Patient Safety Review

Bernard Jenkin Excerpts

Monday 6th July 2026 Commons Chamber

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I am grateful for this opportunity to evaluate the Dash review of patient safety, and I thank the Minister for the meeting with her this afternoon.

I hope that the House and Penny Dash will forgive me, but in the interests of brevity and clarity, I shall be direct. Whenever asked to justify the abolition of the Health Services Safety Investigations Body, Ministers refer to Dash, but Dash fails to make the case for what it recommends. This new clinical incident investigator was established less than three years ago. HSSIB is a new concept in healthcare, conceived to challenge the culture of denial and blame in the NHS. It is proving itself, even with its very limited budget. One early report on aortic dissection led to 300 more people receiving lifesaving treatment. The Minister now has a list of key recommendation impacts produced by HSSIB. A lot of them may seem small or piecemeal, but so far it is only a small body.

After a boy suffered an avoidable death from cancer, HSSIB recommended to NHS England a new community language translation and interpreting services framework so that non-English speaking patients would get appointment letters for their children that they could read and understand. HSSIB recommended a protocol between prisons and ambulance services to avoid wasting ambulance time and new guidance for non-accidental injury of babies in emergency departments where no specific guidance had existed before.

The Dash review shows no understanding of HSSIB’s purpose and no comprehension of coherent safety systems management. Dash gets facts wrong and misinterprets the law, either through a failure of understanding or because the recommendation to abolish HSSIB somehow reflected the desired outcome of the review, regardless of the facts.

I will set out some specific questions, most of which the Minister has had in advance. If she does not have enough time to respond, I look forward to discussing them at a future meeting that we discussed having.

[Sir Jeremy Hunt (Godalming and Ash) (Con)]

My hon. Friend is making a powerful case. Does he agree that one of the common themes in all the maternity scandals that we have been discussing in recent weeks, sadly, has been how a blame culture in the NHS makes it hard for NHS staff to speak openly about why tragedies have happened, and that that is why they welcome HSSIB, with its safe space protections? Is he worried that that could be undermined by putting HSSIB into the Care Quality Commission, which has a legal duty to act on information it receives, therefore creating the worry for people talking to HSSIB that the information that they give to it may no longer be protected in the same way?

[Sir Bernard Jenkin]

I 100% agree with my right hon. Friend. He will note that I will pick up on those points during my remarks.

I come back to the questions that I want to put to the Secretary of State. First, if HSSIB’s investigations are intended to continue unaffected by the transfer to the CQC, why bother with the expense of the transfer? Are Ministers simply using Dash as the pretext for what people in the Department or elsewhere in the NHS would like to have?

HSSIB was deliberately started very small, but the intention was that over time it would take over more investigations in health and replace the need for wasteful, lengthy, inexpert ad hoc public inquiries. Over the years, inquiries have proved to be a chaotic means of investigation, assembling expertise from scratch, which is then lost after the inquiry, and failing to command public confidence or to fix the system. That is why, after the 1999 Paddington rail crash, the Ladbroke Grove inquiry in 2001 established the rail accident investigation branch. Since then, despite many fatal rail accidents, there has been no public inquiry into a rail crash—nor has the public felt the need to demand one—and rail safety has improved.

Given that HSSIB is expert, full time, and can conduct much cheaper and quicker investigations than public inquiries, how can Ministers accept the Dash recommendation to abolish it? Why not consider expanding HSSIB to avoid the need for so many costly public inquiries?

Dash complains about there being far too many recommendations—yes, there are—but, as Dash itself enumerates, it is the 30 public inquiries that, in its language, have “cluttered” the “landscape” with some 1,400 recommendations over recent years. HSSIB is therefore not the source of those recommendations. In HSSIB’s first 34 months of operation, it has produced only 56 recommendations. How can Ministers use that reason to justify HSSIB’s abolition?

Dash refers more than once to

“quality (including safety) of care”.

That elides quality of care with safety. In any other safety-critical industry, safety is seen as a distinct, separate and overriding priority. It is telling that in the report, the words “including safety” are added merely in parentheses, as though safety is ancillary to quality, but that becomes justification for rationalisation while actually compromising safety.

Safety system management is intrinsic to safety and public confidence in other safety-critical activities, such as aviation, but this is alien to NHS culture. I therefore ask the Minister again: without HSSIB, which independent body will promote a coherent understanding of safety system management in health, and who is to hold the NHS and Government to account for safety failures?

[James Naish (Rushcliffe) (Lab)]

Will the hon. Member give way?

[Sir Bernard Jenkin]

Very briefly—I have a lot to say.

[James Naish]

In that case, carry on.

[Sir Bernard Jenkin]

I thank the hon. Gentleman.

Recommendation 1 in the Dash review says that the new National Quality Board should

“avoid unfunded mandates being imposed on the system without due consideration”.

Public inquiries have certainly made well meaning but unaffordable recommendations—I think of the Francis inquiry recommendation on blanket standards for minimum staffing—but it is wrong to see safety as a cost in opposition to other benefits. The cost of safety failures is astronomic, with NHS clinical negligence costing £3.6 billion a year, despite all the public inquiries. Effective safety management is about the cost-effective management of risk, not risk elimination at any cost. If the air accidents investigation branch did not balance costs with effective risk management, aeroplanes would not fly. Can the Minister therefore point out which of HSSIB’s recommendations have been too expensive to implement? If not, where is the justification for abolishing HSSIB?

Neither the NQB nor the CQC should control investigations. The AAIB cannot be prevented from making independent recommendations by the Civil Aviation Authority, the Transport Secretary or airlines themselves. Why should the NQB, which will be subject to political direction, be allowed to decide what safety recommendations should be made and what should be investigated, as Dash recommends?

On page 31, Dash incorrectly states:

“HSSIB was not able to retain the maternity programme because the Health and Care Act 2022 does not make provision for maternity investigations under HSSIB.”

Why have the Government accepted that assertion as true? It is wrong in fact and law. The new statutory HSSIB did not take on maternity and newborn safety investigations, because they were commenced without the safe space protections, so their evidence is available for legal proceedings. That is not how HSSIB operates. Since 2023, HSSIB has been conducting its own maternity investigations. Indeed, when the Amos review was established, it took on the relevant investigations from HSSIB and then relied on HSSIB for assistance with them.

With sufficient resources, HSSIB could conduct all maternity investigations much more effectively than the maternity and newborn safety investigations programme. Amos reported that MNSI investigations are not trusted by families, as my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) was saying, and are not consistent or effective in identifying learning or providing accountability. Amos also says that families should have access to an independent investigation if they lose confidence in the local investigations. Without HSSIB, who will provide those independent investigations?

Finding 6 accuses HSSIB of having “expanded” its

“scope of work beyond the original remit…For example, HSSIB was originally established, along the lines of safety investigatory bodies in other industries, to look at specific cases or incidents of severe harm, but it has since broadened its work into making more systemic recommendations.”

That is what Dash says. It is complete nonsense. HSSIB is exactly equivalent to the AAIB, the marine accident investigation branch and RAIB, and was, like them, set up to conduct systemic investigations. That is why they are such effective bodies. The Health and Care Act 2022 does not limit HSSIB investigations to individual incidents. There is no reference whatsoever to “severe harm”, as Dash puts it, in the 2022 Act. It was always intended by Parliament that HSSIB should make systemic recommendations arising from the investigation of specific incidents or groups of incidents. I can say that with authority because it was my Select Committee that recommended HSSIB in the first place, and I also chaired the pre-legislative scrutiny Committee on the draft legislation, so how can Ministers give any authority to the Dash review, which claimed that HSSIB has expanded its remit, when it has done no such thing?

Recommendation 3 proposes:

“Most investigations into safety incidents should continue to be managed within provider organisations”.

This really is the fundamental flaw in Dash. Recent maternity investigations conducted by trusts have highlighted the deficiency of provider-led investigations, as Ockenden and Amos have pointed out. Do the Government accept that investigations by provider organisations are inherently conflicted? Just ask the clinicians, patients, families and patient safety organisations what they think about trusts marking their own homework. None of them has confidence, because providers are keen to protect themselves from litigation and reputational damage. How can Ministers accept the Dash recommendation that we should rely on investigations conducted by provider organisations?

[Anna Dixon (Shipley) (Lab)]

I commend the hon. Gentleman for speaking so clearly about why having an independent HSSIB—independent of those providers—to investigate is so important. Time and again, we hear about devastating failings in the NHS. He alludes to maternity services, but we could add to the list infected blood and pelvic mesh. Does he agree that professionals and those working inside the NHS must be able to speak freely when things go wrong in order to learn lessons, and that that is only possible with an independent investigating organisation?

[Sir Bernard Jenkin]

I thank the hon. Lady for that intervention. Only an independent investigator can find the causes of the incident that may be part of the culture or practice of that provider, or of the system as a whole. It is like suggesting that airlines or aircraft manufacturers can protect passenger safety without the independent accountability provided by the AAIB. Of course, providers should have the capacity and capability of conducting patient safety investigations, but they must know that HSSIB can and will look at that work and will hold them to account.

Recommendation 3 also says that HSSIB should continue as what it calls

“a centre of excellence for investigations”

in the CQC, but I am afraid that this is just a sop. The CQC, as was pointed out by my right hon. Friend the Member for Godalming and Ash, is a regulator and compliance enforcer, not an investigator. How can the CQC also be an independent investigator? Dash also says that the CQC internal successor should collaborate through the NQB to agree the scope of any investigations it carries out and agree the recommendations. Dash is effectively saying that CQC investigations will be overseen by the NQB. That is a direct attack on the independence of investigations.

Can the Minister explain who in future will conduct independent and unconflicted investigations into safety incidents in the NHS? For example, how would an investigation under the CQC be free to find that the CQC inspections themselves were causing unintended harm to patients, or is it back to the misery of litigation through the courts and more public inquiries?

The recommendation also makes no reference to the statutory safe space raised by the hon. Member for Shipley (Anna Dixon) that provides for protected disclosure by patients and their families, clinicians and others in safety investigation bodies. It is a crucial safeguard, allowing people to speak. It allows for the duty of candour. I would just point out that the duty of candour does not work if it is just imposed on people. People cannot be forced to incriminate themselves. If placed under the CQC, confidence in the safe space investigations will collapse—and back we go to public inquiries.

The Health Bill does attempt to address this by replicating the 2022 Act’s safe space provisions, but that Act also provided for disclosure in certain circumstances, which is allowed on the basis that the benefits for the safety of patients outweighs any impact on current and future investigations. But under this Bill, who will decide what protected information can be disclosed? How will the CQC give the same confidence that the safe space is not being compromised as HSSIB?

Finally, Dash fails to look at the comparative cost of HSSIB investigations versus the cost of public inquiries. HSSIB at the moment only costs £6.3 million per year. To save money, the Secretary of State should request that HSSIB conducts far more investigations into matters which he thinks are important, provided that he also provides the funding for the necessary capacity. HSSIB, for example, has conducted eight investigations into mental health suicides since 2023. Each was completed in a few weeks or months, costing a total of £850,000. In comparison, the Lampard inquiry into the Essex partnership university trust in my constituency—investigating the same problem—is expected to cost more than £5 million. Ockenden cost £14 million. This is very far from the best use of resources for conducting investigations.

So I ask the Minister, why have Dash and the Government ignored the whole question of HSSIB’s value for money? Even if HSSIB only saves a fraction of the £3.6 billion in costs of clinical negligence, it will pay for itself many fold. I do hope that Ministers will reconsider the whole issue, reflecting on the fact that none of the Royal colleges, nor any of the patient safety organisations, nor the all-party group on patient safety support this unjustifiable policy.

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[Preet Kaur Gill]

I thank my hon. Friend for her contribution—she is absolutely right. I take accountability very seriously and am going to talk about it in my remarks in this debate. Far too often, we see so many inquiries and so many recommendations but nobody taking responsibility for implementing the change. In the end, patients have to feel that things have changed, not that we are just having further reports and recommendations.

The Penny Dash review examined six organisations that are overseen by the Department: the Care Quality Commission; the National Guardian’s Office; Healthwatch England and the local Healthwatch network; the Patient Safety Commissioner; the Health Services Safety Investigations Body; and the patient safety learning functions of NHS Resolution. The review’s conclusion was clear. The problem is not that people working in patient safety lack commitment—we all know that there are dedicated people across the system doing important work every day—but that the system around them has become too cluttered, complex and difficult for patients, staff and leaders to navigate.

We inherited a landscape with more than 70 routes for patients and service users to raise concerns or provide feedback, and around 40 public bodies with a formal role in quality and safety. That complexity does not automatically make patients safer. It can make responsibility unclear, create duplication and make it harder to ensure that learning leads to improvement. A cluttered landscape, as we would all agree, is not an effective landscape.

The hon. Member for Harwich and North Essex asked me about the expertise in HSSIB, the full-time job that it does and whether it could undertake investigations more cheaply and quickly than public inquiries. The investigation function within the CQC will be expert and full time, and it will be able to conduct investigations in the same cheap and quick way that HSSIB does now. In future, there will be the same opportunity to use the CQC investigation function instead of needing a public inquiry as there is currently with HSSIB.

The review also found that too many recommendations are generated through reviews, inquiries and investigations, as the hon. Member said, without enough clarity on ownership, prioritisation, implementation and impact. This is the fundamental point: recommendations alone do not make patients safer; change does. That is why the Government have accepted all nine recommendations of the Dash review.

The hon. Member asked how the CQC will provide the same confidence that the safe space is not being compromised. The criteria for disclosing protected information outside the investigative function are set out in the Bill. Those criteria set a high bar for any disclosure—as high as it is currently with HSSIB—and the CQC will publish further guidance setting out much more detail. As the Bill sets out, the CQC will appoint a responsible person who will decide whether the case matches the criteria and whether it warrants information sharing outside the safe space. That person is likely to be the CQC’s chief executive officer.

The hon. Member asked why the Dash review and the Government have ignored the whole question of HSSIB’s value for money. Let me be clear: the Dash reforms are not about saving money; they are about strengthening patient safety and patient voice across the system. The abolition of HSSIB and the transfer of its functions to the CQC play an important part in making the system of patient safety much more effective. Safety is the issue, not money.

Accepting recommendations is the beginning, not the end. Patients who have suffered harm, families who have campaigned for years and staff who have spoken up do not want another report sitting on a shelf. They want evidence that the system can listen, learn and prevent harm from happening again. I want to be absolutely clear: every organisation in the system has a responsibility to meet that challenge. Patient safety cannot be something we support in principle but resist when it requires us to change.

No organisation, however established or well-intentioned, should believe that learning and improvement only apply elsewhere. That is why we are streamlining and strengthening the patient safety landscape. The hon. Member mentioned the National Quality Board. We have revitalised the board by giving it a stronger role in providing a single, authoritative view of quality across the system. That will help reduce duplication, bring greater clarity to recommendations and ensure that effort is focused where it has the greatest impact. All hon. Members recognise that we need fewer recommendations because we know that they disappear into the system. More recommendations are needed that are owned, tracked and delivered.

I recognise the concerns raised by the hon. Member in respect of the Health Services Safety Investigations Body. We had a constructive conversation earlier today. On his point about the accusations that HSSIB had expanded the scope of its work beyond its remit, he explained to me in detail how HSSIB’s inception came about. The Government have accepted the Dash recommendation that HSSIB’s role as a centre of excellence for investigation should continue, and clarified the remit of any future investigations. I think that the investigation function with the CQC will perform the role of a centre of excellence for investigations.

HSSIB has developed important expertise in understanding why things go wrong and identifying system-wide learning, and I acknowledge that work. The question before us is not whether investigations matter —of course they do—but how we ensure that investigations lead to action, because learning without implementation does not improve patient safety. The Dash review recommended transferring HSSIB’s functions to the Care Quality Commission, while maintaining a dedicated investigation capability. I understand why colleagues will want reassurance on that, because, as the hon. Member said, independence, transparency and trust are essential in patient safety investigations, but so is impact. The purpose of these reforms is not to weaken investigation, but to strengthen the link between investigation, learning and improvement. We need a clearer route from identifying problems to making recommendations and ensuring that someone owns delivery and that patients see change.

The hon. Gentleman asked if I could explain who will conduct future investigations into safety in the NHS if the Dash review is implemented. The investigation function in the CQC will have autonomy to launch investigations into any part of the health system and will be able to make recommendations on any part of the system, just as HSSIB does now. There will be no barrier to an investigator finding out that CQC inspections are causing unintended harm. If they are, and if the investigator feels that a recommendation for change should be made, they will make it. There will be no need for litigation through the courts, and insights gained from investigations will continue to inform recommendations concerning the Care Quality Commission’s regulatory functions.

The Bill also allows for the investigation function to make recommendations to the CQC in its report, and the CQC would be legally required to respond to such recommendations. I hope that the hon. Member is assured that we will work carefully with colleagues, patients, staff and system leaders as these reforms are implemented.

The same principle applies to patient voice. Patients do not share their experiences simply for the system to record them; they do so because they want to see things change. Listening matters, but acting on what we hear is what makes patients safer. That is why we are ensuring that patient experience is closer to where decisions are made, with commissioners and providers responsible not only for delivering services, but for listening and responding. The Patient Safety Commissioner will continue to champion patient voice on medicines and medical devices and report directly to Parliament.

[Sir Bernard Jenkin]

I am listening very carefully to what the Minister is saying. She has engaged positively with the questions I have asked, but she has actually made the case for keeping HSSIB separate. Will she reflect on that? If the only thing she wants is for the CQC to own the recommendations, she should amend HSSIB and say, “The CQC must ensure that the recommendations are implemented.” In fact, the recommendations are directed at Ministers and bits of the health service that are answerable to her and to the Secretary of State. We should keep HSSIB separate, but by all means let us discuss how to ensure that the recommendations are implemented properly.

[Preet Kaur Gill]

I am grateful to the hon. Member for his comments. I did recognise the reason for keeping the functions separate, but just because they are part of the CQC does not mean to say that they do not have their independence. I have pretty much set out the powers that they current have and what they will be able to do, but they do not prioritise investigating the situations that we spoke about, such as “never events”. It is not simply about the investigation; it is about how we get those “never events” to lead to learning and change in the system. How do we hold the system to account to ensure that the very thing that the regulator recommends is implemented? What that journey looks like for patients will be far more significant, as opposed to those bodies simply doing investigations that lead to further recommendations.

National Maternity and Neonatal Investigation

Bernard Jenkin Excerpts

Tuesday 30th June 2026 Commons Chamber

[James Murray]

My hon. Friend is absolutely right. I again put on record my thanks to her for supporting families in their fight for justice and accountability. She is absolutely right to say that families have driven this work. It is families who have had the determination, persistence and stamina. It is quite hard to imagine people having those qualities when they are dealing with such unimaginable pain that lasts their whole life, but that is what families have done. That is why I feel that it is our responsibility to ensure that they do not have to drive these changes alone. We as MPs, Government Ministers and Secretaries of State support families in the drive for accountability, justice and change. My hon. Friend is absolutely right; this must be about fundamental reform to all parts of the system, including the regulators, which have let women down far too often.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

Will the Secretary of State keep an open mind as to whether it is right to abolish the Health Services Safety Investigations Body, which was specifically designed to provide for a duty of candour? Clinicians would be obliged to give evidence to HSSIP; they could not refuse, and there would be criminal penalties if they did. As we have already established, the duty of candour, as conceived in the Hillsborough law, does not work, and I suspect there will be no improvement unless HSSIP is allowed to carry out completely independent investigations that have proven that they can carry the confidence of the public, patients and clinicians. Will the Secretary of State keep an open mind about keeping HSSIP?

Puberty Blockers

Bernard Jenkin Excerpts

Tuesday 23rd June 2026 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I beg to move,

That this House calls on the Government to take steps to prevent the PATHWAYS clinical trial into the effect of puberty suppressing hormones on children with gender incongruence.

Before I start, I declare an interest as an NHS consultant paediatrician, a member of the Royal College of Paediatrics and Child Health, and a member of the British Medical Association. It is also important for us to recognise at the beginning of this debate that we are talking about the protection of children—vulnerable children who are troubled, and who need our care and compassion and the very best quality of healthcare.

The healthcare of children distressed about their gender is an area in which attempts have been made to shut down debate with threats and accusations of transphobia; we saw the way that the hon. Member for Canterbury (Rosie Duffield) was treated when she raised concerns. As adults and as elected Members of this House, we have a duty to safeguard children in our country. That means protecting them from adults who—with whatever motivation, good or bad—could do them harm.

As a children’s doctor, I have recruited patients for trials, and I have cared for children and babies participating in clinical trials. I recognise the value of a well-designed clinical trial in improving clinical care, but today the House is not being asked to consider the principle of performing clinical trials in general, or on children in particular—I hope we can all agree that a well-designed trial can improve care. Rather, we are being asked to consider the Pathways trial: whether it meets ethical tests, what it does, the cohort, the protocol and the consent. I will go through each of those points in turn.

The Pathways trial is part of a group of studies run by King’s College London and funded by the Government. So what does it do and why are we so concerned? The trial will take 226 children who are physically healthy—who are developing normally—and inject them with powerful drugs to delay that normal development in a way that may weaken their bones, affect their ability to think, damage their sexual function, and leave them unable to have children of their own.

We are told that the purpose of this is to treat a diagnosis of gender incongruence. So what is gender incongruence? The International Classification of Diseases states that it is

“characterised by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex, which often leads to a desire to ‘transition’”.

We know that gender incongruence is a condition that is subjective. It is based on how someone tells us they feel. There are no blood tests and no lab markers that can be used to diagnose it. As a paediatrician myself, I understand that how patients feel, particularly in relation to their mental health, is very important. We know from the Cass review that the vast majority of children with gender incongruence will get better on their own. Again, as a paediatrician, I am used to providing supportive treatment for conditions such as respiratory viruses and gastroenteritis, which generally get better on their own, but I am not used to giving powerful drugs to children that can cause permanent long-term damage for subjective, self-resolving difficulties during adolescence.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

As a consultant paediatrician, my hon. Friend will be able to give a definitive view on this matter. Some who campaign for this treatment and therapy argue that the effects of gene therapy are reversible. To what extent are they reversible? Should we be treating this as a reversible treatment? My hon. Friend has referred to permanent damage. Can we try to agree across the House at least on this matter: that gene therapy applied to children is not reversible?

[Dr Johnson]

This is not a form of gene therapy. It is a medication that is a GnRH analogue, and what it essentially does is delay puberty. It was designed as a drug to treat children who go into puberty much earlier than they would be expected to, and to delay it until, as it were, the right time. The effects of the use of puberty blockers in older children and for a much longer period, at an age when they ought to have started puberty, are not fully understood.

Health Bill

Bernard Jenkin Excerpts

2nd reading
Monday 1st June 2026 Commons Chamber

[James Murray]

I am going to make some progress.

Following Dr Dash’s recommendations, the Bill will embed the mission and functions of the Health Services Safety Investigations Body into the Care Quality Commission to establish a clearer link between investigating safety concerns and increasing the quality of care. We will ensure that we protect the principle of a safe space for people to share their concerns. To ensure that patients are heard at every stage, from commissioning to delivery, we will make sure that patient feedback is embedded alongside decision makers at every level.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I am most grateful to the Secretary of State for giving way, and I congratulate him on his appointment. He has inherited this policy—it is not his own. I assure him that the abolition of the Health Services Safety Investigations Body is a dreadful mistake, because which other investigative function in the healthcare system is completely unconflicted in what it does? By abolishing HSSIB he is taking its functions into the CQC, which is a regulator and compliance enforcer, not an investigator, so that there is no longer any independent, unconflicted body conducting healthcare investigations. Has he consulted the royal colleges about this? I have not spoken to a single royal college that is in favour of the abolition of HSSIB.

[James Murray]

As I made clear, we will protect the principle of a safe space for people to share their concerns. The investigatory function will remain protected within the CQC. The benefit of embedding the HSSIB in the CQC will be to establish that clearer link between investigating safety concerns and increasing the quality of care. That is something on which we can all agree.

--- Later in debate ---

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I very much welcome the idealistic vision that the hon. Member for Dudley (Sonia Kumar) sets out for us, but I am afraid that it is far from what is in this Bill. Like my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), I shed no tears for the demise of NHS England; it was never an organisation independent of politics, but always looked upwards at the political leadership and did what Ministers wanted. It was created as an unnecessarily complex organisation. However, I ask myself whether reasserting the principle—unspoken in this debate—that somehow the man in Whitehall knows best is not reverting to the previous failures of the system, when we need to be looking for a much more organic and local system.

I speak in this debate to lament the demise of HSSIB, as proposed in this Bill. It is a profound mistake. It represents a downgrading of safety as a priority in this Government’s health policy, because HSSIB is the only organisation that can independently investigate safety incidents in the NHS and is not conflicted by any other function or role. It does not compromise any other functional role in the NHS, yet the Government have decided to get rid of it. It will not save any bureaucracy. This tiny organisation costs a few million pounds, yet it is pioneering a new system of safety management in the NHS that the NHS culturally barely understands.

We forget that NHS reform is really about people and leadership, not management structures and organisational structures. HSSIB was one of the catalysts that was beginning to transform attitudes towards safety. It was a safety valve for clinicians and patients and their families. It was the one place they could go to tell their story, without fear nor favour, in a safe space, and it was instructive.

[Saqib Bhatti]

My hon. Friend is delivering a passionate speech. Is he reassured in any way by the changes the Secretary of State alluded to that will help strengthen the patient voice?

[Sir Bernard Jenkin]

Well, no, and the abolition of HSSIB is an example of that. It was the one organisation that could independently hold any part of the system to account. If its functions are transferred to the CQC, those functions will be compromised in their independence —and they are explicitly intended to be compromised. The Government set great store by the Dash review, but it is a flawed and dishonest document that misleads the public by what it says. The Dash review is not about patient safety. It puts far more emphasis on quality. It elides quality and safety, which are not the same thing, even if many people believe them to be so.

That concern is reflected by the fact that there are too many recommendations flying around and too many resources being diverted to recommendations that the NHS does not want to implement. All those recommendations are coming from this plethora of public inquiries that Secretaries of State keep setting up. Surely we want to replace the public inquiry system with something much more effective, as we did for rail accidents. After the Ladbroke Grove rail crash, we replaced public inquiries with the rail accident investigation branch in the Department for Transport.

There has not been a public inquiry into a rail accident since the Ladbroke Grove inquiry, because we have the rail accident investigation branch. There has not been a public inquiry into an aviation accident since 1972, because we have the air accidents investigation branch. Why can we not have the same principle for safety in healthcare, instead of this ridiculous Dash review, which is full of falsehoods and misleading statements? I will give the House just one example of that. The review says:

“HSSIB was not able to retain the maternity programme because the Health and Care Act 2022 does not make provision for maternity investigations under HSSIB.”

That is wrong. It had to give them up, because it did not have the capacity to do them.

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[Andrew George (St Ives) (LD)]

It is an enormous pleasure to follow my hon. Friend the Member for Gloucester (Alex McIntyre)—I call him my hon. Friend as he is a fellow member of the Health Committee.

The 2012 Act was mentioned earlier, and I am one of the few Members who was in this House when it was passed. I was sitting on the coalition Benches at the time, but I eventually voted against the Second Reading and the Third Reading of the Bill because it broke the coalition agreement. We had agreed that there would be no top-down reorganisation, but it was the biggest reorganisation that the NHS had ever seen. Although the Liberal Democrats made the Bill significantly less bad—and I congratulate all those involved in that—there was still far too much that damaged the NHS. I welcome this Bill as it addresses some of those deficiencies.

On the points made by the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), I strongly agree about the abolition or the merging of the Health Services Safety Investigations Body into the CQC.

[Sir Bernard Jenkin]

Clause 59 states:

“The Health Services Safety Investigations Body is abolished.”

It is going to be abolished.

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[Ian Sollom (St Neots and Mid Cambridgeshire) (LD)]

Reducing duplication, streamlining priorities, and getting resources close to frontline care—these are reasonable aims. My concern is that in pursuing simplification the Bill makes a series of choices on patient safety that it is not clear have been fully thought through and that risk repeating mistakes that this country has paid a very high price to learn from.

Through successive inquiries, including Mid Staffordshire, Morecambe Bay, Shrewsbury, Ian Paterson—I could name more—Parliament has repeatedly recognised that the NHS cannot be relied on to scrutinise itself. Each found the same pattern: concerns present within the system but not acted on, problems developing in isolated services, and a culture in which those who raised concerns were treated as the difficulty rather than as sources of vital information.

Yet the Bill’s general approach is to remove independent scrutiny rather than improve it. I am not arguing that all the bodies that have been created—Healthwatch, the National Guardian’s Office, which has been absorbed into NHS England, which will now be abolished, and HSSIB—have worked exactly as intended. In fact, I have been working with families and others affected by failings at Cambridge University Hospitals trust. It has been suggested that the trust has not published independent information, commissioned by the trust, that found 32 missed opportunities to identify and address concerns about a paediatric orthopaedic surgeon between 2012 and 2024, and children were harmed as a result.

[Sir Bernard Jenkin]

I am most grateful to the hon. Gentleman for raising the HSSIB question. The Dash review accused HSSIB of exceeding its remit. That is completely wrong in law, and it was always intended to look at systemic problems across the system. The new investigation function in the CQC will not be able to do that, because it will not be independent.

[Ian Sollom]

The CQC and HSSIB themselves have expressed concerns about how those two organisations might be brought together. The AAIB is separate from the Civil Aviation Authority, and that model was created for a good reason. The hon. Member made good points about the statistics on that earlier.

Returning to the case I was talking about, a clinician at the trust who did raise concerns formally in 2015 was simultaneously subjected to disciplinary proceedings and told by the trust that they did not want to hear any more complaints. I wish I could say that I had not heard similar stories from NHS staff several times in a little under two years as an MP.

Just because there are some flaws in those independent systems for the NHS, it is not a reason to remove the independence. That would represent a return to conditions that so many of the inquiries warned us about, and I think that patients would rightly question whether lessons have really been learned.

As the Bill proceeds to Committee stage, I urge the Government to ask a simple question about each body that it proposes to absorb or scrap: not just whether the function will still be performed somewhere but whether it will be performed with genuine independence from the organisations that it scrutinises. That independence has been hard-won, and I hope that Ministers will reflect on that carefully before legislating to remove it.

Puberty Suppressants Trial

Bernard Jenkin Excerpts

Wednesday 17th December 2025 Commons Chamber

[Wes Streeting]

I am grateful to my hon. Friend for that question. I recognise that the decision I took, within days of coming into this office, was received by trans people in particular, and the wider LGBT+ community, as a negative decision that detrimentally impacted their rights and identity. That is why it was an uncomfortable decision for me to take; I knew how it would be received and had to balance up the risk. I believed—and still believe, by the way—that it was the right thing to do, for the right reasons: a clinically led decision.

When it comes to the care and health of children and young people in particular, I make no apology for exercising extreme caution. I do want trans people in our country to know that this Government respect them and their identity, and want them to live with dignity, safety and inclusion. That is the approach that the Government are taking. I realise that decisions that I have personally taken have not been received in that way. That has not been comfortable for me, but I do believe it has been the right thing to do.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

If we were resting this judgment on purely clinical evidence, we would tell every child that whatever sex they were was immutable and could not be changed, and that if they took these puberty blockers they might well find that they had irreversibly changed the course of their lives. How is a child of 10 or 11 going to be capable of making that judgment?

Whatever the Cass review says, in the end this is the Secretary of State’s judgment. I remember the covid inquiry repeatedly saying that it was wrong for Ministers to hide behind “the science”. Equally, there is no single clinical advice on this question: clinicians are as divided as the rest of society. We rely on the Secretary of State’s judgment. I am afraid that I think he has got it wrong.

[Wes Streeting]

I thank the right hon. Gentleman for his question and for how he puts his criticism, too. As I said earlier, and for the avoidance of doubt, I know what my responsibilities are. I understand the decisions that I take in this office and that I am accountable for those decisions. I do not resile from that. I am following clinical advice; I think that is the right thing to do in this area.

On the question of sex, the right hon. Gentleman is right: sex is immutable. Even if there has been treatment with hormones or surgery, underlying biology none the less means that trans women, for example, would still need to be screened and treated bearing in mind their biological sex, and the opposite is true for trans men. We have to draw that distinction between biological sex and gender identity.

Whatever my discomfort and personal views about this particular trial or about the notion of young people using puberty blockers in this way, I cannot ignore, and should convey faithfully to the House, conversations that I have had with trans young people and adults. They have described in powerful and unforgettable terms not just the life changing, but the life enhancing experience that they have had. I am thinking particularly of the university student I met; if she walked into this Chamber now, we would assume that she was born female. She is living her best life and described in very powerful and unforgettable terms the impact that treatment has had for her and her quality of life. At the same time, I think of high-profile cases such as Keira Bell’s. That is why we have to tread extremely carefully in this area, to follow evidence and to build an evidence base. It is also why these are such finely balanced judgements and why I can be simultaneously uncomfortable with the permanent ban that I put in place and uncomfortable with the clinical trial. I hope that I have reassured people that I think very deeply about these issues before taking decisions.

NHS 10-Year Plan

Bernard Jenkin Excerpts

Thursday 3rd July 2025 Commons Chamber

[Wes Streeting]

I am so grateful to my hon. Friend for her question. I pay tribute to Professor Ian Abbs. He is an outstanding NHS leader, and we have loved working with him. As with many people of his calibre moving on from their positions of leadership in the NHS, it is a bit like the Hotel California—you can check out any time you like, but you can never leave. We will not let him drift off into a quiet retirement; we are determined to make use of his expertise.

My hon. Friend is absolutely right to raise the importance of nursing. Nurses and midwives will play an increasingly important role in neighbourhood health. They are central to our shift to a modern, digital NHS. They are clinical leaders in their own right. Following the 10-year health plan, the chief nursing officer for England will work with the professions to develop a strategy that will make nursing and midwifery modern careers of choice, to address the decline in applications. As I have set out this week, we are looking forward to working closely with the Royal College of Nursing and Unison—of which, I should say, I am a member—to make sure that the status, the conditions and the impact of nursing on our NHS go from strength to strength, because nurses are the backbone of the NHS. We would not have a national health service without them.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I join others in welcoming much of the Secretary of State’s plan, but I want to return to the question of the Health Services Safety Investigations Body, to which my right hon. Friend the Member for Melton and Syston (Edward Argar) referred. I welcome the tone of the Secretary of State’s response to that part of my right hon. Friend’s questions, but will he agree to meet those of us from the Select Committee—a cross-party group of people—who campaigned over many years to bring this body, which is still in its infancy, into existence before making any further decisions on it?

As my right hon. Friend says, HSSIB is not a regulator, and to put it in with a regulator will create confusion about what it is. If he were Secretary of State for Transport, he would never dream of putting the air accidents investigation branch into the Civil Aviation Authority, because they have completely different and separate functions. That needs to be understood across the health service, and it is obviously not well understood at the moment.

[Wes Streeting]

I welcome the hon. Member’s constructive approach. Of course, we are happy to receive representations on HSSIB. I would just like to outline the problem we are trying to solve, which is that the patient safety landscape is increasingly cluttered. We have far too many bodies trying to do the same thing, cutting across each other, and for frontline staff and leaders on the receiving end of those many and often competing instructions, it can actually make things less safe rather than more safe. I really value the expertise in the Health Services Safety Investigations Body. We do not want to see that expertise lost, nor do we want to move it into the CQC prematurely, before the CQC is ready to receive it. I hope that that reassures him, but we are happy to have that conversation.

Hospice Funding

Bernard Jenkin Excerpts

Tuesday 8th April 2025 Commons Chamber

[Joy Morrissey]

The hon. Gentleman makes an excellent point about the pressure that hospices take off the NHS. The wonderful work of the hospice the hon. Gentleman mentions is the reason the NHS can function in the way it does. The cost savings on palliative care—both in hospital and out-of-hospital care settings—are invaluable. The hospices in our constituencies are a model that already works, and they are trusted by the community. I think we should be funding that model, instead of allowing hospices to die on the vine because of a lack of funding and changes to the funding model. I thank the hon. Gentleman for that point.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I congratulate my hon. Friend on securing this debate. We should not just complain about this terrible new tax that is being applied to hospices, but point out to the Minister that the return on taxpayers’ investment in what hospices spend on the dying is very great indeed. If a little bit of the big increase in funding that the NHS received was transferred to hospices, it would pay great dividends; it would save the need for much more costly care in the hospitals. The return is 300%, according to St Helena hospice, just outside my constituency, on whose behalf I am speaking this evening. I hope the Minister will address that point when he winds up.

[Joy Morrissey]

My hon. Friend makes an excellent point. That 300% cost benefit would be replicated across the country, in every hospice setting. A small amount of money given to hospices through the NHS funding model would be invaluable. We talk about palliative care and assisted dying, but why are we not having a debate about increasing hospice funding, and making that service part of the NHS? If hospice settings were part of the NHS, they would be exempt from the rise in national insurance contributions. That increase is devastating hospices right now. Many rely on volunteers or low-paid workers in charity shops. The money raised helps pay for the running of hospices. Although that is a wonderful model, hospices are not exempt from the NICs increase, as other NHS bodies are. Even changing the status of hospices to make them part of the NHS would go a very long way to making their financial model viable.

--- Later in debate ---

[Stephen Kinnock]

The decisions on ENICs and where they are being levied have been made. I think it was made very clear that the line was drawn where it was drawn. Any attempt to try to reverse engineer where that line should be drawn would not really be aligned with the policy decisions that were made at the Budget.

[Sir Bernard Jenkin]

Was it the Government’s intention to put an additional tax on hospices? Is that exactly what the Government intended to do, or is that an unforeseen consequence?

[Stephen Kinnock]

I would not dare to speak from this Dispatch Box on behalf of the Chancellor, but I am absolutely clear that when she did the autumn Budget, she knew that she had to dig us out of a very deep hole indeed, and that required levying taxes that she had to levy. The line had to be drawn somewhere and that is where the line was drawn.

On the other questions asked by the hon. Member for Beaconsfield, the funding has gone through Hospice UK, so it is not direct funding in that sense. Hospice UK has kindly co-ordinated the process because it is extremely well informed about which hospices across the country have opportunities to upgrade their infrastructure, whether that be IT infrastructure, refurbishment or whatever it might be. It has reviewed those proposals, worked at tremendous pace and, as a result, we have managed to deliver the entire £25 million of the first tranche. We are now working closely with Hospice UK on the £75 million and I am confident that that money will be out of the door and into hospices in very quick time this year, based on the outstanding performance on the first £25 million tranche. I therefore hope the hon. Lady will be reassured on that point.

In closing, I hope that we at least have a consensus on the vital importance of hospices. The Government are committed to working at pace to ensure that we secure a sustainability and solidity for the sector going forward. I thank the hon. Member for Beaconsfield once again for securing this important debate. I also thank and wish everybody in this Chamber all the very best for the recess, and I look forward to seeing them all on the other side.

Question put and agreed to.

Hospice Funding

Bernard Jenkin Excerpts

Thursday 19th December 2024 Commons Chamber

[Karin Smyth]

That is possibly one of the cheekiest questions I have ever heard asked here, and I am obviously going to have to say yes. Frankly, rather him than me, but good luck to my hon. Friend on doing that. I know that many hon. Members raise money for their local constituencies and that the marathon is an important part of that.

We understand how different hospices are funded differently throughout the country. We want to make sure that end of life care, with all the different options that people have in their local systems, is well supported. It is really important for people to have some of that security, and I know that this announcement will be welcomed by my hon. Friend’s local hospice, as it is by the sector today.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

Merry Christmas, Mr Speaker.

The St Helena Hospice in Colchester, which serves my constituency and that of the Labour hon. Member for Colchester (Pam Cox), estimates that the national insurance increase will cost it £300,000 in a full year. Can the Minister now give a guarantee that the hospice will be compensated by the Government in full?

[Karin Smyth]

It is good to hear the hon. Gentleman supporting his local hospice with his neighbour, my hon. Friend the Member for Colchester (Pam Cox). We will announce allocations for the whole sector and the NHS in the usual way in the new year.

NHS: Independent Investigation

Bernard Jenkin Excerpts

Thursday 12th September 2024 Commons Chamber

[Wes Streeting]

My hon. Friend, who I am delighted to see representing Bassetlaw, is already showing herself to be an outstanding champion for her community. She raises a really good challenge that we all face as constituency MPs: the public recognise that change takes time and that we cannot fix more than a decade of problems in the immediate future, but they want to know that at least we are hitting the ground running and getting the job done.

I can reassure my hon. Friend’s constituents in Bassetlaw that within our first couple of months, this Government employed 1,000 more GPs on the frontline who had been left unemployed by the previous Conservative Government. We did that pretty much immediately. We have settled—I hope; we await the outcome of the ballot—the junior doctors’ dispute, so we can remove the cost of disruption and industrial action and start work on getting the waiting lists down. We will be working at pace to deliver 40,000 more appointments every week so that we can cut waiting lists, and 700,000 urgent emergency dentistry appointments so that we can ensure that people get the care they need. Every single promise in our manifesto, notwithstanding the challenges in the public finances, was a fully costed, fully funded promise that we will keep and that the country can afford.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

May I urge the Secretary of State to learn from what is working well in the NHS, as well as from what has gone wrong? In reference to the Health and Care Act 2022, paragraph 14 on page 121 of the report states:

“The result is that the basic structure of a headquarters, regions, and integrated care boards (ICBs) is fit for purpose.”

I draw the Secretary of State’s attention to the Suffolk and North East Essex ICB, which is one of the most successful in the country. Can we learn from that success, and build it into other areas?

[Wes Streeting]

I thank the hon. Gentleman for his constructive approach. The tragedy of the Health and Care Act 2022 was that a large part of its focus was on trying to correct the enormous damage done by Lord Lansley through a top-down reorganisation that nobody wanted and that the country could not afford. That is why I have said very clearly that we will not repeat the mistakes of top-down reorganisation. With the architecture of the system, we will take an approach of evolution rather than counter-revolution.

On the hon. Gentleman’s point about learning from what is working well in the NHS, what gives me great hope for the future of our national health service is that every day there are amazing people providing great-quality care, reforming, innovating and showing us what the future looks like. It is the responsibility of this Government to take the best of the NHS to the rest of the NHS. That is exactly what we will do.

Government Policy on Health

Bernard Jenkin Excerpts

Monday 9th September 2024 Commons Chamber

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. Let the record reflect that, when he was raising the crisis that is leaving people in Hartlepool without access to NHS dentistry, Conservative Members were shouting, “What about Alan Milburn?” That says everything about their priorities, everything about their lack of remorse and contrition, and everything about why they should stay in opposition for a very long time while we sort out the state of NHS dentistry in Hartlepool and across the country.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

How legitimate is it for the House of Commons to ask about external people coming into Departments and potential conflicts of interest? In cases like Alan Milburn’s, or that of a former Conservative Secretary of State, how does the Department identify and manage conflicts of interest?

[Wes Streeting]

It is entirely legitimate to ask questions, and it is also entirely legitimate for Government Departments to invite people with a wide range of experience and insight to advise on policy debates and discussions. That happens all the time. Where do we draw the line? Do we have to send compliance forms to Cancer Research UK before it comes in to talk about how we tackle cancer? Do we have to send declaration of interest forms to patients who want to discuss awful cases they have experienced?

Frankly, I find this pantomime astonishing. I am surprised that the shadow Secretary of State thinks this is such a priority that she should raise it on the Floor of the House rather than NHS waiting lists, ambulance response times, GP access or the state of social care. It is clear that the Conservatives have not learned why they are in opposition.