best placed to decide how private services should be used to meet their populations needs. For example, high waiting times which obviously we were inherited from the party opposite for a particular specialty, may result not from a lack of capacity, but maybe from an increased demand, from referrals by GPS. The ICB must have the flexibility to improve how advice and guidance referral support is.

For example, working for GPS rather than being required to wastefully spend NHS funds on increasing capacity with the private sector. In addition.
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So John Joseph.
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Services Minister.
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Division.
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No. No.
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Yes, please.
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Okay.
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No no.
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No.
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Dave. Robertson.
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No.
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Joe. Robertson.
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I.
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Karen. Smith.
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No.
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Gregory. Stafford.
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I.
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Liz. Twist.
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No.
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Joe. White.
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No.
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Laura. Kirk-smith.
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No.
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No.
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Dave. Robertson. Joe.
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Robertson I.
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Stafford.
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Liz. Twist.
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No.
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Joe White.
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No. No no.
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Joe.
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I.
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Karen. Smith.
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No.
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Gregory.
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Stafford I.
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Liz. Twist.
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No.
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Joe.
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None Portrait Speaker 1
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Thank you. Um, chair new clause 46 requires the Secretary of State to publish a number of staff in the Department of Health and Social Care and the number of people made redundant following the abolition of NHS England. New clause 75 requires the state to prepare a place for Parliament, a formal transition strategy. Amendment 37 in my name prevents the abolition of NHS England before the production of an operating model. Amendment 38 requires the Secretary State to publish and submit to independent scrutiny an impact assessment on the abolition of NHS England containing quantified cost and benefit figures, before making regulations to abolish it, and amendment 39 requires the Secretary of State to publish and lay before Parliament a plan setting out how health services will work alongside the social care system and following the abolition of NHS England, before using their powers in the Bill for abolition.

The plan must address a joint commissioning. Funding flows, delayed hospital discharges and workforce. The. The problem is essentially that ministers marched off into a battle without a plan and continue to fight without one, and we've heard consistently through this, um, committee chair, as you will have heard, the number of times that things have not been thoroughly planned out and properly considered, particularly in relation to social care. I know members on all sides of the House have been concerned about how social care interacts with the um.

The health service under the new um proposed regime in March, 25 ministers and officials were going to work to determine what's needed. In March 26th, they were still progressing to develop the design in 12 months later, there was a change in tense, but there's still no proper plan when putting a bill before the House, the government published an impact assessment. But where there should be numbers, quantifying how much this is all going to cost us, this simply n forward slash a. How is this any way to conduct the organisation?And that's why I've tabled amendments.

37, 38 and 39. They apply the brakes until the operating model is established. So they've planned they require the full publication of a proper impact assessment and a detailed plan of how the health services work, alongside social care and the publication of redundancy figures. So they've worked out what they're going to do before they get on and start doing it.
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Redundancies.
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None Portrait Speaker 4
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Thank you, Doctor Hook. Um the government recognises the importance of clarity and assurance as we undertake this significant transformation, including how functions, governance and the workforce will operate in the future. And this is essentially for our staff, but also for other stakeholders to understand the new role of the department. So a new clause 46. Um we of course recognise transparency around departmental workforce numbers and the impact of abolishing NHS England. The government remains committed to significantly reducing headcount across NHS England and the Department of Health and Social Care.

But I do want to put on record my thanks to all the staff and the talented professionals that are working in both organisations. This is a difficult time for them, but this amendment is not necessary. Workforce information is already published both monthly and through the department's annual reports and accounts, alongside wider government transparency publications and placing a further reporting requirement in legislation would risk duplicating existing transparency data. And as a result, we think it's unnecessary to include, on the face of the bill with regard to amendment 37, I would like to reassure the committee that we will, of course, consult on the proposed structure for the new Department of Health and Social Care, and this is also required under existing employment law.

The structure will clearly explain what every part of the new Department of Social Care will do, and set out every post. We think we need. The target operating model is an internal document that sets out the proposed purpose, role, governance and organisational structure of the future Department. It will be shared internally following engagement with staff and stakeholders, including, of course, trade unions and the chair of NHS England. Doctor Penny Dash has committed to sharing with the Health and Social Care Committee.

Once it is finalise, the target operating model will be used to guide detailed organisational design and will iterate over time. The proposed design of the new organisation will be subject to consultation. The target operating model does not, of course, implement changes which remain subject to parliamentary approval through this Bill. In terms of workforce transition, we will follow two light, whether Tupy or any other transfer mechanisms apply in line with the Cabinet Office Statement of Practice of Public practice on staff transfers in the public sector.

This means that recognised trade unions will be formally consulted and engaged on measures related to the transfer. No changes to contractual terms and conditions will be made without proper consultation and engagement. We, of course, are committed to maintaining an ongoing dialogue with trade unions and staff throughout this period of change, and are updating them as often as possible and where appropriate. We are also committed to working with staff networks on the changes, in particular how we can best support staff. Given these commitments.

I hope the honourable member agrees that placing further requirements on the face of the bill would be disproportionate on amendment 38. We agree that it's important to be transparent about costs and benefits to this programme. The Department has been open about the initial estimate of around £1 billion of savings per year, and we publish an impact assessment alongside the Bill. The detailed timing and scale of costs and savings from the programme depends on factors such as the take up of voluntary exit and redundancy schemes which are underway.

We will continue to refine our assessment of costs and savings as the programme progresses and as we move towards the abolition of NHS England. We continue to be open about those figures. Those savings will support continued investment in frontline services and furthermore, the timescale set out in the amendment risks delaying the abolition of NHS England and as a result, would delay the transfer of savings to frontline services and indeed, the stability and certainty that we need for our staff on amendment 39. The government is committed to support integration between health and social care so that people experience more joined up, person centred care and key planning frameworks, including for the better care funding for neighbourhood health already stressed the critical importance of strong join up and integration, and we expect these frameworks to continue to guide the health and care system following abolition of NHS England.

Most importantly of all, we're committed to developing neighbourhood health approaches as an essential part of our approach to reforming the health and care system, and this approach will deliver more integrated services across health, local government and wider partners, including the voluntary and community sector. Um, the health Bill simplifies existing complex legal frameworks to make it easier and emphasize the role of the Health and Wellbeing Board as a focal point for collaboration. However, partnership and collaboration takes many forms depending on local circumstances and cannot simply be prescribed through a centrally developed plan.

Instead, we should be encouraging areas to develop effective, productive relationships in the interests of the people they serve, and we've discussed this in committee, doctor, and I think honourable members of Parliament, of all parties have a key role to play here. Turning to, I think, this new clause 75, we've taken that at this point. Um, we absolutely recognise the need to ensure that critical functions, expertise and organisational capability are identified, retained and effectively transferred during this period of change. This is essential to maintaining continuity of services and supporting the delivery of key health programmes, including vital services such as cancer care.

And I want to reassure the committee that this work is already well underway. We are carefully mapping all areas of current activity across NHS England, assessing what capabilities we need to deliver these in future, and putting in place processes to support the retention and transfer of expertise. This includes the phased approach we are taking to workforce changes, alongside a robust and consistently applied process for voluntary redundancies and voluntary exits to minimise disruption and protect critical skills. We are also committed to ongoing monitoring and oversight through the transition and as part of our programme governance, there is ongoing consideration of skill retention, knowledge transfer and organisational capability and taking actions where gaps are identified as drafted.

The amendment would introduce a new statutory requirement to produce and lay before Parliament. A formal transition strategy before NHS was abolished and transfer schemes could be implemented, alongside new ongoing reporting obligations. So, while well intentioned, this would add another step into what is already a complex and carefully sequenced programme and is unnecessary. It would reduce the flexibility needed to adapt workforce organisational decisions as the transformation progresses. For these reasons, the government believes the of the amendment has already been delivered through existing programme arrangements, without the need to place further requirements on the bill.
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Shadow Minister.
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Later on 37. Yes. Thank you. Chair. I wish to speak to clause 47, which I've tabled, to require the Secretary of State to publish a plan for securing the provision of universal fracture liaison services across England as we get older. Madam chair, our bone density naturally decreases, increasing the risk of bone fractures and possibly osteoporosis, which affects 3.5 million people across the UK. Services identify people 50 or over who have broken a bone to provide treatment to reduce the risk of further debilitating fractures.

1 in 2 women and 1 in 5 men over 50 will break a bone because of osteoporosis. And heartbreakingly, chair 2000 people each year are dying from preventable fractures. So when the Secretary of State claimed the Delivering Universal Fracture Liaison services, it would be one of his former secretary state, I should say, claimed that delivering universal fracture liaison services would be one of his first priorities if elected to government. Many people hope to see this happen, but it hasn't. The previous conservative government began rolling out fracture liaison services, and it's an indicator of just how little progress the government has made that 97% of today's fracture liaison services were actually delivered by the conservatives.

What have the Labour government been doing?What's more, 1 in 2 NHS trusts on Zoe told me they have no fracture liaison service at all. Quite literally an accident waiting to happen. I'm very grateful for the campaigning by the Royal Osteoporosis Society on this issue. By their calculations, at the current rate of delivery, it will take 38 years for the government to deliver universal fracture liaison services, which is obviously far too slow. And that's why we've tabled this amendment.

They need a plan. The former puppeteer of this government, Morgan McSweeney, made it clear that Labour didn't have a plan for government. This amendment requires the Secretary of State to deliver a plan within 90 days, not just to secure the provision of a universal fracture liaison services, but also to deliver on his predecessor's very clear and very deliberate promise to do so. The minister in the other place was asked if an implementation plan for fracture liaison services was needed. The answer was effectively no.

What is this minister's view?There are so many critical questions which have no answers in this area, which are plan, would and should address. What are the Minister's annual milestones for achieving universal access to fracture liaison services by 2030?How will the Minister's plans to cut ICB budgets by 50% impact this key promise?In an important and crucial question in terms of the promise itself as well. Do the minister's plans to merge Icbs mean fewer services will now be delivered?How will that impact patients?What extra workforce, diagnostic and NHS estates capacity is required to deliver this?Yet again?As with much in this government chair, we're left with a headline grabbing promise with no plan behind it and the consequence?More than 4000 people are projected to die from hip fractures that could have been prevented through timely national implementation intervention.

Of course.
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Shadow Minister?
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Thank you very much. Doctor Harkin, it's a pleasure to serve under your chairmanship this morning. And I also want to welcome the minister back from her son's graduation. I hope it went well. Um, I'd like to state my support for new clause 47, which would require the Secretary of State to publish a clear rollout plan for a fracture liaison services across England, and to report annually to Parliament on progress towards the universal coverage by 2030. Obviously, this is not about creating some kind of new target.

The target already exists. Both this government and the and the previous government committed to achieving 100% fracture Liaison Service coverage by 2030. The question before us has posed by the shadow Minister is simpler how will that promise be delivered?And how will Parliament know whether meaningful progress is being made?Fracture liaison services are one of the most evidence based interventions in osteoporosis care. They systematically identify people aged over 50 who suffer a fragility fracture, assess their bone health, initiate treatment where appropriate, and monitor patients to reduce the risk of subsequent fractures.

Fractures given that around half of patients who sustain a hip fracture have previously broken another bone, these services represent a vital opportunity to intervene before a life changing injury occurs, and the human cost is considerable. Osteoporosis affects millions of people, particularly older women, and fragility fractures can result in a loss of independence, reduced mobility, social isolation and significant pressure on health and social care services. The National Institute for Health and Care Excellence estimates that around 180,000 fractures each year in England and Wales are attributable to osteoporosis.

There's also a compelling economic case the Royal Osteoporosis Society estimates that investing around 30 million in fracture liaison services could prevent approximately 74,000 fractures over five years, including more than 31,000 hip fractures. Saving the NHS around £665 million and freeing up some 750 000 bed days. Few preventative interventions offer that combination of better patient outcomes and substantial savings for the NHS. Now, the government frequently point to their commitment to universal coverage by 2020, by 2030. But as the shadow Minister has pointed out, progress in this government has been achingly slow.

When the Secretary of State appeared before the Health and Social Care Select Committee last week, I think it was I questioned him on this issue directly and whilst he confirmed that the Department remains committed to meeting that 2030 target first established by the conservative government, no plan or no indication of when a plan was given would come, was given, and commitment alone is not a delivery plan, and there are growing concerns that the government have overstated the progress that has already been made. The Royal Osteoporosis Society has confirmed that over 97% of the fracture liaison services counted by the current government were already in place before the change of government.

So rather than representing any significant expansion in national coverage, this government has gone slow. I think, therefore, it is very reasonable to answer the the question from the honourable member for Bury St Edmunds and Stowmarket that Parliament is entitled to ask the additional. What additional progress has actually been made since the commitment was reaffirmed and the new clause would also require the Secretary of State to publish an assessment of access in every integrated Care board area. This clause, I think, would also require annual milestones because at present there is no publicly available timetable showing where the services will be established and which areas will be prioritised, or progress between now and 2030.

Crucially, the clause also requires the government to set out how integrated care boards will actually be supported. Ministers rightly point out that fracture liaison services are commissioned locally by integrated care boards, but if the responsibility for delivery rests locally, while the responsibility for national targets rests with central government, there clearly needs to be a clearly thought through national framework explaining how those boards will be supported through funding, guidance, workforce planning and accountability. It is therefore, I think, a straightforward request for transparency, for accountability and most importantly for delivery.

If ministers are committed to achieving this by 2030, they should have absolutely no objection to publishing that plan that shows how they intend to get there. And for these reasons, I support the new clause in my hon. Friend's name.
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Mr..
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Thank you. Doctor.
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Um.
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So I think can I can I impart agree with the opposition to start off with um because um. Right. That this is a really important issue. Osteoporosis, particularly for older women. And to the honourable gentleman for Farnham and Bordon outline some of the economic case. But crucially, it's a it's a it's a health very strong health issue. I myself have worked in campaigned on this issue in opposition, because it's predominantly something that affects, um much older women, typically older women.

And it is, you know, a large amount of prevention fits very much into our ten year health plan with regard to prevention. And indeed, that's why we have also increased access to resample to Dexa scanners, but it is rather disappointing, though, to have a subject that is obviously so much in agreement to be used as a political, um, you know, back and forth here today. So let me just be very clear, and I think in some of the comments that were made, be very clear why some of this has got a bit confused, I think, for people who genuinely care about this, rather than those who just want to make it a political issue, which again, is entirely that is the opposition's job to oppose the government.

I don't have any problem with that, but there's a really serious issue. Should I just I just it's a very serious issue here about how this is monitored. So, for example, we are absolutely committed to having coverage across the country by 2030, as the Secretary of State has recently said, um, that is why we are rolling out more Dexa scanners and so on. Um, but also now with the movement of Icbs, actually, when you have icbs across the cluster, 92% of the country is covered.

And that's why I think it's important. I, that's why I think it's important that we look at actually what is happening on the ground and how we are moving forward. We are committed to supporting this cohort, particularly of patients, is largely preventable and care close to home based around our ten year plan is absolutely the right way about going about it. Well, I was going to outline the points, but I'm happy to give way if she wants.
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None Portrait Speaker 4
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Well I mean again she's intervened. But that is exactly my point. I think there is a danger here of the opposition party. Um, sort of, you know, hitting a target of a number and totally missing the point, which is to have good locally available services accessible predominantly to this female population, predominantly to older people through, through through our ten year health plan. Because if one counts on, on that target in the nu new cluster, in 92% of areas are covered. And we want to get to the heart of this issue.

Um, and that is why, you know, integrated care boards are the commissioners of local health services. They remain best placed to make decisions according to local need and commissioning these services at a local rather than a national level, which is the entire thrust of our ten year health plan. And indeed, this bill means that Icbs are best placed to commission a holistic, integrated care that wraps around the patients need where the patient is. And we've been very clear in our ten year health plan and indeed, in this bill that we are not expecting patients to fit in with models of care that have been devised over a period of time in places and located largely in hospitals that are far from their homes.

We are looking at a close to home service, building models of care around people's needs, and a legislative requirement for a national implementation plan would cut across that responsibility, undermining local ability to tailor services to patient needs and confusing for delivery. And that's why we don't think this amendment is necessary. The renewed women's health strategy sets an expectation that icbs prioritise community based models when commissioning new fracture prevention services, and the department will continue to work closely with NHS England Icbs to explore a range of options to provide better quality and access to these important preventative services.

And it's for this reason that I ask the honourable member to withdraw the amendment.
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I.
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No.
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I.
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Thank you chair. New clause 48 would require the Secretary of State to publish, maintain a national framework for improving access to radiotherapy services in England. Chair one for people can expect to need radiotherapy in their lives. That's a lot of people who will need consultation, assessment, pre-treatment planning and treatment delivery. Data published a few years ago showed that Scotland, Wales and Northern Ireland have more linear accelerator machines per million people than in England. Can the Minister confirm whether this is still the case?Last year, radiotherapy UK had research indicating that more than 60,000 cancer patients are not getting radiotherapy they need.

And I know there are particular areas of the country which are struggling. Can the minister provide a roll out on the new Linac machines at 28 hospitals that she spoke about in May 2025?We were also told that by March 2027, up to 27.5 a thousand additional treatments will be delivered. Can the minister again share some information on how that will be, how that's going to be achieved?We've the Labour government has now been in power for two years. It's raised taxes now and more than £60 billion, and it doesn't really have very much to show for it.

Um there are obviously concerns that they're going to raise them further now. They haven't produced the workforce plan. They said imminent. Can the minister confirm will it be will it be published today before we break for recess or is intention to publish it during recess, or will we have to wait until the autumn?There's a 31% shortfall in clinical radiologists. New clause 48 essentially requires publication of maintenance of a national framework for improving access to radiotherapy services. This government essentially has shown that if if a requirement isn't in legislation, plans just get delayed, they get diminished.

They even get disowned. But patients can't afford to wait any longer. Thank you chair.
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Helen Morgan.
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Thank you very much. Doctor hook I would like to speak about new clause 53. A new clause 54 tabled in the name of my hon. Friend the member for Epsom and Ewell. A new clause 65, tabled by my friend the member for Westmorland and Lonsdale, who is indeed also honourable. Um new clause 53 would require would give patients a right to start cancer treatment within 62 days of referral and requires the Secretary of State to establish a scheme to deliver this.

It also requires the Secretary of State to update the House on progress against the target on or around the time of World Cancer Day. Nucleus 54 would require the Secretary of State to introduce regulations requiring the government to coordinate research into cancers with the lowest survival rates. Um, I will be very brief on these topics, Doctor Hook, because we have discussed them at length in a number of Westminster Hall debates. But nucleus 53 returned to this point about the inconsistency in the NHS constitution between rights to treatment and pledges for waiting times and some of those areas, I think, require consistent treatment.

So we have a right to elective care within 18 weeks, but we only have pledges on other types of waiting times. And it seems very odd to me because probably you won't come to too much harm waiting for a knee replacement for longer than 18 weeks, but you really will come to a lot of harm if you don't start your cancer treatment within 62 days. And while I appreciate that the government might prefer a different legal mechanism of achieving this, I would be interested to hear if the if the Secretary of State would be willing to consider it, because research shows that every four week delay reduces patients survival by an average of 10%.

And it seems to me something that we should be aiming to achieve consistency on. We know that across the country there has been a real problem with with hitting this target over the last year or so. Um, particularly in 2025 when, uh, a freedom of information request by the Liberal Democrats found that one patient waited 673 days for treatment, and nearly 92% of trusts responded. He responded, recorded patients waiting over six months for cancer treatment had some shocking and heartbreaking instances. In my own constituency of North Shropshire, although I am pleased to report that she's been in Telford, Hospital Trust is one of the most improved trusts in this regard, proving that it can be done with the right focus.

And that's why I would like the Secretary of State to consider those, uh, those issues, um, rare cancers are less survivable. Survivable cancers. Uh, my friends, the honourable member for Wokingham and the honourable member for Witney have campaigned extensively on this issue. There's been a number of Westminster Hall debates on it, and I won't repeat the pleas that they have made there. Um, but, uh, I hope the government has a, uh, a way of considering how we might orchestrate further investigation into them.

Um, nuclear 65 tabled by my honourable friend for Westmorland and Lonsdale, requires the Secretary of State to publish a national framework for improving access to radiotherapy. Um radiotherapy is needed by half of all cancer patients and is incredibly cost effective. England has fewer radiotherapy machines than comparable European countries, and thousands of people are having to travel over 45 minutes for their treatment. In the Darzi review, it was noted that radiotherapy services are on their knees. They have some of the longest waiting times for treatment, as well as vast parts of the country which are classed as radiotherapy deserts due to the lack of accessibility.

Radiotherapy currently has the worst 62 day performance of all the main cancer treatments, and if we're serious about ensuring that all cancer targets are met by 2029, as the government maintained, then we need the infrastructure, people and equipment to deliver cancer. Cases are expected to rise by 30% by 2040, meaning radiotherapy centres must be able to keep pace and importantly, they can be used at an earlier stage in treatment. The saving lives, saving money and meeting important waiting time targets. We ought to be leading the way and keeping pace with our European counterparts so no one is left without the treatment they so desperately need.

Now I know the the the ten year cancer plan, which we absolutely welcome, included a commitment for 28 new radiotherapy machines. But this is far from enough, particularly for a cost effective and successful treatment. And we'd like to see the government go further, particularly in those areas which have significant radiotherapy deserts. Thank you Minister.
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None Portrait Speaker 2
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Thank you. Mr.. And it's a pleasure to serve under your chairmanship this afternoon. So technology, as the honourable member opposite said before the break is a game changer. And it's a key enabler of our ten year health plan and a modernized test. This course follows the plan's five big bets. The transformative technologies, which are the key to NHS improvement, to deliver impact, AI to drive patient care and productivity, genomics and predictive analytics for preemptive personalised care wearables to make real care, real time, and robotics to support precision and to require these diverse areas to be subject to a cohort of plans to be laid before Parliament and make them subject to a perpetual monitoring by Parliament, is legislating for micro-management.

One of the priorities of tech delivery is that it needs to be agile, and this clause would inhibit that. Parliament does not usually have a role in overseeing delivery plans for specific elements of NHS technology. And. Adding in new reporting structures, we believe is unnecessary to block or slow down delivery of these technologies and that impact of patients in some areas. We already have arrangements in place to underpin delivery via legislation approved by Parliament, the Health and Care Act 2022, the Data Use and Access Act 2025 and related legislation have established a framework for mandatory information standards, which can set the technical and data requirements to ensure interoperability and, along with our ten year plan, ambition to be the most AI enabled health care system in the world by 2035, and our commitment to an AI roadmap means that this clause is unnecessary.

So I ask the honourable member to withdraw.
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None Portrait Speaker 4
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Karen Smith.
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No.
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None Portrait Speaker 3
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Thank you. Chair. New cross 51 is a probing amendment. The aim is to press the government to explain why the health Bill does not include provisions to implement statutory regulation of NHS management, so previously said they would need to commit to a timetable for bringing the regulations they promised into force. Um chair I. An NHS consultant, paediatrician and regulated by the General Medical Council, um dot. They regulate doctors and nursing and Midwifery Council would regulate nurse and midwives um other professionals in the health service are regulated by different bodies but not for managers.

The government did say they were going to be such a register. And while there are many excellent managers like I know, the honourable member, the minister was, there are, as in every profession, bad apples within a profession that need to be identified and managed appropriately. The times reported that senior bosses at Leeds Teaching Hospital NHS trust asked consultants and nurses to work in ways which lay outside the national Service recommendations. And we've also heard from Don Ockenden. Out of the 66 former senior staff members in Nottingham that she approached, only 35 agreed to be interviewed.

The minister's colleague, the former health secretary, said he finds it unconscious, unconscionable that staff would deny families and honest account of going wrong. Chair, establishing a register would be the first step in ensuring a bad apples can be held to account. Those who bullied staff cover up problems, endanger patients or misappropriate fund should not be allowed to fail upwards. The NHS benefits from having outside experience, including from the private sector and the armed forces, so I'm not looking for full occupational licensing, but simply a register to look at those who are not suitable to be appointed.

So what we don't see is managers going from one trust to another to another when they when they fail at the first one and chair, I should finish by saying that I worked at the NHS trust, the Nottingham University NHS trust during late 2012 and early 2013.
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None Portrait Speaker 2
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Minister, I thank my hon. Friend for. Indeed, the leader of the opposition for her comments about NHS managers. I agree they often get a bad press and often from politicians as well. We can't. As I said, run the health service without both clinical and non-clinical trained managers and therefore we need to ensure the right support is there for them, um, to, to do that difficult job. And my experience is when that works really well with clinicians.

It's a really powerful partnership. And I've certainly learnt a lot from working with some fantastic clinicians in my career, but we were also absolutely committed to introducing, um, a statutory borrowing system. Um, we will do that through introducing secondary legislation within this Parliament to enable the Health and Care Professional to operate that borrowing system. And as part of the planned secondary legislation to modernise the framework that governs the Health and Care professions. Changes to this legislation are subject to a statutory three month consultation period, in addition to which this legislation will be novel and complex.

It will require extensive stakeholder engagement to ensure that we develop a borrowing system that is proportionate and operates efficiently alongside existing frameworks, codes of practice and other regulation that governs the work of NHS senior leaders. So for these reasons, a 12 month timeline to bring forward the section 60 order is unfeasible. The amendment also sets out prescriptive duties on the content of the section 60, and we would not wish to pre-empt the outcome of a detailed policy development and consultation. I do welcome the honourable member's support for the Broad Programme initiative to professionalise and increase the accountability of managers and leaders in the NHS, and while we do not agree that it would be proportionate to set a requirement in primary legislation to lay before Parliament a timetable to which they be delivered, officials in the Department of Health and Social Care and NHS England are already working in partnership with organisations across the health sector, and will be setting out more on the individual timelines in due course.

And it is for these reasons that I ask the honourable member to withdraw the amendment.
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Formally.
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None Portrait Speaker 6
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Lou. I will move new clause 57 and also speak to clause 58 if that is appropriate. The new clause 57 would ensure that the average waiting time for diagnosis and treatment for elective conditions, for women's health issues do not exceed the average wait time for a wider NHS elective treatment, a new clause 58 would establish an inquiry into the poorer health outcomes faced by women, in communities up and down the country. We've seen the devastating toll of various and sustained failures to invest in and deliver better women's health and vital services remained understaffed and underfunded.

While women and girls go without the care they need. In 2022, we welcome the first womens health strategy, which promised to listen more carefully to women, close gaps in care, improve research and tackle inequalities and these were all vitally important goals. But three years on, the problems remain stubbornly in place. Long waits for gynaecology, patchy access to services, women reporting that they are not listened to, pain not taken seriously and conditions diagnosed too late. Medical misogyny is a perverse and unacceptable norm in the health sector.

Women are not offered pain relief when they need it, and the side effects of treatment and drugs on women in particular, are far too often overlooked and under-researched. So more research needs to be done to improve medical and reproductive products for women to add to the. Around half a million women are waiting for gynaecology treatment across the country, and. We just cannot keep on failing women in this way. The current average wait time for an endometriosis diagnosis is nine years and four months.

Tackling NHS waiting times, including for gynaecological services, must be a top priority for the government. More needs to be done to tackle these backlogs, because it shouldn't be the case that women's specific health condition waits are so much longer than the waits for more general conditions, the former secretary of State himself recognised an appalling culture of medical misogyny and basic everyday sexism within the NHS, and we welcome this acknowledgement. But. But believe that the DHS should ask the same questions of itself. This amendment would ensure that the average waiting time for diagnosis and treatment for elective conditions, for women's health issues do not extend exceed the average, wait times for wider NHS elective treatment.

It would be a meaningful step towards parity and equality. And, as we know in the NHS, what gets measured gets done. Now. The government's new women's strategy was welcome with more urgency and laudable goals are tackling medical misogyny faster diagnosis for conditions like endometriosis and better pain management. But when compared to the men's health strategy released last year, the women's health strategy is lacking in teeth. The goals are laudable, but it lacks a named academic network. A formal NHS, INIH aligned research mandate, a committed stakeholder governance group named Condition Specific Research Investment at a comparable scale to that in the Men's Health strategy or a formal accountability architecture with named organisations, governance structures and public reporting obligations.

So this time now we need to back the strategy with real investment in the services that impact women and which have been stretched to breaking point. Um, this amendment would introduce an inquiry into the poorer health outcomes outcomes faced by women. We hope that an inquiry like this would achieve the same goal and help shed a light on women's health issues that seem to get so little focus at the moment.
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None Portrait Speaker 3
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Thank you. And I rise to discuss new clause 104 in my name, which I believe is also agreed with this one. Thank you chair. Um, the Labour government's general election manifesto made a bold pledge that never again were women's health be neglected. But he's been in power for two years, and I'm not really convinced they're doing all they can for women's health. The latest NHS statistics say that under this government, waiting lists are rising, with the trends particularly acute for gynaecology services and a higher number of women waiting for admission to hospital for gynaecology, treatment or procedures than there were in July 2024.

How does that square with the government's ambition to improve and prioritise women's health?We talked earlier on this morning, chair, about fracture liaison services, also a treatment that predominantly benefit would benefit women if they'd kept their promise and rolled it out as they said they would. The huge report, commissioned by the previous conservative government, um, the Labour government has repeatedly pledged to address this issue at the earliest opportunity. But when will the minister respond to these women that are waiting for so long?The government did publish this renewed women's health strategy in April.

But where are the timelines, the steps and the milestones to deliver and implement these improvements?Women's health. Where is the plan for reducing the wakefulness?Where is the timetable for delivering on. For example, I've no doubt that the Minister's got a desire to improve outcomes for women and improve the care, but I'm concerned about the actual delivery of it. And this has been a theme, I think, throughout. The day I move this amendment to set out this Labour government has made promises to women and it needs to keep them, and therefore it needs a plan of how it's going to keep them.

And this amendment would ensure that they had a plan of how they're going to deliver on the promises they make, rather than just make promises in glossy brochures, checks.
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Minister.
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Thank you, Miss Lou. And this is a really important discussion on women's health that honourable members have brought before the committee today. Um, and I'm very happy to have that discussion. And because the government is committed to prioritizing women's health, which is why I'm so proud that we did publish a renewed women's health strategy earlier this year. And part of the reason in response to Liberal Democrats, that was a renewed strategy to be absolutely fair to the previous party. But much of what had been put in place by the previous government under that women's health strategy, we agreed with.

So we did not see the need to start it from scratch, so to speak. Whereas there had not been a men's health strategy. So they're very different propositions. Um. Much of the direction was already covered, but the implementation wasn't. And to the honourable lady's point opposite, we wanted to go further and faster and acknowledge some things as the former secretary of State did, about medical misogyny, as well as the need to, as I say, renew that strategy. So turning specifically to the clauses on New Clause 57, um, I fully agree that women should get equal access to high quality care, and we're committed to tackling those long services primarily for services affecting women.

I'm acutely aware that women can wait disproportionately longer for a wide range of treatments. There are none more solely impacting women than gynaecology services, and the government recognises this injustice. That is why we implemented measures to improve gynecology services and improve women's access to care, including piloting gynecology pathways in community diagnostic centres for patients with postmenopausal bleeding, increasing the relative funding available to incentivize providers to take on more gynaecological procedures and using surgical hubs to help endometriosis patients get quicker treatment. These measures have helped 18 week referral to treatment times for gynecology to improve by 5.1 percentage points over the past year.

Now we will go further over the course of this Parliament, including the launch of NHS Online's clinical services from 2027, which will initially prioritise nine conditions, including women's health, such as severe menopause symptoms and menstrual problems. That may be a sign of endometriosis or fibroids. Patients will have the choice of getting the specialist care they need from their home, and will be providing additional appointments to help reduce waiting times. More broadly, we have committed to returning by March 2029 to the NHS constitutional standard so that 92% of patients wait no longer than 18 weeks from referral to consultant led treatment across all patient groups and specialties, delivering against this standard would also require the waiting times for diagnostic tests to significantly improve.

And we recognise this, which is why in the medium term planning framework, the target for the NHS is to ensure that by March 2029, no more than 1% of patients are waiting over six weeks for a diagnostic test. Moving to new clause 58, we acknowledge. That women's health has been neglected and that women deserve better. We acknowledge that there have been long standing failings in women's health outcomes and experiences and access to care, and that is why we published the Renewed Women's Health Strategy, making clear that women's voices and choices are central in healthcare, and transforming NHS performance in services that matter most to women.

Support all women to live healthy, prosperous lives and create an approach to research and develop that works for and empowers women. Reducing inequalities is hard wired throughout the strategy. Actions are targeted by deprivation, ethnicity and unmet need, with a focus on marginalised women. Community based services, neighbourhood health models and transparent data. The renewed women's health strategy marks a decisive shift from identifying problems to delivering change by listening to women's voices, improving performance where it most matters, and tackling the drivers of poor health and inequality.

We will ensure that women and girls receive the care, respect and outcomes they deserve and as a result, we do not think conducting an independent inquiry into women's health provision and outcomes in England at this time would add value. Instead, it's now really time to deliver the change that we all know and in fact, I think we agree is absolutely needed. Moving on to new clause 104. Again, I recognise the intention behind the amendment, but I don't believe it's necessary to publish an implementation plan.

The action summary tables in the renewed Women's Health Strategy highlight clearly the responsible delivery organisation and the planned timetable for all 117 actions. Some actions are already underway or funded this year. Others will be delivered over the next 2 to 5 years, and more fundamental reforms will be phased over the next decade, aligned with the ten year health plan, a progress in the renewed strategy will be judged against three overarching outcomes reversing the decline in healthy life expectancy since the 20 tens, raising healthy life expectancy in the poorest regions to at least 61 years and reducing the time women spend in poor health, particularly where inequalities are greatest.

Something I see very starkly in my Bristol South constituency, Miss Lou. We will also be transparent on progress through a new women's health data dashboard, publishing neighbourhood level data on performance, access, outcomes and experience. This government has already undertaken extensive engagement to inform the development of the strategy, including nearly 100,000 responses to the 2022 Women's Health Strategy. Call for evidence over 400 submissions from individuals and organisations with expertise in women's health and analysis from the NHS. Engagement exercise with round tables bringing together women with lived experience.

Clinicians, academics and expert organisations, some of which I was able to be part of myself this law and it was very instructive, very helpful and we thank them for the work that they did in getting us to this point. Now we're going to continue to engage and listen to them through the new Women's Voices partnership and patient reported experience and outcome measures to help shape and improve services. So creating a new statutory duty to publish an implementation plan, risk diverting attention and resources away from delivering the actions in the renewed strategy, which should now be our priority.

And for these reasons, I ask that honourable members to withdraw those amendments.
14:28
14:28
14:28
14:30
None Portrait Speaker 3
-

Thank you, chair, and I rise to move 66 in my name, which relates to the prescription of puberty blocker drugs. Known as RH. Agonists. Um the first rule in medicine or a first rule of medicine is primum non a carer. First do no harm. And that's what this amendment seeks to do. Chair it seems it seeks to make sure that harm does not come necessarily to children. And this is necessary because the government is sponsoring a £10.6 million trial to put 226 physically healthy children on puberty blocking drugs.

This is being done despite the fact that the new health secretary, the current health secretary, I perhaps should say. Claims he feels discomfort and unease at the prospect. There are lots of questions that need to be answered. The minimum age for this trial is 11 year olds for girls and 12 year old for boys. The MHRA recommended a much older uh, group. Um. But when asked why in a written question, did not find the members of the parliamentary Under-Secretary of state gave a holding answer, is that because the government doesn't know or it doesn't want to say?The the other challenge of this trial, chair, is that I'm not convinced it will come to the answers they want it to come to.

So they're asking the question or apparently asking the question whether puberty blockers benefit children who have questions over their gender, who who will later go on to have a trans identity in adulthood. The challenge is that we don't know which of the children who have challenges with gender during puberty will go on to have such an identity in adulthood. So essentially trying a trial on this many children to see if it is beneficial for a small group or a small pool within a small pool, as it was described by the current Secretary of State.

And so the government has the data or some data that it could use in a data linkage study to try and narrow that field down. But for some reason, it's choosing to do this trial before that. And I don't understand why. Perhaps the minister can explain the. I don't want to detain the committee too long on this issue, although I could talk for for some time because we have had debates in the House and opposition data debates in this House, but.

We have seen unease on all sides of the House, and the Minister will be aware when the opposition day debate. We had recently with a vote on this trial. There were a large number of abstentions in her party, as well as many votes against from ours, and three votes against, I think, from her own party. Um, there are risks for puberty blockers which may or may not be reversible. There are concerns about bone density, cognitive damage and fertility loss, all from children who should be enjoying their childhood.

So what this amendment does essentially is it prevents a trial taking place without the vote of the House of Parliament. And I appreciate that. We would not normally want to seek to have a vote of the House of Parliament on a on a on a clinical trial, because it would slow clinical trials in general down. But I think this topic in particular is unfortunately become so polarised that it's very difficult to see how we can get, um, how it can be processed properly. And ultimately, the government has responsibility for what goes on in this country.

And the government should be the government should bring forward the government wants to pay for this trial, then it's the government's trial, and the government should bring it before the House for the government to put us to decide as parliamentarians, whether it's the right thing to do, because I absolutely think it is not. I think we're putting children at risk of permanent harm. Uh, we don't know that their children are going to benefit from them. We don't even know if they're in the pool of children.

Who would, who would in the long term have a trans identity. And they're not even waiting to see if they can find out. Using the, um, the. Data linkage study. It's it's. Wrong chair. And, and I think we need to do what we can to try and prevent it.
14:34
None Portrait Speaker 4
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Puberty blockers.
14:35
14:35
None Portrait Speaker 7
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Thank you very much, Miss Llewellyn. It's a pleasure to serve under your chairmanship this afternoon. And, um, I had written a I would say it was 25 page speech on this, but to the disappointment of my researcher and probably the delight of this committee, I don't intend to read all 25 pages out. Uh, cries of shame from my own side. But I do accept that there are a number of other amendments that we need a new clauses we need to get through.

Um, so, uh, and my, my stated of objection to the puberty blocker trial is well known on record. So again, I don't wish to detain the committee for too long, but I do want to just pick out five areas that I think are where there's a problem. And that's why I support the new clause, as tabled by my hon. Friend the member for Sleaford and North Hykeham. The first is can be described, I suppose, as you don't repeat a mistake to find out whether it was a mistake.

Thousands of children have already received puberty blockers through the former Tavistock pathway, and my view is before exposing a whole new cohort, the government should complete complete the long promised data linkage study to establish what happened to those children. And I think that is probably the core argument. The second is that if the government rightly says that the drugs present present an unacceptable safety risk, their words, how can it be ethical to give them to children in a trial?It must still be an unacceptable safety risk, whether it's for the general population who wish this or for these people.

In the trial, the government banned routine prescribing because of the safety concerns, yet proposes administering the same medicines in a research setting. That's a complete contradiction, um, to the the issue. Second, I would sorry. Thirdly, I would say clinical equipoise doesn't exist in the evidence. If the evidence already points to significant risk and uncertain benefit. The Cass review concluded that the evidence base for puberty blockers is weak while concerns remain over bone health, fertility and neurodevelopment, a trial should not proceed unless there is genuine uncertainty that justifies exposing children to these risks.

Fourth, children should not bear the burden of answering questions of the NHS should have answered itself. The failure to collect the robust, long term evidence from previous patients, including through the data linkage charge, should not be remedied by recruiting another generation of vulnerable children. Ethical research requires exhausting the existing evidence. First. And finally, even the medical even the medicines regulator, the MHRA, had sufficient concerns to halt the trial. The MHRA intervened to pause the pathways trial over safety and wellbeing concerns, reinforcing that the scientific and ethical questions remain unresolved.

Now, a pause should lead to a complete reassessment, not simply restarting as soon as possible. I will give way.
14:37
None Portrait Speaker 1
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Does it?
14:38
14:38
14:39
None Portrait Speaker 1
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Minister.
14:39
None Portrait Speaker 2
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Thank you. Miss Law. And usually I say I'm grateful for bringing this discussion for the committee, and I'm very happy to have it. But it is unusual to have a discussion on the clinical trial in a political environment. Um, and I'd stand to be corrected, but I don't think that there's ever been a clinical trial subject to a parliamentary vote. And obviously the opposition, we won't spend much time discussing this this afternoon because obviously the opposition um, wanted time to take time out, um, to have an opposition day debate about this, which many issues were rightly aired.

But the safety and wellbeing of children and young people is paramount. And children's health care has to be led by evidence and expert scientific and clinical advice. And we all know that that was not the case with regard to some of the incidents at Tavistock over time, um in the late 20 tens. Um and we pay tribute, as we have done several times to the Right Honourable member for Bromsgrove, when he was Secretary of State for health for finally, in 2022, taking action as regards that particular service.

Um, and what went on there in order to commission doctor Hilary Cass review, which we supported on a cross-party basis, because the health and safety of children well-being and Hilary Cass is both interim review 2022, which bears reading for those who have not read it. More recently found the evidence for the service model. Indeed the clinical base to be woefully lacking. That was a situation that was allowed to continue in the 20 tens for a long time. Um, and fortunately was started to be stopped in 2022.

And we've conducted a cross-party agreement ever since. And supporting Doctor Cass's review where she found that the evidence on the use of puberty suppressing hormones for children and young people for treatment of gender incongruence is, and I quote, remarkably weak based on the current available evidence. NHS England then introduced a new clinical policy in March 2024. That means puberty suppressing hormones are no longer available routinely in the NHS for children and young people with gender incongruence for non NHS prescriptions. The government introduced an indefinite ban in December 2024 on the sale and supply of puberty suppressing hormones to children and young people for the purpose of gender dysphoria or incongruence, and this followed independent advice from the Commission on Human Medicines.

Clinical Practice should be based on evidence where evidence is lacking. Clinical research takes place to improve the evidence base, and that is why, to properly understand the impact of puberty suppressing hormones to treat gender incongruence, the Cass review recommended a clinical trial in line with the review's recommendation. A trial has been developed and has now secured updated study approvals from both the MHRA and the Health Research Authority. Now, this country has a well-deserved international reputation for academic and scientific excellence, with robust, independent regulatory process in place to properly scrutinise and assure the scientific rigour and ethics of publicly funded clinical trials.

This helps ensure that individuals receive evidence based care based on the highest quality research, regardless of their clinical diagnosis, and I therefore disagree with the honourable member's view that uniquely clinical trials for these types of medicines must be subject to the scrutiny and the approval of both houses. I will give.
14:41
14:41
14:42
None Portrait Speaker 1
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Minister.
14:42
14:43
14:43
14:44
14:44
14:45
None Portrait Speaker 6
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Abstain.
14:45
14:47
14:48
None Portrait Speaker 6
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Miss Lou, I thank my honourable member, the friend for Guildford for table this amendment, and she has asked me to speak specifically to the issue of dental, uh, deserts in Surrey and East Hampshire, in the area in which she lives and represents. This new clause places a duty on the Secretary of State to ensure that there is adequate provision of NHS dental appointments in Surrey and East Hampshire, and it allows us once again to raise the shocking state of dentistry in this country. Um, as we've discussed on many previous occasions, over 5 million children did not see a dentist at all in 2025.

And it's a stark reminder of what we mean when we talk about dental deserts. We have heard that DIY dentistry has become normalized, and that's pretty horrifying. People using pliers to extract teeth, super glue to reattach crowns, or attempting to fill cavities with household. Andapart from that, obviously shocking Victorian scenes, DIY dentistry is very risky and has tragically led to deaths as a result of sepsis. And that's all because people can't get an NHS dental appointment and cannot afford a private dental appointment.

Now, the last conservative government pushed dentistry to the brink, and it is children and parents in particular, who are paying the price of their neglect. It's a national shame and one we must fix. Now. My honourable member, my honourable friend for Guildford, as I mentioned, tabled this amendment to highlight the issues in her part of the country. Surrey and East Hampshire is not the worst place in the country for access to NHS dentistry, but it does have very, very serious issues.

Some areas and pockets of the population have been left in a situation where they cannot get an NHS dental appointment. The action so far the Labour government haven't been good enough, but unfortunately the fault for this dire situation lies solely at the door of the conservatives. Years of neglect under them have left our dentists in a shocking condition. Healthwatch, once again showing why they are so important, has classified large parts of Hampshire as dental deserts and equally a Healthwatch report into dentistry in Surrey told us the ever so familiar themes.

People can't find a dentist accepting NHS patients, information about dentists accepting NHS patients is not up to date and there are financial barriers to receiving dental care. Clearly, so much more needs to be done for the people of Surrey and East Hampshire and I commend this new clause to the committee.
14:50
14:50
14:50
None Portrait Speaker 7
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Thank you very much, Miss Lowell. And as a member who covers both Surrey and East Hampshire, unlike the Member of Parliament for Guildford, I welcome the focus. This new clause places on our local area constituents regularly raise with me the concerns about seeing an NHS dental dentist and as I've. I think announced a number of times, this committee, though I haven't checked today, so it may not still be true. There is not a single dentist in my constituency who is taking NHS patients at the moment, either for adults or for or for children.

So for many people, the challenge is not simply one of convenience. It's about being able to access timely care when they need it. Good oral health is an essential part of overall health, and we cannot allow dentistry to become an afterthought within our healthcare system. The ability to see a dentist for routine check ups, preventative care and urgent treatment helps reduce pressure elsewhere in the NHS by dealing with problems before they become more serious. This clause rightly highlights the need for both urgent appointments and improved access to routine NHS.

Dental care prevention is at the heart of a sustainable healthcare system and regular access to dental services plays an important role in achieving that. I do welcome the accountability that this new clause seeks to introduce, where there are persistent challenges in access to services, so-called dental deserts, local communities deserve transparency about what action is being taken and why improvements have not yet been delivered. And I've mentioned before the spanking new dental surgery in the Hazelmere hospital that has sat entirely unused since it was built, and there are no plans, as far as I'm aware, to use it.

And that seems like a shocking waste of money. But more importantly, a shocking waste of a dental surgery which could be treating patients not just in hazlemere but across the wider area. Um, I do also note before I close Mr. Jewel, that Mr. Lowell, that whilst um, the honourable member who spoke for the Liberal Democrats obviously always wants to place the blame with the conservatives, uh, she doesn't seem to feel that she needs to challenge the government. I will gently remind her that there was a minister, a Liberal Democrat minister in the in, in, in the Department of Health for five years who did absolutely nothing, apparently to raise this issue.

So while this is a particularly important issue to Surrey and East Hampshire, it reflects a wider challenge facing communities across the country. So residents should not have to struggle to find an NHS dentist and ensuring adequate provision must remain a priority. And I hope the government takes that on board.
14:52
None Portrait Speaker 1
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For.
14:52
None Portrait Speaker 2
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Uh, well, thank you, Mr. Buckley. Welcome again to a rerun of the 20 tens and happier times for our opposition. Um, and sometimes they don't remember. And sometimes I have to remind them. And every now and then they remind us. So there we go. Um, but look, this is a really important issue not only to the honourable member who's raised this amendment and on behalf of Shropshire, but to all our constituencies, it's been a huge priority for this government.

And on clause, uh, on this particular issue. Um, turning to the president for 72, the Secretary of State will continue to have a duty to promote a comprehensive health service in England. And in addition, calls for of this bill provides an injury duty for the Secretary of State to have access to regard to the need to reduce inequalities, access to services across England. And we also recognise the practical action is needed to secure access to urgent and routine NHS dentistry care. And, as we previously discussed, it's why we prioritise a number of improvements over the last two years.

Last year Icbs commissioned additional urgent dental care appointments and there's now an urgent care safety net across the country. In April 2020, we introduced a requirement for NHS dental practices across England to deliver a set of proportion of their contract as urgent care, supported by increased payments for dentists delivering this care, making it easier for patients to get prompt support through the NHS. And we are committed to reforming the NHS dental contract. By the end of this Parliament, something that again, could have been done at any point in the last 14 years.

But there we go. As a first step, the package of reforms we introduced earlier this year will address some of the pressing issues that dentists and dental teams have been experiencing, and these reforms help prioritize those with the greatest need, supporting a shift away from clinically unnecessary checkups. The government is already making progress to improve access to NHS across England, including Surrey and East Hampshire, and I hope the honourable members can now see how legislation for one area in particular conflicts the Secretary of State's duties to promote a comprehensive health service for England as a whole, and risk creating health inequalities in other regions.

And for that reason, I ask that the amendment is withdrawn.
14:54
None Portrait Speaker 1
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Morgan.
14:54
14:55
None Portrait Speaker 2
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You call 72.
14:55
14:55
None Portrait Speaker 2
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No.
14:55
14:55
None Portrait Speaker 8
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Abstain.
14:55
14:58
None Portrait Speaker 2
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No.
14:58
14:58
14:59
14:59
15:00
15:00
15:00
None Portrait Speaker 2
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Nor no.
15:00
15:00
None Portrait Speaker 4
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Edward Argar.
15:01
None Portrait Speaker 8
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No.
15:01
15:02
None Portrait Speaker 6
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I.
15:02
15:04
15:04
15:05
15:06
15:06
15:06
None Portrait Speaker 2
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Well.
15:06
15:07
15:07
None Portrait Speaker 6
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Well, I thank him for his for his intervention. I think it's really important that people who have seen convincing information online, who have been given convincing information by people that ought to know better, including, a political party, conferences. Um, I don't think we should blame them for being convinced by that information. I think we need to battle the source of that information and ensure that accurate, factual information is available to everyone, and that it is communicated to them in an accessible way by people that they trust.

I think that's the the key to all of this. Um, uh. As I, as I've said before, uh, ostracizing or ridiculing people who have been given information and in very, very convincing way is not the way to resolve this problem. We do need to tackle it in a, in an understanding way. Um, by communicating the facts in a sympathetic and. Accessible method. I was going to say it's important to note that these concerns aren't exclusive to a single group of voters, but because there's also significant vaccine hesitancy across some ethnic minority communities and in hard to reach places across the country, we must do more to support our doctors, nurses and the NHS to fight infection fiction with facts.

Otherwise, the long term health of the country will suffer. And this is what that amendment seeks to do. There's some great work being done, but it needs to be a joined up strategy to combat all aspects of disinformation and. This social media video telling people to get their jab won't beat this disinformation, um, particularly now that reform UK have a greater presence in our local government and NHS leaders are going to have to handle difficult conversations with anti-vax and conspiracy theorist counsellors. More and more, they deserve support on how to effectively and constructively engage with these people.

And our strategy would do just this. It would also support medical professionals to build trust and engage with persons who are anti-vaccine, invest in public messaging to combat disinformation, including engagement with trusted online influencers. Invest in outreach campaigns focused on communities who are sceptical about vaccinations. Introduce criminal liability for those, including online influencers and politicians who profit from disinformation and introduce a new verification requirement for any social media account claiming to be a medical professional. We must do more to systematically protect the NHS and our nation's health from the growing threats of medical misinformation.

We urge the government to give this the focus it needs and hope that they should, uh, look at this amendment as one idea of how to do this.
15:10
15:10
15:10
15:11
None Portrait Speaker 1
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Morgan.
15:11
15:11
15:12
15:13
None Portrait Speaker 10
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I am interested.
15:13
15:14
None Portrait Speaker 1
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So Caroline Johnson.
15:14
15:15
None Portrait Speaker 1
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20 Stratford.
15:15
None Portrait Speaker 3
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Yes.
15:15
15:15
None Portrait Speaker 3
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Take an intervention?
15:15
15:15
None Portrait Speaker 10
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Take another.
15:16
15:16
15:16
None Portrait Speaker 1
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Doctor. Peter.
15:16
None Portrait Speaker 4
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This is obviously.
15:16
15:17
None Portrait Speaker 4
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So I.
15:17
None Portrait Speaker 3
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Be the law. Well, for generations it hasn't needed to be the law because doctors haven't gone on strike. Because I think doctors recognize that what would be happening to their patients if they did?What has changed is doctors have gone on strike and therefore the landscape has changed, because now we know that doctors will go. The consultants have just balloted. I should say that I'm an NHS consultant to NHS consultants have just balloted to go on strike. That that would be fundamentally an unsafe thing to happen.

I think the government has a duty to keep people safe. That has to be first and foremost. Job. A job of government is to keep its population safe. And I think doctors going on strike make it fundamentally less safe. And therefore they shouldn't it shouldn't happen. I agree with you that should it be in law, morally, it shouldn't necessarily need to be in law. But I think the evidence suggests that it does need to be law.

So the, um, new clause, um the new clause is essentially say that it would be an offence for medical practitioners to undertake strike action. And it provides for the, the relevant um ability to Secretary of state to appeal any other necessary clauses of other employment regulations in order to be able to do so. Um and then the minimum service levels, the service levels provided across the NHS because. There are perhaps um. Staff who provide an important and valuable service to whose jobs may or may not be clinical.

They may have porters may be able to run with slightly fewer porters if they want to go on strike. I would hope that no member of the NHS staff would want to go on strike, because I would hope they would want to make sure that patients are getting care and they would recognise that in a. Universal service, then they're essentially causing harm to the patients around them that are their friends, their neighbours, people that live on their street, the people that the people that would look after them.

But but the evidence suggests that that is what is happening. And so I'm afraid I do think these clauses are necessary and we do need to put in place a minimum number of staff to support the doctors and that the doctors should be at work to make sure that patients are safe. Thank you.
15:19
15:19
15:20
None Portrait Speaker 7
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Thank you very much, Mr. Newell. Um, hopefully pleasure postponed. Um, I just want to briefly rise to support my hon. Friend from Sleaford and North Hykeham on these two new clauses, 81 and 82, because I think as legislators, we also have a moral duty to ensure that patients are protected during times when there is disruption in the NHS. Nobody's dispute that NHS staff do not work incredibly hard. They absolutely do. The dedication shown by doctors, nurses, paramedics, midwives and all those who keep our health service running is something that deserves enormous respect and having worked in healthcare for pretty much all of my career, including for professional organisations like the College now Royal College of Occupational Therapists, I know firsthand how hard they work, but equally, I think we need to recognise that the NHS is not an ordinary service.

It's not like being a shop assistant. It's not like being a bin collector. It's not like being a tax inspector. It is more akin, I would say, to the health and safety of this nation, of a policeman or a police officer or a member of our armed forces. It's an essential public service. And when people are at their most vulnerable, they must have confidence that they care. They rely on will still be there, either because they are waiting for an operation or procedure or an intervention, or because they're in the process of having those interventions.

And so the right to strike has to come with responsibilities. And in the NHS, the consequences of industrial action are real cancelled operations, delayed treatments, missed appointments and increased pressure on emergency services. And indeed at the health select committee, when I've raised some of these issues with Sir Jim Mackey, he could not tell me, hand on heart, that people had not died because of these strikes, and I suspect they probably have for patients waiting for something like cancer treatment or someone requiring urgent surgery, or families relying on maternity service.

The impact can be deeply serious, potentially even deadly. So I do think there is a moral obligation, both for doctors in the NHS, but also us as legislators, to ensure that we, as a collective have a universal 24 hour, 24 hour, seven days a week free at the point of use service that patients can and should expect to rely on. And therefore I support the minimum service requirements that are in new clause 81 and the removal of the ability to strike for clinicians in new clause 82, we must ensure that our NHS staff are supported, protected, paid appropriately and given the resources that they need to do their job.

The corollary of that is that they should remain to do the job, to be able to serve our constituents.
15:22
None Portrait Speaker 4
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Minister.
15:22
None Portrait Speaker 2
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Thank you, Miss Laura. And as I think, as has been said, that is an interesting discussion point for us in this amendment this afternoon, and I do recognise the intention behind these amendments is to reduce the impact on patients and NHS budgets. When doctors take industrial action, and that's an objective that we we all support. Um, however, I don't agree that these amendments are the best way of achieving this aim. And, and actually to the point of the honourable for Sleaford and North Hykeham raised in in her in her comments.

And I again respect her both her professional um. National politician now, but her professional background and her very strong moral case for why she doesn't feel that it's appropriate. But she talked about that for such a long time. This didn't happen. The doctors didn't go on strike, and something changed in the industrial relations landscape roughly ten years ago that did start that, um, that. Process that perhaps change of culture, that frustration that did lead doctors to strike. And I listened with interest to the health secretary, the former health secretary, the right hon.

Member for Godalming and Ash. Um, sort of reflecting. On this recently. And we were subject to a podcast these days, aren't we?Um, about, you know, those relationships at the time. And I think we should learn from that. It's very helpful to have those recollections, but something changed. Um, and that has resulted in that. And I'd just like to pay tribute to my hon. Friend the member for Bury St Edmunds and Stowmarket and many others.

Um, if I can say of his um his vintage um who wanted to work with particularly on the rest of wine, vintage um with resident doctors to, to talk through a way in which to progress and work and not resolve to strike action. Um, because that is a sign of failure in a system of any system. So on new clause 81, we are committed to reforming trade union legislation to bring it into the 21st century. And we want to create an industrial relations framework that is fit for a modern economy and workplaces that work for everyone, which is why the Employment Rights Act repeal the Strikes Minimum Service Level Act in 2023 at 2023.

The previous legislation did create a hostile environment which is not conducive to good partnership. Working with trade unions nor settling disputes on new clause 82. While strikes are hugely disruptive, a ban on doctors right to strike is not the answer. We believe that constructive. I will.
15:25
None Portrait Speaker 1
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Dave Robertson.
15:25
15:26
None Portrait Speaker 1
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In.
15:26
15:27
None Portrait Speaker 1
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Caroline Johnson.
15:27
15:27
None Portrait Speaker 1
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Minister.
15:27
None Portrait Speaker 2
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I thank her for that. I think I said it's a it's a it's a failure of both management and union side and representatives to agree a solution is what I mean by failure of the system. It is a sign strike action. Ultimately, as my honourable member for literature would have testified to, is is a sign of failure of good, conducive relationships and partnership working. And that's why we don't never, ever want to see it, because constructive dialogue and cooperation with staff and trade unions is the best way to maintain industrial relations.

Whatever the, the, the area we're talking about. And in that constructive spirit, I am pleased that we've seen the end of the dispute with the resident doctors after they voted to accept the government's offer on pay, jobs, pay and conditions in that long running dispute. That is good news for patients and staff and the wider health service. I would remind members that striking workers are still subject to section 240 of the Trade Union and Labour Relations Consolidation Act of 1992, which allows for criminal prosecutions for those who intentionally and maliciously endanger life or cause serious injury to a person by going on strike.

And ultimately, it is a decision for trade unions whether to take strike action. And at the same time, we do want to work constructively with all unions to avoid disrupting services for patients. And to the honourable lady, the opposition spokesperson is disappointed that the consultants have moved to, um to to potentially now lost my head of the exact phrase, um, to that they have a mandate to a ballot to, you know, potentially go on strike. Obviously, we will do all in our efforts to work with them constructively as we are doing with all service groups.

Um, to avoid that situation and work constructively with them on building NHS fit for the future, which we need to do with them, um, in a constructive way. And it's for those reasons, I ask the honourable member to withdraw the amendment.
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No.
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Serena. Emma. Foodie.
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No.
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Stafford a.
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Twist.
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Yes.
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Please strike action.
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None Portrait Speaker 3
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Thank you. Chair. New clause 83 would exempt health and social care services in England from public sector equality. Duty um in its final months, the last Labour government introduced the Equality Act and it consolidated several pieces of anti-discrimination legislation which was welcome. But it also introduced a new public sector equality duty, requiring public authorities to have due regard to preventing unlawful discrimination and fostering of equality and opportunity between the groups. The public sector equality duty also requires authorities to encourage persons who share a relevant, protected characteristic to participate in public life or in any other activity in which participation by such persons is disproportionately low.

Unfortunately, chair, it's become a vehicle for social engineering. It was designed, I believe, to improve equality of opportunity, but it's being used to gerrymander equality of outcome instead. And that can mean discrimination against different groups of people. But discrimination nevertheless. And it's clinically objectionable because it means that health and social care staff may be recruited for reasons other than their clinical abilities. And that's what we need is most important. We have parts of the health service working, spending their time working on, um, cultural learning classes rather than pushing paper around rather than working on patient care.

We must get the health service chair back to basic health care, ensuring that they're delivering the very best health care free at the point of use to all individuals, um, based on, based on their clinical need, not their ability to pay. And we need to focus on the clinical need. And the best possible staff and not on trying to gerrymander some sort of social engineering.
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I.
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No.
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No.
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No.
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Jo. Robertson. A.
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No.
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No.
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Edward Argar a.
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Serena. Emma.
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No.
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I.
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Peter. Princely.
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No.
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Thank you. Chair. Um I want to speak to. 85 and new clause 98. Um the Minister will remember the evidence given earlier in committee by my right hon. Friend the member for Godalming and Ash, in the first sitting as our longest serving Health Secretary, my right hon. Friend focused much of his tenure on patient safety. Yet, as he made clear, and I quote, we are the world champion at doing inquiries and reports, and fortunately, we are also the world champion at allowing those reports to gather dust without anything actually happening.

Clear example of this so far is the Hughes report. 29 months ago, Dr. Henrietta Hughes published a report outlining redress for thousands of victims of pelvic mesh and sodium valproate, scandal time and time again, myself and other honourable and right honourable members have asked this government when it plans to respond, and every time the answer is soon, at the earliest opportunity. We're working on it, but warm words are not enough to secure patient safety. So can the minister confirm when she intends to publish the government's response to the Hughes report?Many patient safety recommendations prompt questions about the effectiveness of the Care Quality Commission, the national care Regulator.

The former health secretary, claimed this was not a fit for purpose, and yet the government has decided to bring accessible hate. Seb within the CQC, as well as to add other measures, including events management. We need some urgent steps to revive the CQC to ensure its fit for purpose to uphold patient safety. Chair. The brief so we've got a lot to get through. But the government needs to respond to the Hughes report. There are too many people, predominantly women, but men also, who are waiting for the answers.

They want to know what the government's going to do. This government's been in office over two years. The report was published shortly before they came into office. They need an answer and going forward for the future. New clause 18. Five new clause 85 means this can't happen again because if we have future reports on patient safety issues, they will have to respond within a set time frame of six months to ensure that we can't have situations where people are waiting far too long for the answers that they need and the answers that they deserve, Madam Chair.
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Thank you very much, Miss Lowell. So, um, I should declare that I am a member of the all party parliamentary group for patient safety. Patient safety cannot be something that's discussed only after a tragedy has occurred. It requires a culture of accountability, transparency, and most importantly, action. And that is why New Clause 85 is such a sensible, I believe, and important amendment to this bill. It does not dictate the outcome of every review or every recommendation, but it does require the government to respond properly.

The new clause creates a straightforward expectation that when experts have identified changes that could improve patient safety, ministers cannot simply leave those recommendations unanswered. And I believe that the amendments brought by my right hon. Friend the member for Godalming and Ash pushed that forward. There must be a clear process and a clear timeline, and that process and that principle is closely connected with new clause 98 and the government's response to the Hughes report on those harmed by sodium valproate and pelvic mesh. These are deeply serious issues involving people who have suffered life changing consequences and have spent years seeking recognition and redress.

And when I've, uh, I think it was last week, uh, at the Health and Social Care Select Committee when I questioned the current secretary of State on this matter, his answer was equivocating, uh, dissembling. And I'm afraid to say frankly, unacceptable to those patients who have suffered under both of those. He couldn't even tell me whether or not the the response would be published by the end of the recess. Well, we've got probably two hours before the recess, unless the minister is going to tell me otherwise.

I suspect it's not coming before the recess. It does seem shocking and perhaps even a slap in the face to those victims that the Secretary of State couldn't even give an answer on that issue. However, they did receive some positive news on Tuesday evening because the right hon. Member for Makerfield, the. We presume the incoming Prime Minister raised this issue in the House in the final stages of the public Office Accountability Bill debate. Uh, himself. And so I do hope that perhaps the Minister has had a chance to speak to the right hon.

Member, unlike the rest of us, have had a chance to speak to the right hon. Member for Makerfield to understand what his priorities are and when redress is coming, because if her new boss has given his stamp of approval, Labour MPs on this committee should have no problem supporting my hon. Friends and I on these new clauses.
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Minister.
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Thank you. Mr.. Um, so I'm grateful to you for bringing this discussion again before the committee today. The safety recommendations are, of course, an important mechanism for improving services and securing better outcomes for patients. And we support the aim of bringing greater clarity to the recommendations landscape. And we are already taking forward work in this area. The review of patient Safety across health and care landscape found that a very high number of recommendations have been made to the NHS that often lack any cost benefit analysis, and that's why the ten year health plan committed to giving specific responsibility for reviewing, analysing and taking forward recommendations to the National Quality Board and in line with the Dash review, work is progressing on recommendations.

Hub that will sit within the department. The hub will include a repository to hold all national level recommendations relevant to care quality, including safety, effectiveness and patient experience, and the hub will provide an efficient system for coordinating, prioritising and overseeing recommendations by the National Quality Board. The hub will record responsibility for implementing prioritized recommendations and, once fully operational, strengthen transparency and accountability for how they are taken forward, something I think we would all welcome and this new approach will enable the NHS to focus on the actions most likely to enhance patient outcomes.

Now, where the Secretary of State commissioned reviews or reports, make recommendations to local bodies, those recommendations will remain subject to local governance arrangements within overall coordination retained by the department and our existing plans. Meet the amendments intention and in fact go further by prioritising national level recommendations for the NHS in a proportionate way without being bound to a specific timescales. They will provide the greater clarity sought by the amendment without the need for legislation. On the specific question, I'm sorry to disappoint. Indeed, the many campaigners on this issue and and the members opposite, um that we will not be announcing anything in the next two hours.

Um, you know, I think this this, this has been well made. I myself responded in a Westminster Hall debate, uh, patient safety minister has previously responded to the commissioner and made that public the work that the government is doing. But due to the cross nature of government, the work we are not able to give exact timelines. Um, we've heard the calls for clarity and speed and decisive action. We're committed to setting out that at the earliest opportunity. I've not had a chance to talk to the right hon.

Member for Makerfield about that directly. I'm sure there'll be many conversations on that and many subjects coming all our ways very soon. It is important, as he made very clear and as in fact, the Prime Minister made clear in relation to the Hillsborough report um on Tuesday night, um that um redress, trust, confidence of patients in the public in all parts of the state is an important, important aspect of. Rebuilding public confidence and trust in the state for people who have been wronged. And we are committed to working to get that out as soon as is credibly possible.

And for that reason, I ask the honourable member to withdraw their amendments.
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Yeah.
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No division.
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Lock the doors.
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Edward Argar a.
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No.
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Dave. Robertson.
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No.
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No.
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Gregory. Stafford.
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I.
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Liz.
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Twist.
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Thank you, Madam Chair. I rise for a move. New clause 86, which is in my name. Advice and guidance services, Madam Chair, were in improvement. So previously if I um general practitioner wanted to um to uh to refer somebody, they would refer someone into the hospital and the clinician would consultant would triage the referral. And sometimes the referral wasn't needed. So you'd say back to the, you might write a message to the GP saying, I wonder if you've tried this or have you tried the other or um, could you give more information please?Um and so born from that was the advice and guidance service, which in many ways is beneficial.

What has concerned me and, and us more generally is the suggestion earlier in the year that advice and guidance would become a compulsory feature and that only after advice and guidance had been received would there be a potential for referrals instead of consult a GP being able to refer to a consultant and a consultant, be able to accept referral advice and guidance would have to be sought first, and that that would cause a delay in patients um pathways and that patient flow. Now, it may mean that the, the date on which the person is added to the waiting list for an appointment is a couple of days later.

And that may slow things down and improve the figures, but I couldn't see any clinical benefit from mandating it. And there was also a concern with that, that there would be what they called a diversion rate of at least 25% by March 2027 for at least ten high volume specialties. And I was concerned about that, too, because. If if someone gets to the point where they're being given an appointment at the hospital, for example, that's because the clinician that saw them in primary care thought that they needed that appointment in their clinical judgment.

And the consultant triaging the referral in his or her clinical judgment decided that they did need to be seen. Of course.
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None Portrait Speaker 2
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Uh, thank you, Miss Lou. Um, and as someone who previously set up a referral management service, I feel the need to join in this interesting clinical discussion. And, and everyone else can watch us for the next hour and a half, but I'm not going to do that, um, to be grateful. I think we've had some interesting discussions, uh, raised, um, and just, just to add my two penny worth to my friend from um, Bury St Edmunds and Stowmarket. Um, I think the change in practice is also partly due to increased specialisms amongst consultants.

It is harder sometimes for to refer through to that and as well as other members of the practice team, often in when we set up referral management service in Bristol and the issues that we found drove up, that is the pressure on general practice, but also the use perhaps of locums. Um, perhaps people who are working temporarily in the area that didn't know the full range of community services that were available. And that was some 12 years ago. So I think it's long overdue, actually support and greater support of advice and guidance.

Um, as we are rolling out, I'll come to the honourable lady's points in a moment. Um the aim is to support, at the end of the day, patients getting the right clinical care in the right place as fast as possible, because that's what we want patients to have that timely assessment of their care needs. Really clear, clear next steps in the right settings and the GP referrals and support to GPS in making those referrals is a crucial part of it. So the advice and guidance model, which allows GPS to seek rapid specialist input into a patient's care without an initial face to face appointment, and the single point of access model, which is rolled out later in October, supports GPS and hospital specialists to work together and make the best treatment plans for patients while reducing, um, referrals that may not be necessary, and increasing those waiting lists.

The trusts and integrated care boards must ensure that local GPS, GP leaders and local medical committees and interfaith groups are involved in the design and ongoing refinement of elective single point of access pathways. And my own experience, that's important because if they're involved in that design work, then they are absolutely one. We gain their expertise in designing it, but also it is more sort of buy in to making it work as a routine part of their work. Now, advice and guidance is already a routine part of GP practice, and GPS continue to be able to make clinical decisions to refer for specialist care, where that is in the patient's best interests, the advice and guidance in the single point of access do not alter the clinical threshold for referral and a GP clinical decision to refer remains unchanged.

All requests for advice and guidance will receive a response from a named consultant with clear accountability and oversight. Now, we are clear that GPS should continue to make a clinical decision to refer to specialist care where that is in the patient's best interest. The model is intended to support decision making, not override it. Be very clear to the honourable lady, the intention was never to mandate. There is a difference. And I think that was made clear in subsequent guidance to the system, um, that the, the, the, the diversion rate, as she calls it, is an estimate of the potential um, of patients who are not referred in the first place to the right place in order to get them to the right place for that case.

It was not compulsory. It is not mandated. But what the amendment proposes already exists, and it does not need to be set out in primary legislation. For those reasons, I ask the honourable member to withdraw the amendment.
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I know.
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A division.
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You know.
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Lock the.
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Doors. No.
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Emma.
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No.
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New clause 87 amends the Medical Training Prioritisation Act 2026, so that British citizens who studied at international branch campuses of UK higher education institutions can be prioritised for foundation programme training places. Students in the selection process would have been the right thing for the government to do, but the way the Medical Training Act is drafted places. British students who studied at international branch campuses of British universities at a disadvantage. In the Act's second reading, a member um spoke of a constituent given a formal guarantee that he'd be at no disadvantage if he chose to study at the Multicampus.

Another member of Parliament said he'd had representations from all quarters, both in the UK and Malta, about the impact of this of Malta. My hon. Friend the member for South West Wiltshire asked about British students who, for reasons and changes at train at, for example, Saint George's in Cyprus or Saint George's in Grenada, and they want to come back and practice in our National Health Service. Member for Uxbridge and South Ruislip spoke of a constituent who was schooled and grew up here. Given a.

Guaranteed by the University that should face no disadvantage compared with students on the London campus. So, Madam Chair, the concerns are shared across the House. So there are. There are young people who. Young British people who trained in a British university, a London based university, have gone to a study in Malta. Perhaps with an adventurous spirit. They wanted to study Malta. Beautiful place to go. Um, and they've done a British degree.

They've graduated a British degree and they found themselves at the back of the queue unable round after round to get jobs, many of them without being able to get jobs in the foundation programme in their home country. And they've done that not just for students who are due to start the degree, but for students who've just completed their degree. They've done those five years training. They've worked really hard, they've passed their exams and suddenly they can't get a job in their home country. On the foundation scheme to continue to complete their full registration with the GMC.
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None Portrait Speaker 14
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The legislation.
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None Portrait Speaker 5
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Thank you, Miss Lou, and I do appreciate the intention behind this amendment. But the government cannot support it. The Medical Training Prioritisation Act is designed to support a sustainable medical workforce that can meet population health needs and deliver the best patient care, while reducing the UK's reliance on an unpredictable international labour market, and by creating a clear pathway for medical school to specialty training. We also strengthen domestic talent and improve retention. What matters is where the doctor is trained, not where they were born.

Data shows that domestic graduates are more likely to stay in the country they trained in than those trained internationally. Doctors trained primarily in the UK are also likely to be better equipped to deliver health care tailored to the UK's population, because they have stronger understanding of the UK specific epidemiology and NHS practice. In addition, the government sets UK medical school places based on future health system needs, student intakes and graduate outputs of overseas campuses are not included in our domestic workforce planning. If we prioritise British citizens for foundation training, regardless of where they studied, that would undermine our aim to build UK trained capacity while ensuring that we do not provide more foundation programme places than we need now.

I'd like to emphasise, and I think this is an important point, that prioritisation does not mean exclusion. Non-priority applicants can still apply for the foundation programme and will be offered places if vacancies remain after prioritise. Applicants have received offers. And I understand that this is already happening for the 2026 recruitment round. For individuals that do not secure a foundation post this year, there remain alternative routes to pursuing a medical career in the UK. These include obtaining GMC registration through the established pathways such as completing an approved internship in the country where they trained, and then entering the UK healthcare system through a locally employed doctor role or other non-training posts.

Um, I don't think new clause 113 despite this group has been moved. So on that point, I'd ask the member to withdraw her amendment.
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No.
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No.
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No.
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A. No.
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Dave. Robertson.
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No.
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No.
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To move.
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George Robertson.
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Thank you. Mr.. It's a pleasure to serve with you in the chair. These two clauses, the latter of which new clause 97 is in my name, deal with the publication of an annual report detailing NHS and social care provision for dementia care and how the government are performing against targets, standards and outcome measures set out in national guidance and frameworks relating to dementia services. And I'd like to thank three important charities working in this area the Alzheimer's Society. Alzheimer's Research UK and dementia UK, who all back these two new clauses.

The data requested is imperative to ensuring that government can measure and monitor progress against relevant national targets. Standards guidance, including the new modern service framework on dementia, the forthcoming CQC statutory guidance and outcome measures that may be set in future NHS operational planning guidance. This is crucial in improving transparency and accountability, allowing systems to see the full picture of dementia provision in England and highlighting challenge areas, or inequalities. Bill that we are debating in this Committee makes provisions for the establishing of information systems which collect, analyze and publish health and care data which is in the interests of the health service in England.

The proposed clause fits into that and would require data, as I say, on dementia, health and social care to be collected. I don't propose to speak too long, but I do want to make a couple of remarks on the current system. Sorry, the current situation, uh, which sets in context this these new clauses. A dementia data is not currently comprehensively or consistently collected, analyzed or published. This means that we cannot fully understand the provision of NHS care or social care for dementia, which is the biggest cause of death in the UK.

How national targets, guidance or frameworks are being met, or where inequalities or challenges lie. Uh, dementia, as well as being the leading cause of death. It is a disease that around 1 million people live with, and that is expected to rise to 1.4 million by 2040. And of course, impacts on so many more friends, families and carers. Uh, that are. Support those living with dementia. Over a third of people living with dementia in England do not have a formal diagnosis.

Those who do receive a diagnosis live with a condition for an average of three and a half years before receiving one Post-diagnostic care and support is often fragmented, leaving people affected by dementia without a clear point of contact, coordinated care or access to specialist support for those with complex needs. Recent findings show that only 14% of people with dementia and an advanced care plan in place, madam chair, this isn't good enough for the disease that affects so many people and as I say, is the leading cause of death in England.

Dementia puts immense pressure on our health care system. 1 in 6 hospital beds are occupied by someone living with the condition. Lord Darcy's investigation into NHS performance highlighted how, and I quote there is an important challenge to improve both the quality and quantity of care for people with dementia, and it's my position that adopting these new clauses within the bill would go some way to addressing that, and I urge the government to support it.
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None Portrait Speaker 11
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Here.
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None Portrait Speaker 5
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Thank you, Miss Lou. Um, and I think the um the amendments here and um may say the, the, the comments by the honourable gentleman, the member for Isle of Wight, um East are ones that we would, you know, largely agree with. He cites some organisations, Alzheimer's, UK, Alzheimer's research UK, dementia UK they are they and many other organisations working in this field. I think all members of Parliament across the House have worked with and value the work that they do. And as he rightly says, um, the work.

That they do to support all our friends, our families, and for people who are carers for people, um, with. With this disease and increasing prevalence, etcetera. Um, and he makes comments about diagnosis and the importance of getting that diagnosis early. We are moving forward, but I, we need to move as fast as we can. I think we would something that we would all absolutely recognise. So I completely understand the rationale behind the amendment and the urgency with which people want to, to have sight of this sort of information, but we do not think it's necessary.

And I will highlight why that is the case. Um, some of the data requested, such as details of research within the NHS and reports of that lived experience is already available and often, uh, is provided by our charity partners, um, as well as others and would lead to a duplication of work, other pieces of requested information, the data collection required to produce this report that has been asked for in this amendment would likely be very onerous, placing additional stress on already overstretched sector and would distract from the core task of improving dementia care.

It would be especially difficult to get consistent and comparable information from across the adult social care sector, where data can sometimes be fragmented, and instead we think that the modern service framework for frailty and dementia is a more helpful vehicle for setting national standards for dementia diagnosis and care, and will serve to hold the sector to account. An additional report, such as referred to in this amendment, would distract from this and result in duplication. Now, the framework is still in development and work is ongoing to review the relevant data metrics and the targets to inform it.

The framework will also set new national standards, and these will help inform meaningful analysis in the future. Something I think we are all very keen to see. So it is for those reasons, I would ask the honourable member to withdraw their amendment.
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None Portrait Speaker 11
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Mr. Robertson.
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Er, correct. Yes.
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No.
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No.
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No.
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Laura. Kirk-smith.
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No.
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Helen.
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Morgan.
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No.
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I.
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Sergeant. Joseph.
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No.
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I.
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Karen. Smith.
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No.
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Gregory.
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Stafford I.
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Liz Twist.
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Thank you chair. I wish to speak to clause 99, which is tabled in my name and it's about the merit um based of applications for doctors because the government have a scheme called the Preference Informed Allocation Scheme. And under this scheme, when a doctor's applying for a foundation post, they are allocated randomly to a job. They get to give a preference. But there's no there's no merit on which, there's no work that they can do to make them more likely to get where they want to be.

There's no certificates they can earn. There's no research they can do. There's no exam results they can get that will improve their chances. And that is fundamentally wrong. And so the government say that many people get their first choices. And of course that's true, which is great for them. But it's not great for those people who don't get their choices and have no control over their future. We had a very good debate attended by many people in this room.

Um, on this a few months ago, Madam Chair. And I think there was widespread agreement across both sides of the House that it was the wrong thing to do. The minister at that time said in January it was that they would keep the system under review. So has the minister reviewed the system?Does she believe that we should prioritise medical graduates and the most relevant qualifications, clinical experience and skills?Does she think that doctors should have the opportunity to have control over where they work in the country, and in what jobs they do, and that they should be able to work harder or get better results, or do additional activities in order to be able to get themselves that job that they want.

Or does she think it should all be just done by a computer?I'd be interested to have thoughts, but essentially what this amendment does is it makes it very clear our position, which is that meritocracy should prevail and people should be rewarded for the work that they do and the results that they get, and that we should be hiring the best clinical clinicians for the jobs that apply for them. So if you have a job in a sorry, you want to, doctor.
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None Portrait Speaker 11
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Um this.
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None Portrait Speaker 5
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So um I mean this this is an area of some discussion. Um and as we've started to partly hear today, but in terms of the bill, um, we don't think this amendment is, um, is, is, is necessary, um, where we are now to have this on the face of primary legislation, the Medical Training and Prioritisation Act establishes a statutory process for prioritising certain groups for training posts. And it's not intended to change eligibility for training nor the high standards applicants must meet. Um and in embedding some of these provisions in primary legislation would lead them in flexible to future workforce needs or standards of education and training.

And if Parliament wishes to change how recruitment processes themselves operate, this could be done as best done outside legislation through in established routes. I think it is worth, um, saying that since the what is called the preference informed allocation system was introduced in 2024 following extensive stakeholder engagement. Um, because the previous system was felt to be unfair and stressful for applicants and a lack of standardization across schools. Since that's been introduced. Um, as I understand it, 82% of applicants were allocated their first choice Foundation school this year, up from 71% in 2023.

Um, so NHS England has committed to review of the system, which will commence later this year. But prescribing the allocation method in legislation would pre-empt that review, limit our ability to make future changes to ensure that the system remains fit for purpose. On that basis, I'd ask the member to withdraw the amendment.
16:37
16:37
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None Portrait Speaker 11
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No.
16:38
None Portrait Speaker 1
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Division.
16:38
None Portrait Speaker 4
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Edward. Argar.
16:39
None Portrait Speaker 11
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Hi.
16:39
None Portrait Speaker 4
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Serena. Breckenridge.
16:39
None Portrait Speaker 11
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E no.
16:39
16:39
None Portrait Speaker 11
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No.
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None Portrait Speaker 4
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Laura. Kirk. Smith.
16:40
None Portrait Speaker 11
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No.
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None Portrait Speaker 4
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Adam. Morgan.
16:40
None Portrait Speaker 11
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Abstain.
16:40
None Portrait Speaker 4
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Peter. Princely.
16:40
None Portrait Speaker 11
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No.
16:41
16:41
None Portrait Speaker 15
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I.
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None Portrait Speaker 4
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Karen. Smith.
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None Portrait Speaker 11
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No.
16:41
None Portrait Speaker 4
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Gregory. Stafford.
16:42
None Portrait Speaker 10
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I.
16:42
None Portrait Speaker 4
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Liz. Twist.
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16:43
None Portrait Speaker 6
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Thank you chair. I rise to move in 94 which is new clause, um new clause 101 from group 94 which is in my name, madam chair, during a Westminster Hall debate in December, a government minister said, and I quote, in the coming months, in the first half of next year, I confirm that we will publish the acquired Brain Injury Action Plan item. Chair, we are now in the second half of 2026. Be familiar with the charity headway UK, which does phenomenal work supporting people affected by brain injury, including people in my own constituency.

Headway has called for the government to treat this as a priority, reiterating that every delay has real consequences and that survivors need support. Now, the Appg for acquired brain injury, which I know the member for Blaydon, has done a great deal to support, has called for the government to take action. So why isn't action forthcoming?Why has this government failed to deliver another policy on time?It's part of a pattern. The government spent a year writing a ten year plan.

It spent another year working on a workforce plan, which has still not been published. It's simultaneously imminent. As of 30 days ago, and non-existent today. It's behind on the Hughes report. It's modern service framework. It's universal mechanical thrombectomy 24 over seven. And it's practices and services and more. This clause simply commits this government to delivering on its promise to the 1 million people living with the effects of acquired brain injury. Madam chair, I struggle to see how the assistant whip can compel members to vote against that.
16:44
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None Portrait Speaker 1
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Liz Twist.
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None Portrait Speaker 5
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Well, I thank my friend the member for Blaydon and Consulate. And as has been highlighted by the opposition party, her work in this area and a commitment to, to to this area, as well as her work working on the Appg with Epic and organisations such as headway, which we pay tribute to for their work supporting patients, public and working with Members of Parliament and the government on getting this right is legion and she has made those comments on the House and I absolutely. Um, you know, the minister is continuing to work.

I will talk about the, the action plan. Um, as we go through, um. The issues raised by the amendment. Prevention, identification, acute treatment, rehabilitation, long term support, care planning, workforce capability data research, they are all among the topics as well as working across eight departments that are being considered. Um we are agreed that there should be a plan. I know the minister will be working on that and I will, of course, pass her comments to the relevant minister.

The question is whether the proposals contained within this amendment as we're discussing this bill, whether they are best placed to ensure that any plan will be robust, sustainable and timely for the patients it's designed to serve. Say to the honourable lady opposite that I think they are not. Firstly, in setting an arbitrary 30 day timeline for publication, we risk either an unnecessary delay or a duplicate plan. And secondly, I hope she can appreciate that we've engaged more widely than the three departments named in the amendment, with as many as I've said, as eight departments departments contributing, reflecting the wide range of areas that are impacted by brain injury.

So let me give the honourable member the assurance, I believe, that she is seeking, as others, that a plan will be published as soon as possible. It is being developed with the breadth, rigour and pace that the issue demands. It's receiving input from across the health system as well as other departments, as I said, that are responsible to support people with acquired brain injury and the departments that they rely on, as well as sector specific stakeholders and organisations. So I hope that the honourable member will work with us to support the plan once it's published and in the interests of our constituents who desperately require a new approach to Abi prevention, care and support, and that she will withdraw the amendment.
16:48
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None Portrait Speaker 5
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No.
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16:51
16:52
None Portrait Speaker 5
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Abstain.
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None Portrait Speaker 10
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Stafford I.
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None Portrait Speaker 4
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Liz Twist. No.
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None Portrait Speaker 6
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Move formally.
16:54
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None Portrait Speaker 14
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No.
16:54
16:55
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None Portrait Speaker 15
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I.
16:57
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None Portrait Speaker 10
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I.
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None Portrait Speaker 4
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Liz. Twist. No.
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None Portrait Speaker 6
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Thank you chair. I wish to speak to new clauses 105 and 106 tabled in my name. The government's ten year health plan says reducing hospital admissions is a key goal for the neighborhood health service, and these new clauses could help because they require the Secretary of state to support. self-care and health literacy in their neighborhood health plans and to conduct a safe and proportionate reclassification of some medicines. Pressure continues to grow on on GPS. Madam Chair, with the total number of GP appointments reaching almost 377,000,000 in 2025, these amendments are designed to relieve pressure on the health care system and allow people to take back control of their health care.

There are medicines that may be considered for reclassification from prescription only to be available from pharmacies without a prescription in the way that, for example, medication for migraine, which previously had to be prescribed but now can be bought with supervision from from chemists. How might measures to increase self or pharmacy care square with the Secretary of State's duty to improve health inequalities, as outlined in this bill. I would also make the point that it might help. To have a new neighborhood. The neighborhood health centers may help within the rural communities to have more availability of medicines close to people's homes.

Um, I'm going to stop there because I know we're running short of time, Madam Chair, but the principle is getting people the ability to take control of their own health care and be able to get access to medications that are currently a higher classification more easily, where that is safe to do so.
16:59
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None Portrait Speaker 5
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Thank you, miss Lord. Um and um Tony first of. All new clause 105. Can I opposite to the honourable Lady government assurance that the government is committed to supporting self-care. Community pharmacies already play a vital role here, offering accessible advice and, where appropriate, over medicines for minor ailments and through pharmacy pharmacy. First, patients can walk in or be referred by NHS one one GPS and A&E to a pharmacist for expert support, including access to treatment under the seven clinical pathways, helping people get the right excuse me quickly while easing pressures in other parts of the NHS.

However, we do not think it's necessary to specify health literacy and self-care in neighbourhood health plans. The Neighbourhood Health framework is clear that Icbs and local authorities should work together through health and wellbeing boards to develop locally led neighbourhood plans to improve local population health and reduce health inequalities, and the framework sets out what should be included in these plans, and is clear that neighbourhood health plans should be informed by local joint strategic needs assessments. If local areas think they would benefit from a greater focus on self-care and health literacy, then they are, of course free to do so.

But that is for them to decide based on the understanding of their local area needs and this provision permissive approach recognises that local leaders know their community best and therefore are best placed to determine how best to meet those population needs. We are not setting a ceiling for what local areas can deliver, and this approach would drive progress more than dictating an overly prescriptive national approach. For these reasons, we do not think it is helpful or appropriate to define the contents of neighborhood health plan in legislation.

Moving to new clause 106. Um, the. It recognises the important role that medicines reclassification can play in supporting self-care, improving access to treatment and helping patients manage their health more effectively, where it is safe to do so. And there is an established, evidence based, proportionate framework for medicines reclassification already in place, which is overseen by the MHRA. The UK is already a world leader in medicines reclassification. The MHRA has reclassified more than 140 medicines over the last 30 years across varied therapeutic areas, including pain and inflammation, and continues to approve new reclassifications each year.

So the government has taken proactive steps to support further reclassification. Um and um, the MHRA has also worked closely with industry partners in recent years to streamline and improve the reclassification application process to ensure that it is as efficient as possible for applicants while ensuring high clinical standards, creating an additional statutory reporting requirement would not improve the assessment of individual applications, nor would it accelerate access to medicines for patients. Instead, it risks duplicating activity already undertaken in recent years and diverting resources from the effective operation of the current system.

And for that reason, I hope the honourable member has a reassurance she needs and feels able to withdraw her amendments. Doctor Caroline Johnson.
17:02
None Portrait Speaker 6
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Please.
17:02
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None Portrait Speaker 10
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AKA I.
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17:03
None Portrait Speaker 14
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Abstain.
13:44
None Portrait Speaker 4
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Peter. Bernstein.
13:44
None Portrait Speaker 10
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No.
13:44
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None Portrait Speaker 10
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I.
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None Portrait Speaker 4
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Liz.
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None Portrait Speaker 10
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No.
13:45
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None Portrait Speaker 10
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I.
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None Portrait Speaker 4
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Liz. Twist.
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None Portrait Speaker 14
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No.
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None Portrait Speaker 14
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Thank you.
13:45
13:45
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None Portrait Speaker 14
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Mr..
13:45
None Portrait Speaker 5
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Thank you. Mr.. Um, this is a really important subject. As everyone approaching the end of their life deserves dignified, compassionate and high quality palliative and end of life care. Hospices do provide extraordinary care. And the honourable member is right to highlight the issues this sector faces and why the government is committed to developing a modern service framework for palliative care and end of life care. The final framework will be published in the autumn, specifically on new Clause 108.

This would require integrated care boards to collect and report data on people who died while waiting for end of life care. It would also require the Department of Health and Social Care to publish that information nationally. Whilst New clause 109 would impose a single statutory three year funding period on hospice funding, I think both are likely to be answered by work already underway or included in the modern service framework on funding. We do recognise the sector faced a serious challenge and the Public Accounts Committee found in March that Integrated Care Board funding ranges from 0 to 80% of an individual hospices income, and that commissioning relies on grants and block contracts.

There are wider funding issues, too, such as the reliance on historic grants, and the government is acting on these issues. We've provided around £80 million over three years for children and young people's hospices, at least 26 million to 20 289 adjusted for inflation and a separate 125 million capital boost for adult and children and young people's hospices. This is the largest investment in hospices for a generation. The MSF will also support commissioning away from grants and block contracts to sustainable contracts, based on integrated assessment of population need, and it will consider contracting arrangements more widely, including a move away from short term grant funding.

As part of the more comprehensive reform the sector agrees it needs. We're also strengthening the data and evidence. We commissioned the National Institute for Health and Care Research Policy Research Unit to build the evidence base on palliative and end of life care, including on inequalities in access and the identification of need. We also expect the MSF give us better insight into the performance of the system, its metrics and its accountability framework is being co-developed with people with lived experience and with partner organisations from across the sector.

It will measure identification, access, quality outcomes and inequalities. In the context of this ongoing work. I do not believe the amendments are necessary. I think the MSF will give the House, the public and far more comprehensive picture of access to care than a single count could. It will also do so as part of improving the entire patient journey. For people who need palliative and end of life care. And because it's a non-statutory approach, there will be more flexibility to adapt and change over time, rather than the system being required to follow requirements set out in primary legislation.

I hope this gives the honourable members the reassurance they need to be able to withdraw their amendments.
13:46
None Portrait Speaker 14
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Helen Morgan.
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I.
13:47
None Portrait Speaker 1
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The contrary. No.
13:47
None Portrait Speaker 14
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No.
13:47
13:47
This debate has concluded
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