Health Bill (Thirteenth sitting)
Caroline Johnson ExcerptsTuesday 7th July 2026
(2 months, 1 week ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 7 July 2026 - (7 Jul 2026)
The Chair
I remind the Committee that with this we are discussing the following:
Amendment 55, in schedule 8, page 110, line 23, at end insert —
“(10) If the Secretary of State certifies that it is in the interests of national security that the powers conferred by subsection (1)—
(a) should not be exercisable in relation to certain premises in which there is a Crown interest, or
(b) should not be exercisable in relation to certain specified premises for other purposes,
those powers are not exercisable in relation to those specified premises.
(7) In this section, “Crown interest” means—
(a) an interest belonging to a government department or held in trust for His Majesty for the purposes of a government department;
(b) an interest belonging to His Majesty in right of the Crown;
(c) an interest belonging to His Majesty in right of the Duchy of Lancaster;
(d) an interest belonging to the Duchy of Cornwall.”.
This amendment makes provision for the Secretary of State to disapply investigation powers under subsection 51J(1) to the Health and Social Care Act 2008, inserted by Schedule 8 of this Bill.
Amendment 56, in schedule 8, page 116, line 8, leave out subsection (9).
This amendment would allow the Commission to recoup charges in excess of the costs incurred in providing assistance.
Amendment 5, in schedule 8, page 120, line 16, at end insert—
“(2A) After paragraph 6(8) insert—
“(9) A committee of the Commission is to be appointed in accordance with regulations.
(10) The purpose of the committee is to oversee the health services safety investigation functions formerly conducted by HSSIB, transferred to the Care Quality Commission under the Health Act 2026.
(11) The committee is to be operationally independent from the Care Quality Commission.
(12) The committee is to consist of a chair appointed by the Secretary of State, and not less than six and not more than twelve other members appointed by the chair.
(13) A majority of the members of the committee must not be members of the Care Quality Commission.
(14) So far as is reasonably practicable, the persons appointed to the committee must include persons with knowledge or experience relevant to the discharge of functions under this paragraph.””.
This amendment would ensure that oversight of HSSIB’s functions would remain operationally independent of the Care Quality Commission (CQC) following the transfer of its functions to the CQC.
Schedule 8.
Clauses 60 and 61 stand part.
New clause 42—Funding for Care Quality Commission (CQC) investigations—
“The Secretary of State has a duty to make provision for adequate funding and resources for patient safety investigations conducted by the CQC, including some initiated by the CQC themselves.”.
I believe Dr Caroline Johnson was mid-intervention.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
My hon. Friend the Member for Isle of Wight East was talking about the importance of the perception of the safe space, in relation to people being able to come forward, and the fears of whistleblowers. Does he agree with me that it is not just this perception that causes potential whistleblowers to worry? If they read the newspapers on a regular basis, or are on social media, they will see examples of people who have suffered mistreatment as the result of having been whistleblowers.
Joe Robertson (Isle of Wight East) (Con)
The shadow Minister is absolutely right. Perception is a problem, but the reality on the ground is perhaps an even greater problem. Both are issues here with what the Government plan.
There could be a reason why this merger, or the abolition of the Health Services Safety Investigations Body, needs to happen, but we have not seen that compelling argument. We have seen some attempts at justification, but they seem to be incredibly thin—and that is being generous.
The principal argument seems to be that there is a busy and confusing landscape when it comes to investigatory and regulatory bodies. The figure Dr Dash put forward was something like 150 different organisations; she was asked to review just six of those. Even if she were to have abolished all six, it clearly does nothing to reduce the busy and confusing landscape. My hon. Friend the Member for Farnham and Bordon made that point well.
A busy and confusing regulatory landscape should not be a justification for getting rid of an essential investigatory body and disincentivising the investigation process and whistleblowing and disclosures, by tying it up with the regulator, which itself may be at fault. Streamlining and dealing with a busy and confusing landscape are objectively good reasons to do something, but not this. That is the central point.
As my hon. Friend the Member for Farnham and Bordon referred to, the question was put to Dr Dash, the author of the recommendations, when she gave evidence: what happens if there is a problem with the Care Quality Commission once HSSIB has become part of it? I think we rightly expected a fairly clear answer on that. The answer was a rhetorical response:
“‘What happens if the problem is this organisation or that one?’”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 8, Q9.]
That was the response from Dr Dash. But we are not talking about whether there is a problem with this organisation or that one; we are talking about the CQC, the organisation that HSSIB will become.
If there is a problem with another organisation, HSSIB can investigate it; if there is a problem with the CQC now, HSSIB can investigate it; but when HSSIB becomes the CQC, there will plainly be a problem with investigating the CQC. When that question was put to the author of the report on whom the Government are relying, no answer was provided. The reply to my hon. Friend the Member for Farnham and Bordon was a rhetorical question.
I urge the Minister to reflect. There is a major issue here that has not been addressed. Until she, or those on whom she relies, can articulate the answer, I urge her to delay these proposals.
Karin Smyth
I thank my hon. Friend for that. He and others on both sides of the House with clinical experience, including the hon. Member for Sleaford and North Hykeham, have shared live examples that can shock the layperson. It is important that those practices are changed clinically, and it is up to Government to make sure that the overarching legislative framework enables that.
Karin Smyth
I want to make some points first. I will pick up any outstanding points I do not cover.
The abolition of HSSIB and the transfer of its functions to CQC is being done to strengthen the link between patient safety investigations and the action being taken on the frontline to simplify the patient safety landscape. We want to align the recommendations with action.
Hon. Members quoted evidence that Dr Dash gave to the Committee. Let me remind the Committee of something else she told us, about how HSSIB’s functions can be better aligned as part of the CQC. She said:
“by bringing HSSIB into the CQC, you can align the work of the two.
For example, if the CQC is going round the country and spotting a particular problem with the way in which anaesthesia is being given or with managing patients post-surgery, the CQC could then say to HSSIB—that team of people with specific expertise—‘Can you go in and take a look at this? Can you do a detailed focus review of this particular area of care that we are spotting through our visits and which seem to be a particular challenge?’ It is that bit about enabling the CQC to identify a problem and then asking HSSIB to review it in detail, and HSSIB bringing its expertise in investigations into the CQC to enable the CQC to go deeper and then come back to the NHS”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.]
to enable best action. These organisations can learn better from each other.
Transferring investigation powers to the Care Quality Commission is an opportunity to strengthen the CQC. We have to move away from a defensive culture to a culture of shared learning if we are to improve patient care. The CQC can learn and improve from HSSIB best practice and take a more holistic approach to patient safety. Those executing the regulatory and investigatory functions can learn from each other and exchange skills, which would strengthen the links between learning, oversight and improvement, leading to real and sustained change across the system, driven by the CQC.
Karin Smyth
I am going to persist on some of these arguments. I think I have addressed all the points made by the Opposition. It is the job of effective leadership to manage those interests and responsibilities, and that is what we expect of the CQC’s leadership.
I will now turn to the amendments on this topic, which I thank the hon. Members for Sleaford and North Hykeham and for North Shropshire for tabling. Amendment 55 would make provision for the Secretary of State to disapply investigation powers in certain circumstances. I recognise the importance of ensuring that investigatory powers are not exercised in relation to sensitive Crown or Government premises where there is a national security interest. I want to be clear: the Bill already provides for that.
The Bill already amends section 96 of the Health and Social Care Act 2008 so that it applies to the new CQC investigatory function. Section 96 makes provision for the application of CQC legislation to the Crown, which means that the mechanism that the amendment is seeking to introduce is already in place within the existing legislative framework. Additionally, the Bill already provides for a power which enables the Secretary of State to disapply these investigatory powers in relation to Crown premises when it is in the interest of national security. The amendment would therefore duplicate an existing provision and would add unnecessary complexity to the legislation without delivering any additional benefit.
Amendment 56 would allow the Care Quality Commission to recover charges that are higher than the actual costs it incurs when providing assistance to anyone other than an NHS body or the Secretary of State. I understand the intention behind the amendment—to give the commission greater financial flexibility—but the Government do not think that it is necessary. The charging framework in the Bill is based on the clear principle of cost recovery. Removing subsection (9) of proposed new section 51R of the Health and Social Care Act 2008 would mean that the commission could charge more than it actually costs to provide a service, shifting away from recovering costs and towards allowing the commission to make a surplus through its charging powers.
Dr Johnson
My understanding is that, in the past, HSSIB has provided services to not only British health services but overseas health services, which were, in some cases, charged for that service, as it is a world-leading organisation. Why would the Minister not want that to continue?
Karin Smyth
I am happy to get back to the hon. Lady on that specific point, if that is the case. The charging framework is about recovering costs, not making a surplus, which is what the amendment would result in. If that is not the case, I will make sure that she receives a proper correction.
The Government do not think that there is a good case for the amendment, because, as I have said, the aim of the provision is to provide for fair and transparent cost recovery, not to raise extra income beyond cost. I am not sure whether the hon. Lady is suggesting that it might be good for the commission to create additional funding, but if that is not clear, I am happy to get back to her on it. The provision makes the recovery of costs more predictable and consistent for those who have to pay them. That is usual for public bodies.
New clause 42 relates to funding provisions for the CQC’s new investigation function. The Department already provides grant in aid to the CQC to provide adequate funding for investigations and special reviews; similarly, HSSIB’s budget is provided through grant in aid and is set each year. When the CQC takes on HSSIB’s functions, the funding streams will remain distinct, and the CQC will have to assure the Department that the amount allocated to the new investigation function is being used for that purpose.
Funding decisions for the investigation function will continue to be captured in wider departmental budget-planning processes and considered centrally. That provides assurance that business and strategic priorities for the investigation functions can be met. Robust financial oversight will require the CQC to demonstrate that grant in aid is used appropriately, and solely to support the investigation function, without the need to prescribe funding arrangements in legislation.
As there is already an operational mechanism for the Secretary of State to provide adequate funding and resources for investigations, the new clause is not needed. It would also be inappropriate to prescribe the form or level of funding in legislation. The new clause would reduce the Department’s ability to manage funding through the established spending review and estimates process; introduce unnecessary rigidity as the merged function evolves; and risk creating binding funding expectations that may not align with future fiscal constraints. A non-legislative approach ensures flexibility, scale and adaptive function while maintaining robust oversight.
I agree with the intention behind amendment 5, tabled by the hon. Member for North Shropshire, which is, as I understand it, to ensure that the Health Services Safety Investigations Body functions that are transferred to the CQC retain a high level of operational independence and continue to command the confidence—the Committee heard that word a lot this morning; I completely agree on its importance—of patients and their families, healthcare professionals and the wider public. Similarly, I understand that the objective of the amendment is to maximise the perception—again, that is a word I am coming back to; I tried to address the issue earlier—of independence in the CQC.
The Government have protected safe spaces in legislation, and we agree that operational independence of the investigation function is required, but our plans support and enable that. For that reason, we cannot support the amendment, which would impose a highly prescriptive governance structure on the CQC by requiring the creation of a separate statutory committee and setting out in primary legislation detailed requirements for its purpose, membership appointments and operational arrangements. While the Government fully agree that effective safety investigations must be conducted independently and objectively, we do not consider it necessary to put such detailed organisational arrangements in the Bill.
The Bill already provides a clear legislative framework for the transfer of those functions and enables the CQC to discharge them appropriately, within its broader statutory responsibilities. Furthermore, the CQC already operates within a robust statutory framework and is capable of establishing governance arrangements that support the effective delivery of its functions, including appropriate safeguards to protect investigative independence and the handling of safe-space material.
The amendment would reduce organisational flexibility by mandating a specific committee structure, and would constrain the CQC’s ability to adapt its governance arrangements over time in response to operational experience, changes in circumstances or future improvements in best practice. Under the amendment, governance arrangements would be fixed in statute, rather than having the capability to evolve as the organisation learns and develops.
Those additional administrative and governance requirements would increase bureaucracy and complexity, which the Government are looking to reduce. I re-emphasise that, in addition, a statutory committee would weaken the important links between learning and the action that the transfer of this organisation is intended to support. One of the key benefits of bringing these functions into the CQC is the opportunity to strengthen strategic oversight and ensure that learning from investigations can more readily inform improvement activity across the system.
Dr Johnson
The Minister seems to be saying that her reasoning for moving HSSIB into the CQC is to ensure that actions take place in response to the recommendations. But if HSSIB outwith the CQC makes recommendations that are delivered by the provider organisations, commissioned by the ICBs and overseen by Ministers, and then the CQC checks that as part of the regulation, why does HSSIB need to be within the CQC for that to happen?
Karin Smyth
We are probably not going to agree on this point. I have made the point several times—and we made it in the Dash review—about bringing these organisations together. As I said again in my opening comments, it is about the opportunity to get this right and share that learning and experience. It is not about the cost but about aligning the recommendations and the actions that follow through from them. That learning, and the opportunity to push that through, is something we should grasp.
Coming back to amendment 5, creating a separate statutory committee risks introducing additional layers of separation that could slow the flow of intelligence and impede timely action in response to emerging patient safety concerns. We believe the integration of investigatory functions can be secured through clear statutory functions and appropriate safeguards, rather than through organisational structures set out in primary legislation that are too rigid. Establishing detailed governance requirements in statute may also make future improvements more difficult to implement without legislative change.
I understand and respect the concerns that underpin the amendment, but the Government believe that the Bill already provides the necessary framework for the safe and effective delivery of health services’ safety investigations following their transfer to the CQC. We will of course work closely with both the CQC and HSSIB on their transition arrangements through a transition board, whether on the issues of ensuring operation independence of the investigation function and the ways in which that learning is shared, or, further to the Opposition spokesperson’s point, how we make sure that learning is shared and creates an impact, and where that is felt most clearly. For those reasons, I ask hon. Members not to press their amendments, and I commend clauses 59, 60 and 61 to the Committee.
Question put, That the clause stand part of the Bill.
Dr Johnson
The Minister has reassured us that, although it has not been lifted and shifted from the original, the amendment is a duplication of another clause. Therefore, we believe the Committee—
Karin Smyth
Clause 62 underscores the importance that we place on special reviews and investigations, and it will maintain the Care Quality Commission’s ability to conduct them by ensuring that the CQC’s investigatory role remains properly aligned with its original statutory purpose. The CQC is the independent regulator of health and care providers, and in the case of commissioners, it has the powers to undertake a special review or investigation when requested to by the Secretary of State.
On 30 January 2024, the then Secretary of State, the right hon. Member for Louth and Horncastle (Victoria Atkins), commissioned a section 48 review into mental health services in Nottinghamshire following the tragic events of June 2023. As we know, that revealed serious and systemic failings and led to strengthened oversight and a clear improvement plan. With NHS England being abolished and its functions being transferred to the Department and across the wider system, this clause will remove NHSE from the scope of section 48 and allow Ministers to set out, through regulations, the future scope of section 48.
NHS England’s commissioning functions will mostly transfer to the integrated care boards but, as we discussed previously, NHSE’s most specialised commissioning functions will transfer to the Secretary of State. In future, regulations will set out the specific commissioning functions that the Secretary of State will be responsible for and that the CQC may review or investigate. The scope of the special reviews and investigations will continue to apply only to commissioning functions under the National Health Service Act 2006 or section 117 of the Mental Health Act 1983, which is the CQC’s existing remit.
This approach will ensure that the CQC’s investigatory powers will not be automatically extended to departmental functions, which would fundamentally change the relationship between an arm’s length body and a Government Department and would not align with the original intention of section 48 reviews. For that reason, the Bill will provide for scrutiny through secondary legislation. That will set out a transparent and accountable way to specify which commissioning functions are in scope, enabling parliamentary scrutiny and CQC oversight where it is genuinely relevant to patient safety and care quality.
This approach will also provide important flexibility: as commissioning arrangements change, the right function can be brought into scope without unnecessary delays. Taken together, this clause will protect the CQC’s independence, maintain accountability and provide a sensible framework for scrutiny where it adds real value for patient safety and care quality. I commend the clause to the Committee.
Dr Johnson
I have just a couple of questions. Clause 62 will update the CQC’s power to conduct special reviews of NHS commissioning to cover ICBs and the Secretary of State’s commissioning functions, and the requirement for ministerial approval before the CQC can investigate will be retained. How will that apply when HSSIB is moved into the CQC? Is it the Minister’s intention that HSSIB will need the Secretary of State’s approval to complete investigations?
Karin Smyth
My understanding is that the clause will not change that particular power, but I will get back to the hon. Lady if I am wrong.
Question put and agreed to.
Clause 62 accordingly ordered to stand part of the Bill.
Clause 63
Time limit for bringing proceedings
Question proposed, That the clause stand part of the Bill.
Karin Smyth
The 10-year health plan reaffirms the Government’s commitment to families affected by bereavement or serious harm, ensuring that lessons are learned from their experience and that more cases are fully reviewed and acted on. Families seek closure following serious harm to or the death of a loved one by wanting to understand what went wrong and what could be done to stop other families experiencing similar trauma, and by wanting to hold someone to account. Families often turn to the Care Quality Commission for help.
Clause 63 will extend the CQC’s power to bring proceedings against a health and social care provider for a serious breach of regulations from the existing limitation of three years from the date of the offence to five years. Let me be clear: extending the three-year limitation from the time of the offence will not alter the first requirement that the CQC should act within 12 months of sufficient evidence of a serious breach of regulations becoming available. That 12-month window for action once the regulator is aware of the offence will remain unchanged. Extending the limitation period to five years from the date of the offence will mean that fewer events that should be considered by the regulator will effectively time out and go beyond the reach of the regulator’s action.
The CQC is not the only body with an interest in investigating serious breaches of regulations that result in unnatural death; there are other investigatory bodies, such as the police, with equal interest and powers to investigate deaths for the purpose of pursuing criminal prosecution. The coronial process serves a different purpose. A coroner’s role is to establish facts surrounding an unnatural death rather than to find fault. In a complex case, a police investigation or a coroner’s inquest—sometimes both—can take time to conclude. Those independent processes are a useful source of information for the CQC to form a full picture of a breach of regulation.
A culture of learning from investigations, inquiries, errors and poor care should be the norm in the NHS. It is therefore expected that a service provider may also commission its own internal investigation to learn from an unnatural death. Furthermore, there are cases where the CQC is approached late with information after an offence may have been committed. For example, the CQC may only receive information about an offence two and half years after it was committed, leaving little time in the remaining six-month period to investigate. Extending the period to five years would help mitigate such circumstances, and that is why we are extending the statutory limitation period. This will ensure that the CQC has the ability in far more cases to address the serious regulatory failings that it should and must address, without risking falling foul of a time limitation. I therefore commend the clause to the Committee.
Dr Johnson
As the Minister said, clause 63 amends section 90(2) of the Health and Social Care Act 2008 to extend the limit on proceedings relating to the registration of offences under part 1 from three to five years. The impact assessment talks a little about the time it takes to investigate these cases, but as the Minister said, the time to investigate is 12 months from the CQC being given enough evidence to consider whether the case is prosecutable. Why has she chosen not to change that too? Does she think people will have enough time to investigate? She is looking puzzled.
Karin Smyth
Apologies—I missed the exact question as to what needed to be changed. Could the hon. Lady repeat that?
Dr Johnson
The Minister talked about changing the time period in which proceedings can be effected from three to five years, but once the CQC is aware that an investigation could be brought and there is evidence that needs to be looked at, it will still get only 12 months. That has not been changed. I wonder what the rationale is for that. I am not criticising it; I am just asking the question.
The other issue is that clause 63 is prospective, so if an offence were committed immediately after the Act was passed, for the first three years things would effectively be as they are now; the change from three years to five would be relevant only after three years. Clause 71(2) on commencement provides that clause 63 will not come into force until two months after the Act is passed. I just wonder in practical terms why, given that it will take three years to come into effect in any case, it will not come into force on the day the Act receives Royal Assent.
The impact assessment talks about the CQC prosecuting two or three additional cases a year, and a cost of £4.3 million over 10 years with fines of £2.7 million over 10 years. Will the regulator keep the fines, or will they go back into the Treasury? Can the Minister guarantee that the additional funds that are estimated to be required for the additional cases under this new regulation will be provided so that the CQC can do the investigations that she is giving it the opportunity to do?
Karin Smyth
Put simply, the answer to the hon. Lady’s questions is that we are not seeking to change other aspects. The CQC wants to get to points as soon as possible, so the 12-month period has not been changed. The function of clause 63 is merely to recognise the issues around the three years and to change that to five years. We are not seeking to alter anything else in that regard. On her point about the commencement date, that is merely recognising what is considered to be parliamentary convention.
Question put and agreed to.
Clause 63 accordingly ordered to stand part of the Bill.
Clause 64
Abolition of Healthwatch England
Question proposed, That the clause stand part of the Bill.
Dr Johnson
Clause 64 abolishes Healthwatch England, which I believe is a mistake, and introduces schedule 9 to facilitate that. The impact assessment talks about the roles of local healthwatch and Healthwatch England, with local healthwatch obtaining views, making reports and recommendations, promoting and supporting public institutions, signposting to advice, and giving views to Healthwatch England nationally; and Healthwatch England then providing leadership, guidance and support to local healthwatch, escalation to the CQC, which we have heard a lot about already, and advice to the Secretary of State or NHS England.
Members may be familiar with the term “nothing about us without us”—the idea that policies should not be decided and services should not be shaped without the participation of those who will use those services or be affected by the decisions that are made. As a medical practitioner, I believe that is an important principle. Patients must have a voice, because it is they who have the lived experience of their conditions and know their needs better than any civil servant in Whitehall. They know what is working and what needs to change.
Let us look at the history of patient voice. In the two decades after the NHS’s inception, the provision of care was really quite paternalistic. Patients did not really have any role in shaping the services that they received. That changed in 1974 with the establishment of community health councils, made up of volunteers. They carried out research, conducted visits to inspect standards and represented communities when changes were proposed. They also helped the public with information about local services, including how to make complaints—very similar processes.
The Labour Government abolished community health councils in 2003, although a cursory trip to Hansard reveals that the Government repeatedly stated before the publication of the NHS plan that at that point they envisaged no immediate changes to community health councils, but they did go on to do that. That is reminiscent of what we are discussing today, because abolishing Healthwatch was not in the Labour party manifesto.
In 2003, the community health councils became patient and public involvement forums, and five years later they became local involvement networks. The names and structures have changed, but the principle of patients having an independent voice remained. Healthwatch is the latest iteration. To be precise, Healthwatch England was established initially as a committee of the Care Quality Commission in 2013. It operates a hub-and-spoke model with more than 150 local healthwatches spread across local authority areas.
Healthwatches play a vital role in exposing problems in the health service. Indeed, even the King’s Speech contained a reference to Healthwatch England. According to Healthwatch England’s May 2025 report,
“nearly one in four…adults have noticed inaccuracies or missing details in their medical records”,
such as inaccurate personal details and inaccurate records of medicines, diagnoses, treatments and conditions.
I note that the Minister herself has relied on Healthwatch when bringing problems facing her constituents to the House. She said:
“In a recent Adjournment debate about Bristol and the south-west, I raised the issue of a pregnant constituent who was unable to access care at that critical time. This is the No. 1 issue raised by Healthwatch. Patients are struggling.”—[Official Report, 10 February 2022; Vol. 708, c. 484WH.]
So Healthwatch is valuable.
I invite Members to look at the impact that Healthwatch had in 2023-24. More than 925,000 people used their local healthwatch to get advice and information about their health and care. More than 329,000 people shared their experiences to help improve services. Healthwatch England helped to secure changes to Royal Mail so that NHS letters are delivered to patients on time. It also led new NHS guidance so that patients commencing cancer treatment have priority access to NHS dentists. A piece of Healthwatch research indicated that millions of eligible adults may be missing out on social care.
Recently, my local branch, Healthwatch Lincolnshire, produced a report on the challenges facing carers nationally. Healthwatch has influenced the future of attention deficit and hyperactivity disorder care, encouraged the uptake of cervical cancer screening and so much more. That is why the public and health experts are alarmed by the Government’s plans.
As for HSSIB, the success of Healthwatch is due to its independence, but the Government want to do away with that. Their policy paper commits to replacing Healthwatch with a new patient experience directorate, which will sit inside the Minister’s Department. Instead of having organisations embedded in communities sitting on local health and wellbeing boards, the public will need to interface with the Minister’s Department. How can she guarantee the independence, and the perception of independence, of the new directorate? How can she be sure the public will trust it?
I remind Members of what Councillor Dr Wendy Taylor of the Local Government Association said:
“The current proposals to disband Healthwatch and allow health and social care services to gather and respond to feedback, rather than being challenged by an independent voice, risks organisations being seen to mark their own homework.”
When Healthwatch conducts surveys, it often solicits information that proves problematic for the Government of the day. How can the public have confidence that the new directorate’s process will do the same? What will stop the Secretary of State deciding what questions get asked and what data gets published? From my reading of the Bill, the answer is nothing.
The Government have made it clear that, alongside the new directorate, ICBs will take over several patient voice functions. I appreciate that this strays slightly into the subject of the next group of provisions, Ms Lewell, but it is difficult to separate Healthwatch from local healthwatches. The Patients Association has warned:
“Splitting local Healthwatch between ICBs and local authorities risks creating a patchwork of accountability with no single body responsible for ensuring patients are heard”.
If responsibility to deliver those functions is shared between different parts of the health system, who becomes accountable if it is not funded? Who is accountable if people fall through the cracks? If accountability is divided, it often means that accountability is somewhat diminished.
Members also need to ask whether it is financially feasible for ICBs to deliver patient voice. In its evidence, the Health Foundation wrote:
“Moving the NHS functions of local HealthWatch organisations into newly enlarged ICB footprints could also result in the loss of a more nuanced local understanding of the public’s priorities and needs, with particular implications for seldom heard or more vulnerable communities.”
We know that ICBs are under financial pressure because of decisions by the Labour Government; they have had to slash operating costs by 50%, and many are pencilling in cuts to frontline services. Against that backdrop, how can they afford to deliver patient voice functions? Ms Lewell, your guess is as good as mine.
We have not heard about any additional funding from the Government for the purpose of patient voice. Healthwatch England was provided £3.3 million in 2025-26, and local healthwatch £14.1 million. How much of that money will be redirected to the patient experience directorate and the ICBs?
I tabled a written question about the benefits to the public purse of abolishing Healthwatch. The Minister’s response was as follows:
“The potential savings from abolishing Healthwatch England and Local Healthwatch are dependent future policy decisions regarding the approach taken to collecting user experiences post-abolition.”
She set out an intention for “future policy decisions”, but there was, and still is, an absence of a plan. That is something we have heard again and again in relation to health, in Committee and throughout the two years that this Government have been in power: the absence of a plan for how things will be achieved. They have lofty aims, and understandable and sometimes really good goals, but no understanding of how they are going to get there.
It is not just the Opposition who are concerned; I will give some examples of Government Members who are, too. The hon. Member for Birmingham Erdington (Paulette Hamilton) said:
“One of my biggest concerns about the Bill is the reduction in independent patient representation, including the abolition of Healthwatch structures.”—[Official Report, 1 June 2026; Vol. 786, c. 921.]
The hon. Member for York Central (Rachael Maskell) said:
“Replacing Healthwatch will mean that, ultimately, patients will not have confidence in the commissioners.”—[Official Report, 9 June 2026; Vol. 787, c. 136.]
The hon. Member for Blaydon and Consett said:
“I understand that the Government’s real intention, through the Bill, is to strengthen the patient voice and the ability to raise issues, but there is real concern that an organisation inside the Department of Health and Social Care will not provide that independence. Will the Minister commit to looking again at how that independence can be built in and…with the ability to pull the levers”?—[Official Report, 1 June 2026; Vol. 786, c. 944.]
We have also heard concerns from the Health and Social Care Committee.
But the Member that the Minister may be most interested in is the right hon. Member for Makerfield (Andy Burnham). He wrote to the former Secretary of State last year saying:
“People speak to Healthwatch because they are outside the system—they are impartial, trusted, and provide a safe space for concerns to be shared.”
Does the Minister agree? If so, why does she want to remove the independence of patient voice? The right hon. Member for Makerfield also said:
“The independence of resident and patient voice is a necessity. Without it, we risk losing the trust of the public, the richness of lived experience, and the ability to challenge and improve the system from within, particularly during this time of significant system reform”.
My plea to the Minister is this: think again about the importance of the independence of patient voice. People will give their views when they think they can do so independently and safely—a principle that was echoed in the debate this morning. Removing the independence does not seem necessary, and I do not understand why the Minister thinks that it will improve patient care and thereby patient safety. It is clear that Members not only on the Opposition Benches, but right across the Government Benches—in fact, potentially the new Prime Minister from next week or the week after—may think the same. I encourage the Minister to reconsider this step.
Dave Robertson
I will make some progress. There are concerns that if we roll some responsibilities into ICBs or councils, the Department needs to make sure that the issue does not get pushed to the side and that the funding does genuinely remain for patient voice. I am reassured that there will be a patient experience directorate within the Department. That will bring decision making and the patient voice into the Department while also keeping an eye on what is happening with those ICBs and ensuring that they have standards to hit.
The Department needs to ensure that it is sharing good practice and keeping oversight of local authority commissioning of social care. The CQC is starting to do that, and there are some positive indicators. There is obviously more work to do, and we need to stay on top of it because, as I said earlier, there are risks whenever there are changes to healthcare. I am reassured that bringing the patient voice into the room with decision makers is the right way to enact change.
Karin Smyth
Clause 65 and schedule 10 will abolish the current local healthwatch arrangements and place responsibility for gathering the views of local people firmly with the bodies with the clearest levers to act: integrated care boards and local authorities.
At present, many organisations are gathering views, running engagement exercises and raising issues, often with the best of intentions, but the result can be duplication, variable coverage and uncertainty about who is accountable for responding. We can end up with lots of feedback but too little clarity on the action that follows. By placing those duties on integrated care boards and local authorities, we are ensuring that insight from patients, service users and communities feeds directly into where commissioning and service planning decisions are made for both health and care. As my hon. Friend the Member for Lichfield said, the people are in the room. It makes it easier to connect lived experience to priorities, quality improvement and the tackling of inequalities, rather than leaving intelligence at arm’s length from decision makers.
This is about strengthening impact, not silencing criticism. Integrated care boards and local authorities will have a statutory duty to demonstrate how they have engaged with all people in their area, including seldom heard groups, and will be expected to have clear routes for people to raise concerns. We expect transparency about what people have told the system, what the system has done in response and how learning is shared across partners.
As I said in my evidence, many constituents in my Bristol South constituency are said to be hard to reach. They are not hard to reach, in my view. We know exactly where they live, who they are, how old they are and what sex they are. We know largely what diseases they have. We know their level of income. We know their levels of education and attainment, and how they impact their health outcomes. They are not hard to reach; the system is not set up to listen to them. That is what we are determined to change.
Dr Penny Dash’s review of patient safety described a cluttered landscape, with overlaps in how user experience and advocacy are organised. It described the burden that that can place on the frontline, producing multiple, poorly co-ordinated asks with limited impact. Bringing the patient and community voice closer to the organisations responsible for improvement—it is actually their job as commissioners—will help to make feedback more actionable, reduce confusion and support better services. I commend the clause to the Committee.
Dr Johnson
As I understand it, the objectives of the Bill are to replace the local healthwatch with a less independent, internalised gatherer of patient experience feedback. The objectives appear to be featuring feedback more centrally in strategic decision making, getting people into the room and simplifying the patient landscape.
There are things that I do not understand about that. If the problem is that those who commission or deliver the services are not listening adequately to the people who gather the patient experience information, why not invite the independent individual who has gathered that information into the room? Why ask someone in the room to gather the information and risk the independence? Why not compel more listening?
The Minister talked about who is accountable for action. My understanding is that it is the healthwatches’ job to gather the patient experience and present it to Healthwatch England and the decision makers. It is not their job, as I understand it, to make decisions on how care is delivered or to deliver that care differently. Does the Minister intend that to change?
The Minister also talked about strengthening the impact of Healthwatch, but I do not understand how this change will do that. We have heard how its independence allows Healthwatch to go on telly, talk to Members of Parliament, Select Committees, radio stations and others, and publicise its findings. If it is within the Department, will it be able to do so as freely? I suggest that it will not.
The other thing that I do not really understand—perhaps the Minister can help us with this—is the organisation. At the moment, it is done in local authority areas. It will now become the job of the local authority and the ICB to commission feedback, but we have already heard how the 50% cuts to ICB budgets have led to ICBs merging into larger conglomerates. Those do not necessarily overlap with the strategic mayoral authorities in the way the Minister eventually wants. What geography does the Minister want the feedback to be gathered over? How does she see that working? Will it require further restructuring? The hon. Member for Lichfield talked about the importance of localism and how different areas of his constituency have different health needs. How does the Minister think that that will work under her new plans?
The Minister said that one benefit of the new process is reaching vulnerable individuals, but what is to stop Healthwatch doing that? Ultimately, if we have Healthwatch doing things now that are independent and respected across the House—I am sure your local healthwatch is also excellent, Ms Lewell; Lincolnshire’s certainly is—why not strengthen that voice? Why not say to those who are providing that service, “We’re going to give you more resources,” or “We’re going to ask you to deliver it in a slightly different way,” or “We’re going to ask you to focus on particular populations,” or even, “We’re going to invite you into the room with the ICBs so that they can hear you and listen carefully”?
Why not compel those making the decisions and delivering the services to listen to Healthwatch, rather than replacing it? It was not Healthwatch’s job to listen to them, but to gather the information and present it, and that is what it has done. Can the Minister explain how removing its independence is going to help? I simply do not understand it.
Helen Morgan
I am very grateful to serve under your chairship, Ms Lewell. My hon. Friend the Member for Winchester has made some general points about Healthwatch and the importance of an independent patient voice; I will not reiterate them, because he made them very well, but I want to speak specifically about local healthwatches and the benefits that they bring.
I find it quite difficult to hear in this room, so I hope the hon. Member for Lichfield will correct me if I have misunderstood the gist of his speech, but I was frankly astonished by the suggestion that if local managers had heard about the problems at Mid Staffs or at Shrewsbury and Telford hospital NHS trust, the concerns raised in those extremely serious scandals would have been addressed. The reality is that the management of both providers knew exactly about the concerns in those trusts, and they did not address them. That is why we have Healthwatch.
The hon. Member for Lichfield may be aware that my parents live in Stone, which was in the Mid Staffordshire constituency at the time. My mum was a clerk to Staffordshire county council, and I recollect very strongly that the health scrutiny committee at that council questioned the trust about its appalling mortality rate and was constantly reassured that there was nothing to see here. It absolutely failed to mark its own homework. The suggestion that my constituents Kayleigh and Colin Griffiths, who fought for the Ockenden report on Shrewsbury and Telford, did not first try the local services is, I think, missing the point.
With the Ockenden report on Nottinghamshire a couple of weeks ago, we also saw that the hospital trust commissioned several reports into its own maternity services, which found that it was failing. Instead of acting on them, it brushed them under the carpet and commissioned another. The suggestion that providers are capable in the current culture of dealing with those issues does not, I am afraid, hold true in the way it should across every trust.
Dr Johnson
Is there not a third issue: that the local authority and the ICB will no longer have congruent areas and will therefore look at different populations?
Helen Morgan
The hon. Lady raises a good point. I do not want to revisit an earlier part of the debate, but it is certainly relevant that where there is not a local authority representative on the ICB and there is not a mayor in place, and the ICB’s area is not coterminous with the local authority boundary, that adds another element to the issue of the separation out of Healthwatch. Does the Minister agree that the independent and locally rooted Healthwatch cannot be replaced by processes that sit within the NHS system? Will she please reconsider the change? There is concern on all sides of the House, given the value that Healthwatch brings to the service.
Karin Smyth
I will begin with Government new clauses 91 to 95. Many hon. Members will know that the current regulatory framework for medicines and medical devices is seen as overly complicated and difficult to navigate. It is also slow and burdensome to amend, limiting our ability to ensure that it keeps pace with developments. Maintaining the safeguards to public health is central to every decision we make. However, the regulatory framework currently slows down innovation and delays patient access to healthcare products. From a market growth perspective, it also places barriers to the UK market, particularly for small and medium-sized enterprises.
These new clauses will deliver a more streamlined regime for making and updating secondary legislation. The ability to make faster and more responsive updates to secondary legislation will enable the Department and the Medicines and Healthcare Products Regulatory Agency to address the current barriers that I have highlighted in the regulation more quickly.
New clauses 91 and 92 provide for changes with regard to powers to make “ambulatory references”, which are references in legislation to external documents such as technical standards and lists, which can be updated from time to time. These changes will ensure that the legislation continues to capture updated versions of those documents without the need for further regulations. International and domestic standards are crucial in the highly technical areas targeted by the change. It is important that the regulatory regime remains aligned with the technical, scientific and international framework that is designed to evolve over time.
Currently, there are limited powers for medical devices regulations to refer to external international agreements or standards that change over time, and there are no such powers at all for medicines. Without the ability to make ambulatory references to those documents, legislation is needed each time the standards are updated. That is disproportionate and risks unintentional regulatory divergence that creates uncertainty for industry.
The new clauses introduce a power for human medicines regulations to refer to external international agreements or standards that are updated over time. For medical devices, the provisions also extend the current ambulatory reference power to make reference to lists of countries subject to mutual recognition agreements, lists of devices or categories of device that are eligible for an international reliance pathway, and lists of British technical standards. Amendment 80 sets out that the extent of new clause 92 will cover England, Scotland and Wales.
The provisions of new clause 93 enable a more flexible approach to consultations on regulatory changes related to medicines and medical devices, rather than the current one-size-fits-all requirement. Under the amended powers, the MHRA and the Department will still retain a legal duty to consult relevant stakeholders, and significant regulatory changes will continue to be subject to public consultation. The measure is designed to enable consultations that are proportionate to the scale of the change in hand. That will ensure that regulations can be updated more efficiently and in line with the needs of the health service.
New clause 94 will enable certain technical updates to medicines and medical devices regulations to be made using the negative rather than the affirmative procedure. Specifically, it relates to changes that routinely arise as clinical practice evolves—for example, updating detailed lists of medicines or making limited adjustments to the professional groups who may prescribe, supply, sell or administer particular medicines. At present, even minor or time-sensitive changes of this sort can require a debate under the affirmative procedure, which is not always the best use of parliamentary time.
New clause 95 is the final measure in the regulatory framework package for the MHRA. It is designed to streamline the process for routine fee updates made using powers under the European Union (Withdrawal) Act 2018 by allowing the use of the negative parliamentary procedure for routine fee uplifts. That will bring the powers in line with those relating to fees in the Medicines and Medical Devices Act 2021, where uplifts to existing fees can be made with the negative procedure. That will also reduce delays in making and communicating such adjustments, while maintaining appropriate safeguards, including the requirement to set out the cost basis for any new uplifts with any legislation—whether it is made under the negative or affirmative procedure. The draft affirmative procedure will be retained for any substantive changes, such as the introduction of a new chargeable function.
Finally, there are a number of consequential provisions related to those I have just discussed. Government amendments 80 to 82 primarily relate to the commencement period in which they come into force.
In conclusion, the amendments will enable a faster and more responsible reform of the existing legislative framework, while preserving proportionate safeguards and necessary scrutiny. I commend the new clauses to the Committee.
Dr Johnson
New clause 91 would amend the Medicines and Medical Devices Act to enable regulations
“to refer to both international agreements and standards and standards developed in the United Kingdom”
and enable the Secretary of State
“to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom.”
New clause 92 would amend the definition of “mutual recognition agreement” so that
“agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.”
New clause 93
“amends the duty to consult in relation to regulations about human medicines and medical devices.”
That means that instead of a public consultation, it
“gives the option of consulting such persons as the relevant authority considers appropriate”.
I would be grateful if the Minister clarified whether that could be nobody, or whether it has to at least be somebody.
New clause 94
“changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure.”
That relates to regulations about medicines and medical devices. I want to ask about scrutiny, because we have had a number of statutory instruments over the last few years that, under the new regulations, would now be put under the negative procedure. When we have looked at them, there have been questions and potential changes.
Why does the Minister want a lower level of scrutiny? In general, scrutiny is a good thing. I understand that this could smooth out procedure and make it a bit quicker in some cases, but we had an example where a Minister brought forward fee increases. I then raised the issue of national insurance and that Minister was not aware of whether it was paid at that time. The civil service pay estimate was significantly lower than expected and lower than what was given. Therefore, six months later we were back in Committee with a different Minister asking for more money. There is a scrutiny issue with new clause 94. That also relates to the fees and terms in new clause 95, which was one of the examples I gave.
Karin Smyth
I thank the hon. Lady for her comments. The purpose of the new clauses is to support our life sciences and medicine sector, in order to make that more streamlined. She will be aware of the proposals about the negative and affirmative procedure. If there were particular issues of scrutiny, normal parliamentary rules and processes would apply if Members wanted to raise any particular issue.
Question put and agreed to.
New clause 91 accordingly read a Second time, and added to the Bill.
New Clause 92
Medical Devices Regulations 2002: mutual recognition agreements
“(1) The Medical Devices Regulations 2002 (S.I. 2002/618) are amended as follows.
(2) For regulation 1A (Schedules) substitute—
‘1A Schedule
Schedule 2A has effect.’
(3) In regulation 2 (interpretation), in paragraph (1)—
(a) in the definition of ‘mutual recognition agreement’, in paragraph (a), for ‘country listed in Schedule 2’ substitute ‘country specified in a list published by the Secretary of State from time to time’;
(b) in the definition of ‘third country conformity assessment body’, for ‘established in a country which is listed in Schedule 2 and designated in accordance with a relevant’ substitute ‘designated in accordance with a’.
(4) Omit Schedule 2 (mutual recognition agreements).”—(Karin Smyth.)
This new clause would amend the definition of “mutual recognition agreement” in the Medical Devices Regulations 2002 (as it has effect in England and Wales, and Scotland) so that agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.
Brought up, read the First and Second time, and added to the Bill.
New Clause 93
Consultation about medicines and medical devices regulations
‘(1) Section 45 of the Medicines and Medical Devices Act 2021 (consultation) is amended as follows.
(2) In subsection (1), for “a provision of Part 1, 2, 3 or 4” substitute “Part 1 or 3”.
(3) After subsection (1) insert—
“(1ZA) Before making regulations under Part 2 or 4 the relevant authority must—
(a) carry out a public consultation, or
(b) consult such persons as it considers appropriate.”
(4) In subsection (3), at the beginning insert “Where a public consultation is carried out”.
(5) In subsection (4), in the words before paragraph (a), for “subsection (1)” substitute “subsection (1ZA)”.’—(Karin Smyth.)
This amends the duty to consult in relation to regulations about human medicines and medical devices. It gives the option of consulting such persons as the relevant authority considers appropriate instead of a public consultation.
Brought up, read the First and Second time, and added to the Bill.
New Clause 94
Medicines and medical devices regulations: parliamentary procedure
‘In section 47 of the Medicines and Medical Devices Act 2021 (regulations: procedure), for subsection (3) substitute—
“(3) Regulations under Part 1 are subject to the draft affirmative procedure.
(3A) Regulations under Part 2—
(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—
(i) provision made in reliance on section 6(1)(a) (fees);
(ii) provision amending the meaning of ‘appropriate practitioner’ or ‘approved country health professional’ for the purposes of Part 12 of the Human Medicines Regulations 2012 (see regulation 214 of those regulations);
(iii) provision amending any of the following provisions of the Human Medicines Regulations 2012—
• regulations 217C(3) or 217CA(3) (original pack dispensing for products containing relevant substances: definition of ‘relevant substance’),
• Schedule 13 (prescription only medicines for which community practitioner nurse prescribers are appropriate practitioners),
• Schedule 15 (requirements for specific products subject to general sale),
• Schedule 16 (patient group directions and vaccine group directions),
• Schedule 17 (exemption for sale, supply or administration by certain persons),
• Schedule 18 (substances that may not be sold or supplied by a pharmacist without a prescription in reliance on emergency provisions),
• Schedule 19 (medicinal products for parenteral administration in an emergency), or
• Schedule 21 (medicinal products at high dilutions);
(iv) provision amending regulation 250 of the Human Medicines Regulations 2012 (restrictions on persons to be supplied with medicinal products: exceptions) for the purpose of changing the products to which any exception from time to time provided for by that regulation applies;
(v) provision that is consequential on provision of a description mentioned in any of sub-paragraphs (ii) to (iv);
(b) are subject to the made affirmative procedure if they—
(i) contain only provision that is made in reliance on section 7 (emergencies),
(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health, and
(iii) are not within paragraph (a);
(c) are subject to the draft affirmative procedure if they are not within sub-paragraphs (a) or (b).
(3B) Regulations under Part 3—
(a) are subject to the negative procedure if they contain only provision made in reliance on section 12(1)(a) (fees), and
(b) are subject to the draft affirmative procedure if they are not within paragraph (a).
(3C) Regulations under Part 4—
(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—
(i) provision made in reliance on—
• section 17(1)(a) (fees), or
• paragraph 9 of Schedule 2 (supplementary provision about civil sanctions);
(ii) provision amending or revoking regulation 1ZA of the Medical Devices Regulations 2002 (expiry of certain provisions) or consequential on such provision;
(b) are subject to the made affirmative procedure if they—
(i) contain only provision made in reliance on section 18 (emergencies), and
(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health;
(c) are subject to the draft affirmative procedure if they are not within paragraph (a) or (b).”’—(Karin Smyth.)
This changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure. The changes all relate to regulations about medicines and medical devices (although the procedural provisions relating to certain other matters are restated in the amendment).
Brought up, read the First and Second time, and added to the Bill.
New Clause 95
Medical devices etc: parliamentary procedure for certain fees regulations
‘In Schedule 7 to the European Union (Withdrawal) Act 2018 (regulations), in paragraph 12—
(a) in sub-paragraph (1) for “relate to altering the amount of a fee or charge to reflect changes in the value of money” substitute “fall within sub-paragraph (1A)”.
(b) after sub-paragraph (1) insert—
“(1A) Provision falls within this sub-paragraph if it relates to—
(a) altering the amount of a fee or charge to reflect changes in the value of money,
(b) altering the amount of a fee or charge to be charged in connection with the exercise of a function which a public authority has by virtue of provision made under section 8C in connection with the EU medical devices Regulations, or
(c) altering the amount of a fee or charge to be charged under the Blood Safety and Quality Regulations 2005 (S.I. 2005/50).
(1B) In sub-paragraph (1A)(b) ‘the EU medical devices Regulations’ means—
(a) Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC, or
(b) Regulation (EU) 2017/746 of the European Parliament and of the Council of 5 April 2017 on in vitro diagnostic medical devices and repealing Directive 98/79/EC and Commission Decision 2010/227/EU,
as they have effect from time to time by virtue of Article 5(4) of the Windsor Framework.”’—(Karin Smyth.)
This allows regulations altering certain fees in relation to medical devices etc to be made subject to the negative resolution procedure. At the moment those regulations are subject to the affirmative resolution procedure.
Brought up, read the First and Second time, and added to the Bill.
New Clause 1
National Maternity Commissioner
“(1) The Secretary of State must, within six months of the passing of this Act, appoint a National Maternity Commissioner, situated within the Department of Health and Social Care.
(2) The functions of the National Maternity Commissioner are to—
(a) oversee NHS maternity services;
(b) act as an independent voice for women and families;
(c) ensure lessons are learned from identified failures and that the recommendations of maternity reviews are acted upon;
(d) promote consistency, safety and accountability across NHS maternity services; and
(e) advise the Secretary of State on matters relating to the safety, quality and provision of maternity services in England.
(3) The person appointed as Commissioner must—
(a) be a person with knowledge, expertise and experience relevant to the discharge of functions of the role;
(b) have first-hand experience of working in maternity services, so far as reasonably possible; and
(c) not be a sitting Member of Parliament.”—(Helen Morgan.)
This new clause would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise of maternity services, and not a political appointment.
Brought up, and read the First time.
Helen Morgan
New clause 1, which I tabled, would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise in maternity services, and not a political appointment.
It is important to start by saying that I tabled the new clause before we had the report from Donna Ockenden on the Nottingham review, and last week’s report from Baroness Amos on her national review, both of which recommended the appointment of a maternity commissioner. Obviously, since then, the Secretary of State has announced that he will appoint a maternity commissioner. None the less, I will state the arguments for having one, and if the Minister can give us some assurances today, I will not press the new clause to a vote.
Just to set the scene, which I think we all know too well, maternity services in England have suffered a series of high-profile scandals. The cost of political neglect has been paid by families in terms of trauma, injury and lost lives. We have known for a long time that maternity services in this country have been failing. Numerous recommendations have been made over that period, but they have not been effectively acted on in a consistent way, and Baroness Amos’s inquiry finally confirms that.
It is important to say that the vast majority of births take place safely, successfully and happily. However, where things go wrong, having a baby safely has become a postcode lottery. Women are being routinely silenced, and staff who raise the alarm on unsafe care or systemic discrimination have been put off or crushed by a culture of fear. We therefore need to make England the safest country in the world to have a baby.
The Liberal Democrats have been campaigning on that for a long time, and following the Ockenden and Amos reviews it genuinely feels that there is now the will and focus to deal with the problem once and for all. This issue has been going on for far too long. We thank the Secretary of State for hearing our campaign and Baroness Amos’s calls for a national maternity commissioner to oversee national standards and drive change. We also pay tribute to campaigners such as Louise Thompson and the former MP for Stafford, Theo Clarke; without their advocacy, and without so many women sharing their stories, we would not be moving forward.
It is important to say that one individual—one maternity commissioner—will not solve all the issues in maternity by themselves, but they can help drive change and address recurrent issues, whether those are cultural or about safe staffing. They can hold Ministers to account, help restore public confidence in NHS maternity service and ensure that accountability exists. But I want to be clear that the buck should always stop with the Secretary of State; they hold the power and the purse strings, and this role cannot be used by Ministers as a way to shirk that responsibility.
I hope the Minister will clarify a few key points. First, can she reassure us that the commissioner will be independent and not a political appointee? It is essential that this individual feels confident to hold the Government to account and have those difficult conversations. That is far less likely if they are a political appointee.
Secondly, women have made it clear that for them to be reassured that this change will happen and happen meaningfully, they need a clear timetable for when the maternity commissioner will be in place and operating. Understandably, the Secretary of State has not been able to provide that yet, given the need for this Bill to pass through Parliament and for the statutory role to be on the books, and given the time it will take his maternity taskforce to define what it wants the role to look like and for the appropriate legislation to be written and put in place. However, we hope we can get a firm commitment to a timetable from the Minister today or, if not today, then on Report.
We think the commissioner should be involved in the establishment of the taskforce, because it is important that it does not develop a plan that they are required to implement, despite it being something they personally would not have approved. I therefore hope the commissioner will be in place very quickly, even if only on a temporary basis, so that they are working to get the taskforce plan into place.
We heard from the Secretary of State that the commissioner will co-chair the taskforce alongside him. That seems to be the right move, and I welcome it, but, as I said, it is important that they have some role in shaping its action plan, so that they can feel responsibility for it and be fully behind its implementation. Will the Minister commit to introducing a temporary maternity commissioner so that that can happen?
Finally, we have heard reports that the taskforce is not meeting very regularly. I hope the Minister can reassure me that it is now meeting much more regularly and getting that plan into place as quickly as possible, and that the Secretary of State is fully on board in driving forward the commissioner’s role as soon as possible.
New clause 13, which is also in my name, is about putting a duty on the Secretary of State to create a scheme to ensure that every maternity unit in the country achieves a good or outstanding rating from the CQC. I will not repeat some of the points I have just outlined about failing maternity services, but the first quarter of 2026 saw the worst ever recorded rate for maternity injuries. Four years ago, the Ockenden review into the Shrewsbury and Telford hospital NHS trust, which is in my area, found that over 200 babies had died unnecessarily in Shropshire. Yet, despite several immediate and essential actions being put in place, a subsequent CQC review found that the majority of maternity units in this country did not achieve a good rating for safety—they were inadequate in some way. That is just not acceptable.
Our package of measures includes the maternity commissioner, which the Government are obviously progressing with, and we are very pleased about that. However, we also need investment in the service to ensure that that maternity commissioner has the resources they need to make the changes required. We therefore call for one-to-one midwifery care for every woman in labour; a consultant on every labour ward 24 hours a day, seven days a week; a director of midwifery—a senior, experienced midwife—in every maternity service to ensure that more junior midwives on that ward are suitably supervised; the restoration of ringfenced service development funding; and a dedicated neonatal workforce plan.
New clause 13 also requires an annual report to be laid before the House on the “effectiveness of the scheme”. That would allow Parliament to track progress and hold the Government’s feet to the fire on it. Baroness Amos has also called for regular reporting to Parliament to maintain accountability, albeit through the maternity commissioner.
There seems to be consensus, here and across the NHS, on the need for meaningful and decisive action on maternity. There is a great deal of overlap between our plan and the recommendations Baroness Amos has made, and I hope the Minister will be able to take some of these points on board and incorporate them into the Bill.
Dr Johnson
As the hon. Lady said, new clause 1 seems somewhat redundant, because the Government appear to have decided to appoint a maternity commissioner.
New clause 13 asks for a report. Before I go any further, I should say that I am a member of the Royal College of Paediatrics and Child Health and have attended the delivery of many babies as a paediatrician at different levels of seniority. I should also say that I am a member of the British Medical Association, that I continue to work as an NHS consultant paediatrician and that I worked at Nottingham University hospitals NHS trust in late 2012, early 2013.
I have great sympathy with the reasoning behind what the hon. Member for North Shropshire is proposing. We have all been shocked by the many reports we have read, the circumstances we have heard about, the tragedies that have occurred over many years and the challenges that are faced by maternity care. I am not sure that writing more reports is going to help; I think we need more action rather than words.
The hon. Lady mentioned the taskforce. I was disappointed that it took the Government so many months to establish it, that it took so long for it to meet and that it has met only a few times. As we have talked about things such as Healthwatch and the HSSIB, the Minister has shown her enthusiasm to get on with things and ensure that the recommendations made in the varying reports are implemented. I would therefore be interested to understand how that will occur in maternity.
My understanding is that the Government are going to produce a plan on how to deliver the recommendations in the recent report, and that is going to be available by Christmas. However, that means that we will then be in a situation where the Government came into power in mid-2024 and then spent a year writing a plan—the 10-year “Fit for the Future” plan. Around the time that they published that, they decided that they needed an urgent maternity report; that was going to take a few months, but it ended up taking another year in of itself. Now we are going to take another six or seven months writing another plan on how to implement the plan we have written, based on the plan we wrote before, based on the plan we did not have at the general election.
I am interested to understand how the Government are going to convert the good intentions I am sure they have into action. In particular, their manifesto promised that thousands more additional midwives would be trained. I would be interested to know what progress they have made on that.
Karin Smyth
I am grateful to the hon. Member for North Shropshire for bringing this discussion before the Committee. I put on record our thanks for the work she has done in this area and for her engagement with me, and indeed with officials at the Department, to help us understand it more clearly, particularly in the light of the new clause.
Hon. Members across the Committee are committed, as are the Government, to ensuring that women, families and babies receive the care and support they need. We know that the vast majority of births are safe and that there are outstanding examples of care in the NHS. However, where things do go wrong, it can have a devastating impact on women and their families.
That is why the Government launched the national investigation into NHS maternity and neonatal care, chaired by the noble Lady Baroness Amos. Baroness Amos brought the findings from past reviews, local rapid reviews and new evidence from families and staff together into one clear national set of recommendations, which as we heard was published last week. The Government also launched the maternity and neonatal taskforce, chaired personally by the Secretary of State, which will translate Baroness Amos’s recommendations into action.
As we heard, Baroness Amos recommended the appointment of a statutory maternity and neonatal commissioner. We have accepted that recommendation, and I know there is support for it across the House. To be clear, the Secretary of State stated last week that we are committed to putting the role on a “statutory basis” as soon as possible.
I am afraid I cannot give the hon. Member for North Shropshire a more detailed timetable at the moment, because we are currently looking at options to legislate at pace, including potentially through this Bill, subject to discussions through the usual channels, while also—this is crucial—giving the taskforce the opportunity to shape the scope of the role. That was one of Baroness Amos’s urgent actions, and we accept it as a crucial first step in overseeing systemic improvements to care and outcomes and earning back the trust of women and families.
The maternity and neonatal commissioner will champion the voices of families and drive forward that necessary change. The Secretary of State will remain accountable to Parliament for maternity services. The role will be discussed urgently with the taskforce and will have a relentless focus on driving those improvements, which will include co-chairing the taskforce.
As the Committee knows, these are complex matters. The Government, having accepted the Baroness Amos’s recommendation, intend to legislate as soon as practicable. Our immediate priority is to work quickly through the taskforce to define the scope and responsibilities of the role. I know that the hon. Member for North Shropshire will not press the new clause, but I commit to keeping in touch with her and other hon. Members as this work progresses.
Dr Johnson
We talked about clause 1—on the abolition of NHS England—at the beginning of the Bill. The Minister was keen at that time to take unelected individuals out of the picture and create accountability by returning things to democratic control through the abolition of NHS England and putting them back in the Secretary of State’s hands. However, this proposal essentially does the reverse with maternity care, taking it out of the hands of Ministers and the Secretary of State and putting it into the hands of a commissioner. Could the Minister explain that?
Karin Smyth
I am sorry, but I did not get the end of that sentence. However, I think the hon. Lady was saying that the Bill essentially abolishes NHS England. Again, as I have said repeatedly, nobody is opposing that. As is well known, the recommendations on the maternity commissioner have come through a separate process. Given the need for public assurance and to earn back the trust of women and families, as well as—I think the hon. Lady said this herself—the shocking revelations that have come through some of this work, Baroness Amos recommended a maternity and neonatal commissioner to drive through these changes and give confidence to the system. That is why we are going to accept her recommendation. Accountability for maternity services obviously remains with the Secretary of State, who will be co-chairing the taskforce. I hope that addresses the comments the hon. Lady made.
On new clause 13, we know that the vast majority of births are safe, but the devastating trauma experienced by many through failures in care must be brought to an end. The CQC has an important role in assessing whether patients are receiving safe, effective and high-quality care, and it is essential that it can do that objectively and independent of Government. It is therefore not appropriate to impose a duty on the Secretary of State to ensure particular ratings.
Dr Chambers
I would not always object to that, because the whole point of the new clause is that such a contract would come to Parliament and then might well be approved if it turned out to be the best system and in our national interest. The thrust of all three new clauses is to ensure that we do not get exposed and make ourselves vulnerable, which could affect the functioning of the NHS and compromise people’s data. A future Government could set up their own AI system in the UK. How would data be used by that system? We are looking at future-proofing people’s privacy and future-proofing the ability of our country to deliver a service properly.
There is also an economic opportunity. We should always prioritise domestic suppliers where possible, and even cultivate them, and help them to innovate and develop, because spending potentially tens of millions of pounds with foreign companies will not do anything to grow our own economy. Given the world-beating talent in our country, we see no reason why the long-term effect of domestic options to foreign systems could not be developed with sufficient Government support. As such, where a contract is signed with a foreign supplier, new clause 4 would require the Secretary of State to take steps to support domestic alternatives. We recognise the complexities involved with NHS procurement, and our new clauses represent one vision built on the core principles of domestic resilience and digital sovereignty.
I have a few questions for the Minister, which I would appreciate some comments on. How do the Government intend to build trust in the single patient record to make sure that it is not undermined, rather like the federated data platform has been? Does the Minister agree that the poor reputation of Palantir and distrust has been an important element in the slow roll-out of the federated data platform? Has she considered undertaking a risk assessment with a national security focus of current NHS digital and tech contracts? Does she agree that, in an ever more turbulent world, building domestic capability in this area is central to the security of our country?
Does the Minister agree that the domestic life sciences and tech sector is more than capable of developing and scaling many of the systems that we rely on foreign companies for at the moment? The Government have very much positioned AI and technology as the NHS’s white knight. We agree that the potential is huge, but do the Government not think that the NHS needs a long-term digital strategy to support a joined-up development and roll-out of these systems and technology? An analogy to this is how the defence investment plan and future defence procurement can help prioritise and boost economic growth in the UK. We think this is another way that economic growth could be nurtured.
Dr Johnson
I rise to discuss new clauses 3 to 5 and 43, which I am sure that the Whips will not let me forget. I understand the sentiment behind the Liberal Democrat new clauses. The hon. Member for Winchester is keen to ensure that uses of NHS data are limited to uses for which people can consent, uses in relation to their care or specifically approved research. Having heard examples of this data being tracked or leaked by accident, the hon. Gentleman is keen to ensure that that does not happen. He is particularly concerned about the risk of that happening in another jurisdiction where we have less control of the system. I am not sure that the new clauses have been properly thought through, however.
New clause 3 says:
“Within six months of the passing of this Act, the Secretary of State must conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside of the UK.”
That is “all contracts”. In subsection (2), it says that the Secretary of State must “pay particular regard” to contracts with technology companies, but not only to those. I am being a bit pedantic here, but has the hon. Member for Winchester considered the wording of “all contracts”? The NHS does not just provide drugs and medical technology; it provides bedding, blankets, pillows, bananas for people to eat at lunchtime, bedpans and loo roll. There is a whole range of things procured as supplies by the NHS that may or may not be procured from overseas. It would be cumbersome and completely unnecessary to include all of those.
Even with the tech companies themselves, there is a risk for small contracts for small pieces of tech to create a huge amount of bureaucracy. I am not sure that it would specifically improve data quality or data protection. It is reasonable that the Minister would consider risk assessments, and I hope that she would automatically consider them before contracts that are particularly sensitive or contain patient data, but I am not sure that the new clause works.
Moving on to new clauses 4 and 5, the hon. Member talked about Palantir. It may even have been his intention for these new clauses to target one specific American firm, but the actual impact would erect costly barriers to trade. The NHS contracts IT functions to firms based in other countries when the business case is strong. It uses Microsoft, an American company that offers software, cloud services and Outlook for emails; Oracle for standardising and automating financial processes; Sectra, a Swedish company, for transferring medical images and reports; and Dedalus, an Italian company, for migrating services to the cloud. To echo the point made by the hon. Member for Bury St Edmunds and Stowmarket, should the NHS prioritise a British company over an international company if the service has better functionality and a lower cost and is safe?
The hon. Member for Winchester spoke about the vibrant life sciences and tech sector in this country, but if we close off our markets to those from overseas, will others not do the same? Would he want those life sciences companies to be unable to export? There is a barrier to free trade here.
Dr Chambers
This is not about closing off markets or shutting off the potential to use foreign companies if they are most appropriate. It is about prioritising and investing in UK technology and our economy to solve some of our domestic problems while also providing security. Saying that we are closing off domestic markets is misunderstanding the thrust of the new clause.
Dr Johnson
I think it is about balance. I agree that we need to ensure that the data is kept safely. Using British technology where we can is a good thing, but we have to be reasonable about it. For example, there are alternatives to Microsoft Outlook, but how much more would that cost the NHS and how much would it affect patient care? There is a balance to be struck. I understand what the hon. Gentleman is trying to do in protecting our data. That is an extremely important issue, and I am sure the Minister will tell us about the work she is doing to ensure our data is kept safe.
New clause 43, in my name, is about private providers’ data. We often do freedom of information requests about, for example, surgical procedures, but one in 10 procedures are performed in private settings and are not subject to FOI, which means that less data is available to the public. Data from private independent providers is less transparent than that of standard NHS provision. This is a probing amendment to find out the Minister’s thoughts about how to ensure people can access transparent data on operations performed in local independent hospitals, particularly as the Government have signalled their intention towards more and more of those being provided.
Edward Argar
My questions will be very brief. I am conscious that, given that these are mostly Liberal Democrat new clauses, for once I will be asking the hon. Member for Winchester for a response, not the Minister.
New clause 4 would require that contracts be laid before Parliament. I would be grateful if the hon. Gentleman can tell the Committee how many such contracts he thinks would end up being laid before the House in any given year, based on historical data, and therefore how much parliamentary time that would take up. Does he envisage that being handled by an affirmative or negative statutory instrument? What will the process be?
I can see what the hon. Gentleman is trying to do, but I have a certain wariness, along the lines of that expressed by the hon. Member for Bury St Edmunds and Stowmarket. Although it is important that we have appropriate protections and scrutiny, when we are procuring services and technology for the NHS we should be looking for the most effective and best tools that have those safeguards but can do the job that eminent surgeons and clinicians need them to do in order to do their work for patients.
Health Bill (Thirteenth sitting)
Caroline Johnson Excerpts(2 months, 1 week ago)
Public Bill CommitteesRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Chair
I remind the Committee that with this we are discussing the following:
Amendment 55, in schedule 8, page 110, line 23, at end insert —
“(10) If the Secretary of State certifies that it is in the interests of national security that the powers conferred by subsection (1)—
(a) should not be exercisable in relation to certain premises in which there is a Crown interest, or
(b) should not be exercisable in relation to certain specified premises for other purposes,
those powers are not exercisable in relation to those specified premises.
(7) In this section, “Crown interest” means—
(a) an interest belonging to a government department or held in trust for His Majesty for the purposes of a government department;
(b) an interest belonging to His Majesty in right of the Crown;
(c) an interest belonging to His Majesty in right of the Duchy of Lancaster;
(d) an interest belonging to the Duchy of Cornwall.”.
This amendment makes provision for the Secretary of State to disapply investigation powers under subsection 51J(1) to the Health and Social Care Act 2008, inserted by Schedule 8 of this Bill.
Amendment 56, in schedule 8, page 116, line 8, leave out subsection (9).
This amendment would allow the Commission to recoup charges in excess of the costs incurred in providing assistance.
Amendment 5, in schedule 8, page 120, line 16, at end insert—
“(2A) After paragraph 6(8) insert—
“(9) A committee of the Commission is to be appointed in accordance with regulations.
(10) The purpose of the committee is to oversee the health services safety investigation functions formerly conducted by HSSIB, transferred to the Care Quality Commission under the Health Act 2026.
(11) The committee is to be operationally independent from the Care Quality Commission.
(12) The committee is to consist of a chair appointed by the Secretary of State, and not less than six and not more than twelve other members appointed by the chair.
(13) A majority of the members of the committee must not be members of the Care Quality Commission.
(14) So far as is reasonably practicable, the persons appointed to the committee must include persons with knowledge or experience relevant to the discharge of functions under this paragraph.””.
This amendment would ensure that oversight of HSSIB’s functions would remain operationally independent of the Care Quality Commission (CQC) following the transfer of its functions to the CQC.
Schedule 8.
Clauses 60 and 61 stand part.
New clause 42—Funding for Care Quality Commission (CQC) investigations—
“The Secretary of State has a duty to make provision for adequate funding and resources for patient safety investigations conducted by the CQC, including some initiated by the CQC themselves.”.
I believe Dr Caroline Johnson was mid-intervention.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
My hon. Friend the Member for Isle of Wight East was talking about the importance of the perception of the safe space, in relation to people being able to come forward, and the fears of whistleblowers. Does he agree with me that it is not just this perception that causes potential whistleblowers to worry? If they read the newspapers on a regular basis, or are on social media, they will see examples of people who have suffered mistreatment as the result of having been whistleblowers.
Joe Robertson (Isle of Wight East) (Con)
The shadow Minister is absolutely right. Perception is a problem, but the reality on the ground is perhaps an even greater problem. Both are issues here with what the Government plan.
There could be a reason why this merger, or the abolition of the Health Services Safety Investigations Body, needs to happen, but we have not seen that compelling argument. We have seen some attempts at justification, but they seem to be incredibly thin—and that is being generous.
The principal argument seems to be that there is a busy and confusing landscape when it comes to investigatory and regulatory bodies. The figure Dr Dash put forward was something like 150 different organisations; she was asked to review just six of those. Even if she were to have abolished all six, it clearly does nothing to reduce the busy and confusing landscape. My hon. Friend the Member for Farnham and Bordon made that point well.
A busy and confusing regulatory landscape should not be a justification for getting rid of an essential investigatory body and disincentivising the investigation process and whistleblowing and disclosures, by tying it up with the regulator, which itself may be at fault. Streamlining and dealing with a busy and confusing landscape are objectively good reasons to do something, but not this. That is the central point.
As my hon. Friend the Member for Farnham and Bordon referred to, the question was put to Dr Dash, the author of the recommendations, when she gave evidence: what happens if there is a problem with the Care Quality Commission once HSSIB has become part of it? I think we rightly expected a fairly clear answer on that. The answer was a rhetorical response:
“‘What happens if the problem is this organisation or that one?’”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 8, Q9.]
That was the response from Dr Dash. But we are not talking about whether there is a problem with this organisation or that one; we are talking about the CQC, the organisation that HSSIB will become.
If there is a problem with another organisation, HSSIB can investigate it; if there is a problem with the CQC now, HSSIB can investigate it; but when HSSIB becomes the CQC, there will plainly be a problem with investigating the CQC. When that question was put to the author of the report on whom the Government are relying, no answer was provided. The reply to my hon. Friend the Member for Farnham and Bordon was a rhetorical question.
I urge the Minister to reflect. There is a major issue here that has not been addressed. Until she, or those on whom she relies, can articulate the answer, I urge her to delay these proposals.
Karin Smyth
I thank my hon. Friend for that. He and others on both sides of the House with clinical experience, including the hon. Member for Sleaford and North Hykeham, have shared live examples that can shock the layperson. It is important that those practices are changed clinically, and it is up to Government to make sure that the overarching legislative framework enables that.
Karin Smyth
I want to make some points first. I will pick up any outstanding points I do not cover.
The abolition of HSSIB and the transfer of its functions to CQC is being done to strengthen the link between patient safety investigations and the action being taken on the frontline to simplify the patient safety landscape. We want to align the recommendations with action.
Hon. Members quoted evidence that Dr Dash gave to the Committee. Let me remind the Committee of something else she told us, about how HSSIB’s functions can be better aligned as part of the CQC. She said:
“by bringing HSSIB into the CQC, you can align the work of the two.
For example, if the CQC is going round the country and spotting a particular problem with the way in which anaesthesia is being given or with managing patients post-surgery, the CQC could then say to HSSIB—that team of people with specific expertise—‘Can you go in and take a look at this? Can you do a detailed focus review of this particular area of care that we are spotting through our visits and which seem to be a particular challenge?’ It is that bit about enabling the CQC to identify a problem and then asking HSSIB to review it in detail, and HSSIB bringing its expertise in investigations into the CQC to enable the CQC to go deeper and then come back to the NHS”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.]
to enable best action. These organisations can learn better from each other.
Transferring investigation powers to the Care Quality Commission is an opportunity to strengthen the CQC. We have to move away from a defensive culture to a culture of shared learning if we are to improve patient care. The CQC can learn and improve from HSSIB best practice and take a more holistic approach to patient safety. Those executing the regulatory and investigatory functions can learn from each other and exchange skills, which would strengthen the links between learning, oversight and improvement, leading to real and sustained change across the system, driven by the CQC.
Karin Smyth
I am going to persist on some of these arguments. I think I have addressed all the points made by the Opposition. It is the job of effective leadership to manage those interests and responsibilities, and that is what we expect of the CQC’s leadership.
I will now turn to the amendments on this topic, which I thank the hon. Members for Sleaford and North Hykeham and for North Shropshire for tabling. Amendment 55 would make provision for the Secretary of State to disapply investigation powers in certain circumstances. I recognise the importance of ensuring that investigatory powers are not exercised in relation to sensitive Crown or Government premises where there is a national security interest. I want to be clear: the Bill already provides for that.
The Bill already amends section 96 of the Health and Social Care Act 2008 so that it applies to the new CQC investigatory function. Section 96 makes provision for the application of CQC legislation to the Crown, which means that the mechanism that the amendment is seeking to introduce is already in place within the existing legislative framework. Additionally, the Bill already provides for a power which enables the Secretary of State to disapply these investigatory powers in relation to Crown premises when it is in the interest of national security. The amendment would therefore duplicate an existing provision and would add unnecessary complexity to the legislation without delivering any additional benefit.
Amendment 56 would allow the Care Quality Commission to recover charges that are higher than the actual costs it incurs when providing assistance to anyone other than an NHS body or the Secretary of State. I understand the intention behind the amendment—to give the commission greater financial flexibility—but the Government do not think that it is necessary. The charging framework in the Bill is based on the clear principle of cost recovery. Removing subsection (9) of proposed new section 51R of the Health and Social Care Act 2008 would mean that the commission could charge more than it actually costs to provide a service, shifting away from recovering costs and towards allowing the commission to make a surplus through its charging powers.
Dr Johnson
My understanding is that, in the past, HSSIB has provided services to not only British health services but overseas health services, which were, in some cases, charged for that service, as it is a world-leading organisation. Why would the Minister not want that to continue?
Karin Smyth
I am happy to get back to the hon. Lady on that specific point, if that is the case. The charging framework is about recovering costs, not making a surplus, which is what the amendment would result in. If that is not the case, I will make sure that she receives a proper correction.
The Government do not think that there is a good case for the amendment, because, as I have said, the aim of the provision is to provide for fair and transparent cost recovery, not to raise extra income beyond cost. I am not sure whether the hon. Lady is suggesting that it might be good for the commission to create additional funding, but if that is not clear, I am happy to get back to her on it. The provision makes the recovery of costs more predictable and consistent for those who have to pay them. That is usual for public bodies.
New clause 42 relates to funding provisions for the CQC’s new investigation function. The Department already provides grant in aid to the CQC to provide adequate funding for investigations and special reviews; similarly, HSSIB’s budget is provided through grant in aid and is set each year. When the CQC takes on HSSIB’s functions, the funding streams will remain distinct, and the CQC will have to assure the Department that the amount allocated to the new investigation function is being used for that purpose.
Funding decisions for the investigation function will continue to be captured in wider departmental budget-planning processes and considered centrally. That provides assurance that business and strategic priorities for the investigation functions can be met. Robust financial oversight will require the CQC to demonstrate that grant in aid is used appropriately, and solely to support the investigation function, without the need to prescribe funding arrangements in legislation.
As there is already an operational mechanism for the Secretary of State to provide adequate funding and resources for investigations, the new clause is not needed. It would also be inappropriate to prescribe the form or level of funding in legislation. The new clause would reduce the Department’s ability to manage funding through the established spending review and estimates process; introduce unnecessary rigidity as the merged function evolves; and risk creating binding funding expectations that may not align with future fiscal constraints. A non-legislative approach ensures flexibility, scale and adaptive function while maintaining robust oversight.
I agree with the intention behind amendment 5, tabled by the hon. Member for North Shropshire, which is, as I understand it, to ensure that the Health Services Safety Investigations Body functions that are transferred to the CQC retain a high level of operational independence and continue to command the confidence—the Committee heard that word a lot this morning; I completely agree on its importance—of patients and their families, healthcare professionals and the wider public. Similarly, I understand that the objective of the amendment is to maximise the perception—again, that is a word I am coming back to; I tried to address the issue earlier—of independence in the CQC.
The Government have protected safe spaces in legislation, and we agree that operational independence of the investigation function is required, but our plans support and enable that. For that reason, we cannot support the amendment, which would impose a highly prescriptive governance structure on the CQC by requiring the creation of a separate statutory committee and setting out in primary legislation detailed requirements for its purpose, membership appointments and operational arrangements. While the Government fully agree that effective safety investigations must be conducted independently and objectively, we do not consider it necessary to put such detailed organisational arrangements in the Bill.
The Bill already provides a clear legislative framework for the transfer of those functions and enables the CQC to discharge them appropriately, within its broader statutory responsibilities. Furthermore, the CQC already operates within a robust statutory framework and is capable of establishing governance arrangements that support the effective delivery of its functions, including appropriate safeguards to protect investigative independence and the handling of safe-space material.
The amendment would reduce organisational flexibility by mandating a specific committee structure, and would constrain the CQC’s ability to adapt its governance arrangements over time in response to operational experience, changes in circumstances or future improvements in best practice. Under the amendment, governance arrangements would be fixed in statute, rather than having the capability to evolve as the organisation learns and develops.
Those additional administrative and governance requirements would increase bureaucracy and complexity, which the Government are looking to reduce. I re-emphasise that, in addition, a statutory committee would weaken the important links between learning and the action that the transfer of this organisation is intended to support. One of the key benefits of bringing these functions into the CQC is the opportunity to strengthen strategic oversight and ensure that learning from investigations can more readily inform improvement activity across the system.
Dr Johnson
The Minister seems to be saying that her reasoning for moving HSSIB into the CQC is to ensure that actions take place in response to the recommendations. But if HSSIB outwith the CQC makes recommendations that are delivered by the provider organisations, commissioned by the ICBs and overseen by Ministers, and then the CQC checks that as part of the regulation, why does HSSIB need to be within the CQC for that to happen?
Karin Smyth
We are probably not going to agree on this point. I have made the point several times—and we made it in the Dash review—about bringing these organisations together. As I said again in my opening comments, it is about the opportunity to get this right and share that learning and experience. It is not about the cost but about aligning the recommendations and the actions that follow through from them. That learning, and the opportunity to push that through, is something we should grasp.
Coming back to amendment 5, creating a separate statutory committee risks introducing additional layers of separation that could slow the flow of intelligence and impede timely action in response to emerging patient safety concerns. We believe the integration of investigatory functions can be secured through clear statutory functions and appropriate safeguards, rather than through organisational structures set out in primary legislation that are too rigid. Establishing detailed governance requirements in statute may also make future improvements more difficult to implement without legislative change.
I understand and respect the concerns that underpin the amendment, but the Government believe that the Bill already provides the necessary framework for the safe and effective delivery of health services’ safety investigations following their transfer to the CQC. We will of course work closely with both the CQC and HSSIB on their transition arrangements through a transition board, whether on the issues of ensuring operation independence of the investigation function and the ways in which that learning is shared, or, further to the Opposition spokesperson’s point, how we make sure that learning is shared and creates an impact, and where that is felt most clearly. For those reasons, I ask hon. Members not to press their amendments, and I commend clauses 59, 60 and 61 to the Committee.
Question put, That the clause stand part of the Bill.
Dr Johnson
The Minister has reassured us that, although it has not been lifted and shifted from the original, the amendment is a duplication of another clause. Therefore, we believe the Committee—
Karin Smyth
Clause 62 underscores the importance that we place on special reviews and investigations, and it will maintain the Care Quality Commission’s ability to conduct them by ensuring that the CQC’s investigatory role remains properly aligned with its original statutory purpose. The CQC is the independent regulator of health and care providers, and in the case of commissioners, it has the powers to undertake a special review or investigation when requested to by the Secretary of State.
On 30 January 2024, the then Secretary of State, the right hon. Member for Louth and Horncastle (Victoria Atkins), commissioned a section 48 review into mental health services in Nottinghamshire following the tragic events of June 2023. As we know, that revealed serious and systemic failings and led to strengthened oversight and a clear improvement plan. With NHS England being abolished and its functions being transferred to the Department and across the wider system, this clause will remove NHSE from the scope of section 48 and allow Ministers to set out, through regulations, the future scope of section 48.
NHS England’s commissioning functions will mostly transfer to the integrated care boards but, as we discussed previously, NHSE’s most specialised commissioning functions will transfer to the Secretary of State. In future, regulations will set out the specific commissioning functions that the Secretary of State will be responsible for and that the CQC may review or investigate. The scope of the special reviews and investigations will continue to apply only to commissioning functions under the National Health Service Act 2006 or section 117 of the Mental Health Act 1983, which is the CQC’s existing remit.
This approach will ensure that the CQC’s investigatory powers will not be automatically extended to departmental functions, which would fundamentally change the relationship between an arm’s length body and a Government Department and would not align with the original intention of section 48 reviews. For that reason, the Bill will provide for scrutiny through secondary legislation. That will set out a transparent and accountable way to specify which commissioning functions are in scope, enabling parliamentary scrutiny and CQC oversight where it is genuinely relevant to patient safety and care quality.
This approach will also provide important flexibility: as commissioning arrangements change, the right function can be brought into scope without unnecessary delays. Taken together, this clause will protect the CQC’s independence, maintain accountability and provide a sensible framework for scrutiny where it adds real value for patient safety and care quality. I commend the clause to the Committee.
Dr Johnson
I have just a couple of questions. Clause 62 will update the CQC’s power to conduct special reviews of NHS commissioning to cover ICBs and the Secretary of State’s commissioning functions, and the requirement for ministerial approval before the CQC can investigate will be retained. How will that apply when HSSIB is moved into the CQC? Is it the Minister’s intention that HSSIB will need the Secretary of State’s approval to complete investigations?
Karin Smyth
My understanding is that the clause will not change that particular power, but I will get back to the hon. Lady if I am wrong.
Question put and agreed to.
Clause 62 accordingly ordered to stand part of the Bill.
Clause 63
Time limit for bringing proceedings
Question proposed, That the clause stand part of the Bill.
Karin Smyth
The 10-year health plan reaffirms the Government’s commitment to families affected by bereavement or serious harm, ensuring that lessons are learned from their experience and that more cases are fully reviewed and acted on. Families seek closure following serious harm to or the death of a loved one by wanting to understand what went wrong and what could be done to stop other families experiencing similar trauma, and by wanting to hold someone to account. Families often turn to the Care Quality Commission for help.
Clause 63 will extend the CQC’s power to bring proceedings against a health and social care provider for a serious breach of regulations from the existing limitation of three years from the date of the offence to five years. Let me be clear: extending the three-year limitation from the time of the offence will not alter the first requirement that the CQC should act within 12 months of sufficient evidence of a serious breach of regulations becoming available. That 12-month window for action once the regulator is aware of the offence will remain unchanged. Extending the limitation period to five years from the date of the offence will mean that fewer events that should be considered by the regulator will effectively time out and go beyond the reach of the regulator’s action.
The CQC is not the only body with an interest in investigating serious breaches of regulations that result in unnatural death; there are other investigatory bodies, such as the police, with equal interest and powers to investigate deaths for the purpose of pursuing criminal prosecution. The coronial process serves a different purpose. A coroner’s role is to establish facts surrounding an unnatural death rather than to find fault. In a complex case, a police investigation or a coroner’s inquest—sometimes both—can take time to conclude. Those independent processes are a useful source of information for the CQC to form a full picture of a breach of regulation.
A culture of learning from investigations, inquiries, errors and poor care should be the norm in the NHS. It is therefore expected that a service provider may also commission its own internal investigation to learn from an unnatural death. Furthermore, there are cases where the CQC is approached late with information after an offence may have been committed. For example, the CQC may only receive information about an offence two and half years after it was committed, leaving little time in the remaining six-month period to investigate. Extending the period to five years would help mitigate such circumstances, and that is why we are extending the statutory limitation period. This will ensure that the CQC has the ability in far more cases to address the serious regulatory failings that it should and must address, without risking falling foul of a time limitation. I therefore commend the clause to the Committee.
Dr Johnson
As the Minister said, clause 63 amends section 90(2) of the Health and Social Care Act 2008 to extend the limit on proceedings relating to the registration of offences under part 1 from three to five years. The impact assessment talks a little about the time it takes to investigate these cases, but as the Minister said, the time to investigate is 12 months from the CQC being given enough evidence to consider whether the case is prosecutable. Why has she chosen not to change that too? Does she think people will have enough time to investigate? She is looking puzzled.
Karin Smyth
Apologies—I missed the exact question as to what needed to be changed. Could the hon. Lady repeat that?
Dr Johnson
The Minister talked about changing the time period in which proceedings can be effected from three to five years, but once the CQC is aware that an investigation could be brought and there is evidence that needs to be looked at, it will still get only 12 months. That has not been changed. I wonder what the rationale is for that. I am not criticising it; I am just asking the question.
The other issue is that clause 63 is prospective, so if an offence were committed immediately after the Act was passed, for the first three years things would effectively be as they are now; the change from three years to five would be relevant only after three years. Clause 71(2) on commencement provides that clause 63 will not come into force until two months after the Act is passed. I just wonder in practical terms why, given that it will take three years to come into effect in any case, it will not come into force on the day the Act receives Royal Assent.
The impact assessment talks about the CQC prosecuting two or three additional cases a year, and a cost of £4.3 million over 10 years with fines of £2.7 million over 10 years. Will the regulator keep the fines, or will they go back into the Treasury? Can the Minister guarantee that the additional funds that are estimated to be required for the additional cases under this new regulation will be provided so that the CQC can do the investigations that she is giving it the opportunity to do?
Karin Smyth
Put simply, the answer to the hon. Lady’s questions is that we are not seeking to change other aspects. The CQC wants to get to points as soon as possible, so the 12-month period has not been changed. The function of clause 63 is merely to recognise the issues around the three years and to change that to five years. We are not seeking to alter anything else in that regard. On her point about the commencement date, that is merely recognising what is considered to be parliamentary convention.
Question put and agreed to.
Clause 63 accordingly ordered to stand part of the Bill.
Clause 64
Abolition of Healthwatch England
Question proposed, That the clause stand part of the Bill.
Dr Johnson
Clause 64 abolishes Healthwatch England, which I believe is a mistake, and introduces schedule 9 to facilitate that. The impact assessment talks about the roles of local healthwatch and Healthwatch England, with local healthwatch obtaining views, making reports and recommendations, promoting and supporting public institutions, signposting to advice, and giving views to Healthwatch England nationally; and Healthwatch England then providing leadership, guidance and support to local healthwatch, escalation to the CQC, which we have heard a lot about already, and advice to the Secretary of State or NHS England.
Members may be familiar with the term “nothing about us without us”—the idea that policies should not be decided and services should not be shaped without the participation of those who will use those services or be affected by the decisions that are made. As a medical practitioner, I believe that is an important principle. Patients must have a voice, because it is they who have the lived experience of their conditions and know their needs better than any civil servant in Whitehall. They know what is working and what needs to change.
Let us look at the history of patient voice. In the two decades after the NHS’s inception, the provision of care was really quite paternalistic. Patients did not really have any role in shaping the services that they received. That changed in 1974 with the establishment of community health councils, made up of volunteers. They carried out research, conducted visits to inspect standards and represented communities when changes were proposed. They also helped the public with information about local services, including how to make complaints—very similar processes.
The Labour Government abolished community health councils in 2003, although a cursory trip to Hansard reveals that the Government repeatedly stated before the publication of the NHS plan that at that point they envisaged no immediate changes to community health councils, but they did go on to do that. That is reminiscent of what we are discussing today, because abolishing Healthwatch was not in the Labour party manifesto.
In 2003, the community health councils became patient and public involvement forums, and five years later they became local involvement networks. The names and structures have changed, but the principle of patients having an independent voice remained. Healthwatch is the latest iteration. To be precise, Healthwatch England was established initially as a committee of the Care Quality Commission in 2013. It operates a hub-and-spoke model with more than 150 local healthwatches spread across local authority areas.
Healthwatches play a vital role in exposing problems in the health service. Indeed, even the King’s Speech contained a reference to Healthwatch England. According to Healthwatch England’s May 2025 report,
“nearly one in four…adults have noticed inaccuracies or missing details in their medical records”,
such as inaccurate personal details and inaccurate records of medicines, diagnoses, treatments and conditions.
I note that the Minister herself has relied on Healthwatch when bringing problems facing her constituents to the House. She said:
“In a recent Adjournment debate about Bristol and the south-west, I raised the issue of a pregnant constituent who was unable to access care at that critical time. This is the No. 1 issue raised by Healthwatch. Patients are struggling.”—[Official Report, 10 February 2022; Vol. 708, c. 484WH.]
So Healthwatch is valuable.
I invite Members to look at the impact that Healthwatch had in 2023-24. More than 925,000 people used their local healthwatch to get advice and information about their health and care. More than 329,000 people shared their experiences to help improve services. Healthwatch England helped to secure changes to Royal Mail so that NHS letters are delivered to patients on time. It also led new NHS guidance so that patients commencing cancer treatment have priority access to NHS dentists. A piece of Healthwatch research indicated that millions of eligible adults may be missing out on social care.
Recently, my local branch, Healthwatch Lincolnshire, produced a report on the challenges facing carers nationally. Healthwatch has influenced the future of attention deficit and hyperactivity disorder care, encouraged the uptake of cervical cancer screening and so much more. That is why the public and health experts are alarmed by the Government’s plans.
As for HSSIB, the success of Healthwatch is due to its independence, but the Government want to do away with that. Their policy paper commits to replacing Healthwatch with a new patient experience directorate, which will sit inside the Minister’s Department. Instead of having organisations embedded in communities sitting on local health and wellbeing boards, the public will need to interface with the Minister’s Department. How can she guarantee the independence, and the perception of independence, of the new directorate? How can she be sure the public will trust it?
I remind Members of what Councillor Dr Wendy Taylor of the Local Government Association said:
“The current proposals to disband Healthwatch and allow health and social care services to gather and respond to feedback, rather than being challenged by an independent voice, risks organisations being seen to mark their own homework.”
When Healthwatch conducts surveys, it often solicits information that proves problematic for the Government of the day. How can the public have confidence that the new directorate’s process will do the same? What will stop the Secretary of State deciding what questions get asked and what data gets published? From my reading of the Bill, the answer is nothing.
The Government have made it clear that, alongside the new directorate, ICBs will take over several patient voice functions. I appreciate that this strays slightly into the subject of the next group of provisions, Ms Lewell, but it is difficult to separate Healthwatch from local healthwatches. The Patients Association has warned:
“Splitting local Healthwatch between ICBs and local authorities risks creating a patchwork of accountability with no single body responsible for ensuring patients are heard”.
If responsibility to deliver those functions is shared between different parts of the health system, who becomes accountable if it is not funded? Who is accountable if people fall through the cracks? If accountability is divided, it often means that accountability is somewhat diminished.
Members also need to ask whether it is financially feasible for ICBs to deliver patient voice. In its evidence, the Health Foundation wrote:
“Moving the NHS functions of local HealthWatch organisations into newly enlarged ICB footprints could also result in the loss of a more nuanced local understanding of the public’s priorities and needs, with particular implications for seldom heard or more vulnerable communities.”
We know that ICBs are under financial pressure because of decisions by the Labour Government; they have had to slash operating costs by 50%, and many are pencilling in cuts to frontline services. Against that backdrop, how can they afford to deliver patient voice functions? Ms Lewell, your guess is as good as mine.
We have not heard about any additional funding from the Government for the purpose of patient voice. Healthwatch England was provided £3.3 million in 2025-26, and local healthwatch £14.1 million. How much of that money will be redirected to the patient experience directorate and the ICBs?
I tabled a written question about the benefits to the public purse of abolishing Healthwatch. The Minister’s response was as follows:
“The potential savings from abolishing Healthwatch England and Local Healthwatch are dependent future policy decisions regarding the approach taken to collecting user experiences post-abolition.”
She set out an intention for “future policy decisions”, but there was, and still is, an absence of a plan. That is something we have heard again and again in relation to health, in Committee and throughout the two years that this Government have been in power: the absence of a plan for how things will be achieved. They have lofty aims, and understandable and sometimes really good goals, but no understanding of how they are going to get there.
It is not just the Opposition who are concerned; I will give some examples of Government Members who are, too. The hon. Member for Birmingham Erdington (Paulette Hamilton) said:
“One of my biggest concerns about the Bill is the reduction in independent patient representation, including the abolition of Healthwatch structures.”—[Official Report, 1 June 2026; Vol. 786, c. 921.]
The hon. Member for York Central (Rachael Maskell) said:
“Replacing Healthwatch will mean that, ultimately, patients will not have confidence in the commissioners.”—[Official Report, 9 June 2026; Vol. 787, c. 136.]
The hon. Member for Blaydon and Consett said:
“I understand that the Government’s real intention, through the Bill, is to strengthen the patient voice and the ability to raise issues, but there is real concern that an organisation inside the Department of Health and Social Care will not provide that independence. Will the Minister commit to looking again at how that independence can be built in and…with the ability to pull the levers”?—[Official Report, 1 June 2026; Vol. 786, c. 944.]
We have also heard concerns from the Health and Social Care Committee.
But the Member that the Minister may be most interested in is the right hon. Member for Makerfield (Andy Burnham). He wrote to the former Secretary of State last year saying:
“People speak to Healthwatch because they are outside the system—they are impartial, trusted, and provide a safe space for concerns to be shared.”
Does the Minister agree? If so, why does she want to remove the independence of patient voice? The right hon. Member for Makerfield also said:
“The independence of resident and patient voice is a necessity. Without it, we risk losing the trust of the public, the richness of lived experience, and the ability to challenge and improve the system from within, particularly during this time of significant system reform”.
My plea to the Minister is this: think again about the importance of the independence of patient voice. People will give their views when they think they can do so independently and safely—a principle that was echoed in the debate this morning. Removing the independence does not seem necessary, and I do not understand why the Minister thinks that it will improve patient care and thereby patient safety. It is clear that Members not only on the Opposition Benches, but right across the Government Benches—in fact, potentially the new Prime Minister from next week or the week after—may think the same. I encourage the Minister to reconsider this step.
Dave Robertson
I will make some progress. There are concerns that if we roll some responsibilities into ICBs or councils, the Department needs to make sure that the issue does not get pushed to the side and that the funding does genuinely remain for patient voice. I am reassured that there will be a patient experience directorate within the Department. That will bring decision making and the patient voice into the Department while also keeping an eye on what is happening with those ICBs and ensuring that they have standards to hit.
The Department needs to ensure that it is sharing good practice and keeping oversight of local authority commissioning of social care. The CQC is starting to do that, and there are some positive indicators. There is obviously more work to do, and we need to stay on top of it because, as I said earlier, there are risks whenever there are changes to healthcare. I am reassured that bringing the patient voice into the room with decision makers is the right way to enact change.
Karin Smyth
Clause 65 and schedule 10 will abolish the current local healthwatch arrangements and place responsibility for gathering the views of local people firmly with the bodies with the clearest levers to act: integrated care boards and local authorities.
At present, many organisations are gathering views, running engagement exercises and raising issues, often with the best of intentions, but the result can be duplication, variable coverage and uncertainty about who is accountable for responding. We can end up with lots of feedback but too little clarity on the action that follows. By placing those duties on integrated care boards and local authorities, we are ensuring that insight from patients, service users and communities feeds directly into where commissioning and service planning decisions are made for both health and care. As my hon. Friend the Member for Lichfield said, the people are in the room. It makes it easier to connect lived experience to priorities, quality improvement and the tackling of inequalities, rather than leaving intelligence at arm’s length from decision makers.
This is about strengthening impact, not silencing criticism. Integrated care boards and local authorities will have a statutory duty to demonstrate how they have engaged with all people in their area, including seldom heard groups, and will be expected to have clear routes for people to raise concerns. We expect transparency about what people have told the system, what the system has done in response and how learning is shared across partners.
As I said in my evidence, many constituents in my Bristol South constituency are said to be hard to reach. They are not hard to reach, in my view. We know exactly where they live, who they are, how old they are and what sex they are. We know largely what diseases they have. We know their level of income. We know their levels of education and attainment, and how they impact their health outcomes. They are not hard to reach; the system is not set up to listen to them. That is what we are determined to change.
Dr Penny Dash’s review of patient safety described a cluttered landscape, with overlaps in how user experience and advocacy are organised. It described the burden that that can place on the frontline, producing multiple, poorly co-ordinated asks with limited impact. Bringing the patient and community voice closer to the organisations responsible for improvement—it is actually their job as commissioners—will help to make feedback more actionable, reduce confusion and support better services. I commend the clause to the Committee.
Dr Johnson
As I understand it, the objectives of the Bill are to replace the local healthwatch with a less independent, internalised gatherer of patient experience feedback. The objectives appear to be featuring feedback more centrally in strategic decision making, getting people into the room and simplifying the patient landscape.
There are things that I do not understand about that. If the problem is that those who commission or deliver the services are not listening adequately to the people who gather the patient experience information, why not invite the independent individual who has gathered that information into the room? Why ask someone in the room to gather the information and risk the independence? Why not compel more listening?
The Minister talked about who is accountable for action. My understanding is that it is the healthwatches’ job to gather the patient experience and present it to Healthwatch England and the decision makers. It is not their job, as I understand it, to make decisions on how care is delivered or to deliver that care differently. Does the Minister intend that to change?
The Minister also talked about strengthening the impact of Healthwatch, but I do not understand how this change will do that. We have heard how its independence allows Healthwatch to go on telly, talk to Members of Parliament, Select Committees, radio stations and others, and publicise its findings. If it is within the Department, will it be able to do so as freely? I suggest that it will not.
The other thing that I do not really understand—perhaps the Minister can help us with this—is the organisation. At the moment, it is done in local authority areas. It will now become the job of the local authority and the ICB to commission feedback, but we have already heard how the 50% cuts to ICB budgets have led to ICBs merging into larger conglomerates. Those do not necessarily overlap with the strategic mayoral authorities in the way the Minister eventually wants. What geography does the Minister want the feedback to be gathered over? How does she see that working? Will it require further restructuring? The hon. Member for Lichfield talked about the importance of localism and how different areas of his constituency have different health needs. How does the Minister think that that will work under her new plans?
The Minister said that one benefit of the new process is reaching vulnerable individuals, but what is to stop Healthwatch doing that? Ultimately, if we have Healthwatch doing things now that are independent and respected across the House—I am sure your local healthwatch is also excellent, Ms Lewell; Lincolnshire’s certainly is—why not strengthen that voice? Why not say to those who are providing that service, “We’re going to give you more resources,” or “We’re going to ask you to deliver it in a slightly different way,” or “We’re going to ask you to focus on particular populations,” or even, “We’re going to invite you into the room with the ICBs so that they can hear you and listen carefully”?
Why not compel those making the decisions and delivering the services to listen to Healthwatch, rather than replacing it? It was not Healthwatch’s job to listen to them, but to gather the information and present it, and that is what it has done. Can the Minister explain how removing its independence is going to help? I simply do not understand it.
Helen Morgan
I am very grateful to serve under your chairship, Ms Lewell. My hon. Friend the Member for Winchester has made some general points about Healthwatch and the importance of an independent patient voice; I will not reiterate them, because he made them very well, but I want to speak specifically about local healthwatches and the benefits that they bring.
I find it quite difficult to hear in this room, so I hope the hon. Member for Lichfield will correct me if I have misunderstood the gist of his speech, but I was frankly astonished by the suggestion that if local managers had heard about the problems at Mid Staffs or at Shrewsbury and Telford hospital NHS trust, the concerns raised in those extremely serious scandals would have been addressed. The reality is that the management of both providers knew exactly about the concerns in those trusts, and they did not address them. That is why we have Healthwatch.
The hon. Member for Lichfield may be aware that my parents live in Stone, which was in the Mid Staffordshire constituency at the time. My mum was a clerk to Staffordshire county council, and I recollect very strongly that the health scrutiny committee at that council questioned the trust about its appalling mortality rate and was constantly reassured that there was nothing to see here. It absolutely failed to mark its own homework. The suggestion that my constituents Kayleigh and Colin Griffiths, who fought for the Ockenden report on Shrewsbury and Telford, did not first try the local services is, I think, missing the point.
With the Ockenden report on Nottinghamshire a couple of weeks ago, we also saw that the hospital trust commissioned several reports into its own maternity services, which found that it was failing. Instead of acting on them, it brushed them under the carpet and commissioned another. The suggestion that providers are capable in the current culture of dealing with those issues does not, I am afraid, hold true in the way it should across every trust.
Dr Johnson
Is there not a third issue: that the local authority and the ICB will no longer have congruent areas and will therefore look at different populations?
Helen Morgan
The hon. Lady raises a good point. I do not want to revisit an earlier part of the debate, but it is certainly relevant that where there is not a local authority representative on the ICB and there is not a mayor in place, and the ICB’s area is not coterminous with the local authority boundary, that adds another element to the issue of the separation out of Healthwatch. Does the Minister agree that the independent and locally rooted Healthwatch cannot be replaced by processes that sit within the NHS system? Will she please reconsider the change? There is concern on all sides of the House, given the value that Healthwatch brings to the service.
Karin Smyth
I will begin with Government new clauses 91 to 95. Many hon. Members will know that the current regulatory framework for medicines and medical devices is seen as overly complicated and difficult to navigate. It is also slow and burdensome to amend, limiting our ability to ensure that it keeps pace with developments. Maintaining the safeguards to public health is central to every decision we make. However, the regulatory framework currently slows down innovation and delays patient access to healthcare products. From a market growth perspective, it also places barriers to the UK market, particularly for small and medium-sized enterprises.
These new clauses will deliver a more streamlined regime for making and updating secondary legislation. The ability to make faster and more responsive updates to secondary legislation will enable the Department and the Medicines and Healthcare Products Regulatory Agency to address the current barriers that I have highlighted in the regulation more quickly.
New clauses 91 and 92 provide for changes with regard to powers to make “ambulatory references”, which are references in legislation to external documents such as technical standards and lists, which can be updated from time to time. These changes will ensure that the legislation continues to capture updated versions of those documents without the need for further regulations. International and domestic standards are crucial in the highly technical areas targeted by the change. It is important that the regulatory regime remains aligned with the technical, scientific and international framework that is designed to evolve over time.
Currently, there are limited powers for medical devices regulations to refer to external international agreements or standards that change over time, and there are no such powers at all for medicines. Without the ability to make ambulatory references to those documents, legislation is needed each time the standards are updated. That is disproportionate and risks unintentional regulatory divergence that creates uncertainty for industry.
The new clauses introduce a power for human medicines regulations to refer to external international agreements or standards that are updated over time. For medical devices, the provisions also extend the current ambulatory reference power to make reference to lists of countries subject to mutual recognition agreements, lists of devices or categories of device that are eligible for an international reliance pathway, and lists of British technical standards. Amendment 80 sets out that the extent of new clause 92 will cover England, Scotland and Wales.
The provisions of new clause 93 enable a more flexible approach to consultations on regulatory changes related to medicines and medical devices, rather than the current one-size-fits-all requirement. Under the amended powers, the MHRA and the Department will still retain a legal duty to consult relevant stakeholders, and significant regulatory changes will continue to be subject to public consultation. The measure is designed to enable consultations that are proportionate to the scale of the change in hand. That will ensure that regulations can be updated more efficiently and in line with the needs of the health service.
New clause 94 will enable certain technical updates to medicines and medical devices regulations to be made using the negative rather than the affirmative procedure. Specifically, it relates to changes that routinely arise as clinical practice evolves—for example, updating detailed lists of medicines or making limited adjustments to the professional groups who may prescribe, supply, sell or administer particular medicines. At present, even minor or time-sensitive changes of this sort can require a debate under the affirmative procedure, which is not always the best use of parliamentary time.
New clause 95 is the final measure in the regulatory framework package for the MHRA. It is designed to streamline the process for routine fee updates made using powers under the European Union (Withdrawal) Act 2018 by allowing the use of the negative parliamentary procedure for routine fee uplifts. That will bring the powers in line with those relating to fees in the Medicines and Medical Devices Act 2021, where uplifts to existing fees can be made with the negative procedure. That will also reduce delays in making and communicating such adjustments, while maintaining appropriate safeguards, including the requirement to set out the cost basis for any new uplifts with any legislation—whether it is made under the negative or affirmative procedure. The draft affirmative procedure will be retained for any substantive changes, such as the introduction of a new chargeable function.
Finally, there are a number of consequential provisions related to those I have just discussed. Government amendments 80 to 82 primarily relate to the commencement period in which they come into force.
In conclusion, the amendments will enable a faster and more responsible reform of the existing legislative framework, while preserving proportionate safeguards and necessary scrutiny. I commend the new clauses to the Committee.
Dr Johnson
New clause 91 would amend the Medicines and Medical Devices Act to enable regulations
“to refer to both international agreements and standards and standards developed in the United Kingdom”
and enable the Secretary of State
“to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom.”
New clause 92 would amend the definition of “mutual recognition agreement” so that
“agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.”
New clause 93
“amends the duty to consult in relation to regulations about human medicines and medical devices.”
That means that instead of a public consultation, it
“gives the option of consulting such persons as the relevant authority considers appropriate”.
I would be grateful if the Minister clarified whether that could be nobody, or whether it has to at least be somebody.
New clause 94
“changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure.”
That relates to regulations about medicines and medical devices. I want to ask about scrutiny, because we have had a number of statutory instruments over the last few years that, under the new regulations, would now be put under the negative procedure. When we have looked at them, there have been questions and potential changes.
Why does the Minister want a lower level of scrutiny? In general, scrutiny is a good thing. I understand that this could smooth out procedure and make it a bit quicker in some cases, but we had an example where a Minister brought forward fee increases. I then raised the issue of national insurance and that Minister was not aware of whether it was paid at that time. The civil service pay estimate was significantly lower than expected and lower than what was given. Therefore, six months later we were back in Committee with a different Minister asking for more money. There is a scrutiny issue with new clause 94. That also relates to the fees and terms in new clause 95, which was one of the examples I gave.
Karin Smyth
I thank the hon. Lady for her comments. The purpose of the new clauses is to support our life sciences and medicine sector, in order to make that more streamlined. She will be aware of the proposals about the negative and affirmative procedure. If there were particular issues of scrutiny, normal parliamentary rules and processes would apply if Members wanted to raise any particular issue.
Question put and agreed to.
New clause 91 accordingly read a Second time, and added to the Bill.
New Clause 92
Medical Devices Regulations 2002: mutual recognition agreements
“(1) The Medical Devices Regulations 2002 (S.I. 2002/618) are amended as follows.
(2) For regulation 1A (Schedules) substitute—
‘1A Schedule
Schedule 2A has effect.’
(3) In regulation 2 (interpretation), in paragraph (1)—
(a) in the definition of ‘mutual recognition agreement’, in paragraph (a), for ‘country listed in Schedule 2’ substitute ‘country specified in a list published by the Secretary of State from time to time’;
(b) in the definition of ‘third country conformity assessment body’, for ‘established in a country which is listed in Schedule 2 and designated in accordance with a relevant’ substitute ‘designated in accordance with a’.
(4) Omit Schedule 2 (mutual recognition agreements).”—(Karin Smyth.)
This new clause would amend the definition of “mutual recognition agreement” in the Medical Devices Regulations 2002 (as it has effect in England and Wales, and Scotland) so that agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.
Brought up, read the First and Second time, and added to the Bill.
New Clause 93
Consultation about medicines and medical devices regulations
‘(1) Section 45 of the Medicines and Medical Devices Act 2021 (consultation) is amended as follows.
(2) In subsection (1), for “a provision of Part 1, 2, 3 or 4” substitute “Part 1 or 3”.
(3) After subsection (1) insert—
“(1ZA) Before making regulations under Part 2 or 4 the relevant authority must—
(a) carry out a public consultation, or
(b) consult such persons as it considers appropriate.”
(4) In subsection (3), at the beginning insert “Where a public consultation is carried out”.
(5) In subsection (4), in the words before paragraph (a), for “subsection (1)” substitute “subsection (1ZA)”.’—(Karin Smyth.)
This amends the duty to consult in relation to regulations about human medicines and medical devices. It gives the option of consulting such persons as the relevant authority considers appropriate instead of a public consultation.
Brought up, read the First and Second time, and added to the Bill.
New Clause 94
Medicines and medical devices regulations: parliamentary procedure
‘In section 47 of the Medicines and Medical Devices Act 2021 (regulations: procedure), for subsection (3) substitute—
“(3) Regulations under Part 1 are subject to the draft affirmative procedure.
(3A) Regulations under Part 2—
(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—
(i) provision made in reliance on section 6(1)(a) (fees);
(ii) provision amending the meaning of ‘appropriate practitioner’ or ‘approved country health professional’ for the purposes of Part 12 of the Human Medicines Regulations 2012 (see regulation 214 of those regulations);
(iii) provision amending any of the following provisions of the Human Medicines Regulations 2012—
• regulations 217C(3) or 217CA(3) (original pack dispensing for products containing relevant substances: definition of ‘relevant substance’),
• Schedule 13 (prescription only medicines for which community practitioner nurse prescribers are appropriate practitioners),
• Schedule 15 (requirements for specific products subject to general sale),
• Schedule 16 (patient group directions and vaccine group directions),
• Schedule 17 (exemption for sale, supply or administration by certain persons),
• Schedule 18 (substances that may not be sold or supplied by a pharmacist without a prescription in reliance on emergency provisions),
• Schedule 19 (medicinal products for parenteral administration in an emergency), or
• Schedule 21 (medicinal products at high dilutions);
(iv) provision amending regulation 250 of the Human Medicines Regulations 2012 (restrictions on persons to be supplied with medicinal products: exceptions) for the purpose of changing the products to which any exception from time to time provided for by that regulation applies;
(v) provision that is consequential on provision of a description mentioned in any of sub-paragraphs (ii) to (iv);
(b) are subject to the made affirmative procedure if they—
(i) contain only provision that is made in reliance on section 7 (emergencies),
(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health, and
(iii) are not within paragraph (a);
(c) are subject to the draft affirmative procedure if they are not within sub-paragraphs (a) or (b).
(3B) Regulations under Part 3—
(a) are subject to the negative procedure if they contain only provision made in reliance on section 12(1)(a) (fees), and
(b) are subject to the draft affirmative procedure if they are not within paragraph (a).
(3C) Regulations under Part 4—
(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—
(i) provision made in reliance on—
• section 17(1)(a) (fees), or
• paragraph 9 of Schedule 2 (supplementary provision about civil sanctions);
(ii) provision amending or revoking regulation 1ZA of the Medical Devices Regulations 2002 (expiry of certain provisions) or consequential on such provision;
(b) are subject to the made affirmative procedure if they—
(i) contain only provision made in reliance on section 18 (emergencies), and
(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health;
(c) are subject to the draft affirmative procedure if they are not within paragraph (a) or (b).”’—(Karin Smyth.)
This changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure. The changes all relate to regulations about medicines and medical devices (although the procedural provisions relating to certain other matters are restated in the amendment).
Brought up, read the First and Second time, and added to the Bill.
New Clause 95
Medical devices etc: parliamentary procedure for certain fees regulations
‘In Schedule 7 to the European Union (Withdrawal) Act 2018 (regulations), in paragraph 12—
(a) in sub-paragraph (1) for “relate to altering the amount of a fee or charge to reflect changes in the value of money” substitute “fall within sub-paragraph (1A)”.
(b) after sub-paragraph (1) insert—
“(1A) Provision falls within this sub-paragraph if it relates to—
(a) altering the amount of a fee or charge to reflect changes in the value of money,
(b) altering the amount of a fee or charge to be charged in connection with the exercise of a function which a public authority has by virtue of provision made under section 8C in connection with the EU medical devices Regulations, or
(c) altering the amount of a fee or charge to be charged under the Blood Safety and Quality Regulations 2005 (S.I. 2005/50).
(1B) In sub-paragraph (1A)(b) ‘the EU medical devices Regulations’ means—
(a) Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC, or
(b) Regulation (EU) 2017/746 of the European Parliament and of the Council of 5 April 2017 on in vitro diagnostic medical devices and repealing Directive 98/79/EC and Commission Decision 2010/227/EU,
as they have effect from time to time by virtue of Article 5(4) of the Windsor Framework.”’—(Karin Smyth.)
This allows regulations altering certain fees in relation to medical devices etc to be made subject to the negative resolution procedure. At the moment those regulations are subject to the affirmative resolution procedure.
Brought up, read the First and Second time, and added to the Bill.
New Clause 1
National Maternity Commissioner
“(1) The Secretary of State must, within six months of the passing of this Act, appoint a National Maternity Commissioner, situated within the Department of Health and Social Care.
(2) The functions of the National Maternity Commissioner are to—
(a) oversee NHS maternity services;
(b) act as an independent voice for women and families;
(c) ensure lessons are learned from identified failures and that the recommendations of maternity reviews are acted upon;
(d) promote consistency, safety and accountability across NHS maternity services; and
(e) advise the Secretary of State on matters relating to the safety, quality and provision of maternity services in England.
(3) The person appointed as Commissioner must—
(a) be a person with knowledge, expertise and experience relevant to the discharge of functions of the role;
(b) have first-hand experience of working in maternity services, so far as reasonably possible; and
(c) not be a sitting Member of Parliament.”—(Helen Morgan.)
This new clause would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise of maternity services, and not a political appointment.
Brought up, and read the First time.
Helen Morgan
New clause 1, which I tabled, would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise in maternity services, and not a political appointment.
It is important to start by saying that I tabled the new clause before we had the report from Donna Ockenden on the Nottingham review, and last week’s report from Baroness Amos on her national review, both of which recommended the appointment of a maternity commissioner. Obviously, since then, the Secretary of State has announced that he will appoint a maternity commissioner. None the less, I will state the arguments for having one, and if the Minister can give us some assurances today, I will not press the new clause to a vote.
Just to set the scene, which I think we all know too well, maternity services in England have suffered a series of high-profile scandals. The cost of political neglect has been paid by families in terms of trauma, injury and lost lives. We have known for a long time that maternity services in this country have been failing. Numerous recommendations have been made over that period, but they have not been effectively acted on in a consistent way, and Baroness Amos’s inquiry finally confirms that.
It is important to say that the vast majority of births take place safely, successfully and happily. However, where things go wrong, having a baby safely has become a postcode lottery. Women are being routinely silenced, and staff who raise the alarm on unsafe care or systemic discrimination have been put off or crushed by a culture of fear. We therefore need to make England the safest country in the world to have a baby.
The Liberal Democrats have been campaigning on that for a long time, and following the Ockenden and Amos reviews it genuinely feels that there is now the will and focus to deal with the problem once and for all. This issue has been going on for far too long. We thank the Secretary of State for hearing our campaign and Baroness Amos’s calls for a national maternity commissioner to oversee national standards and drive change. We also pay tribute to campaigners such as Louise Thompson and the former MP for Stafford, Theo Clarke; without their advocacy, and without so many women sharing their stories, we would not be moving forward.
It is important to say that one individual—one maternity commissioner—will not solve all the issues in maternity by themselves, but they can help drive change and address recurrent issues, whether those are cultural or about safe staffing. They can hold Ministers to account, help restore public confidence in NHS maternity service and ensure that accountability exists. But I want to be clear that the buck should always stop with the Secretary of State; they hold the power and the purse strings, and this role cannot be used by Ministers as a way to shirk that responsibility.
I hope the Minister will clarify a few key points. First, can she reassure us that the commissioner will be independent and not a political appointee? It is essential that this individual feels confident to hold the Government to account and have those difficult conversations. That is far less likely if they are a political appointee.
Secondly, women have made it clear that for them to be reassured that this change will happen and happen meaningfully, they need a clear timetable for when the maternity commissioner will be in place and operating. Understandably, the Secretary of State has not been able to provide that yet, given the need for this Bill to pass through Parliament and for the statutory role to be on the books, and given the time it will take his maternity taskforce to define what it wants the role to look like and for the appropriate legislation to be written and put in place. However, we hope we can get a firm commitment to a timetable from the Minister today or, if not today, then on Report.
We think the commissioner should be involved in the establishment of the taskforce, because it is important that it does not develop a plan that they are required to implement, despite it being something they personally would not have approved. I therefore hope the commissioner will be in place very quickly, even if only on a temporary basis, so that they are working to get the taskforce plan into place.
We heard from the Secretary of State that the commissioner will co-chair the taskforce alongside him. That seems to be the right move, and I welcome it, but, as I said, it is important that they have some role in shaping its action plan, so that they can feel responsibility for it and be fully behind its implementation. Will the Minister commit to introducing a temporary maternity commissioner so that that can happen?
Finally, we have heard reports that the taskforce is not meeting very regularly. I hope the Minister can reassure me that it is now meeting much more regularly and getting that plan into place as quickly as possible, and that the Secretary of State is fully on board in driving forward the commissioner’s role as soon as possible.
New clause 13, which is also in my name, is about putting a duty on the Secretary of State to create a scheme to ensure that every maternity unit in the country achieves a good or outstanding rating from the CQC. I will not repeat some of the points I have just outlined about failing maternity services, but the first quarter of 2026 saw the worst ever recorded rate for maternity injuries. Four years ago, the Ockenden review into the Shrewsbury and Telford hospital NHS trust, which is in my area, found that over 200 babies had died unnecessarily in Shropshire. Yet, despite several immediate and essential actions being put in place, a subsequent CQC review found that the majority of maternity units in this country did not achieve a good rating for safety—they were inadequate in some way. That is just not acceptable.
Our package of measures includes the maternity commissioner, which the Government are obviously progressing with, and we are very pleased about that. However, we also need investment in the service to ensure that that maternity commissioner has the resources they need to make the changes required. We therefore call for one-to-one midwifery care for every woman in labour; a consultant on every labour ward 24 hours a day, seven days a week; a director of midwifery—a senior, experienced midwife—in every maternity service to ensure that more junior midwives on that ward are suitably supervised; the restoration of ringfenced service development funding; and a dedicated neonatal workforce plan.
New clause 13 also requires an annual report to be laid before the House on the “effectiveness of the scheme”. That would allow Parliament to track progress and hold the Government’s feet to the fire on it. Baroness Amos has also called for regular reporting to Parliament to maintain accountability, albeit through the maternity commissioner.
There seems to be consensus, here and across the NHS, on the need for meaningful and decisive action on maternity. There is a great deal of overlap between our plan and the recommendations Baroness Amos has made, and I hope the Minister will be able to take some of these points on board and incorporate them into the Bill.
Dr Johnson
As the hon. Lady said, new clause 1 seems somewhat redundant, because the Government appear to have decided to appoint a maternity commissioner.
New clause 13 asks for a report. Before I go any further, I should say that I am a member of the Royal College of Paediatrics and Child Health and have attended the delivery of many babies as a paediatrician at different levels of seniority. I should also say that I am a member of the British Medical Association, that I continue to work as an NHS consultant paediatrician and that I worked at Nottingham University hospitals NHS trust in late 2012 and 2013.
I have great sympathy with the reasoning behind what the hon. Member for North Shropshire is proposing. We have all been shocked by the many reports we have read, the circumstances we have heard about, the tragedies that have occurred over many years and the challenges that are faced by maternity care. I am not sure that writing more reports is going to help; I think we need more action rather than words.
The hon. Lady mentioned the taskforce. I was disappointed that it took the Government so many months to establish it, that it took so long for it to meet and that it has met only a few times. As we have talked about things such as Healthwatch and the HSSIB, the Minister has shown her enthusiasm to get on with things and ensure that the recommendations made in the varying reports are implemented. I would therefore be interested to understand how that will occur in maternity.
My understanding is that the Government are going to produce a plan on how to deliver the recommendations in the recent report, and that is going to be available by Christmas. However, that means that we will then be in a situation where the Government came into power in mid-2024 and then spent a year writing a plan—the 10-year “Fit for the Future” plan. Around the time that they published that, they decided that they needed an urgent maternity report; that was going to take a few months, but it ended up taking another year in of itself. Now we are going to take another six or seven months writing another plan on how to implement the plan we have written, based on the plan we wrote before, based on the plan we did not have at the general election.
I am interested to understand how the Government are going to convert the good intentions I am sure they have into action. In particular, their manifesto promised that thousands more additional midwives would be trained. I would be interested to know what progress they have made on that.
Karin Smyth
I am grateful to the hon. Member for North Shropshire for bringing this discussion before the Committee. I put on record our thanks for the work she has done in this area and for her engagement with me, and indeed with officials at the Department, to help us understand it more clearly, particularly in the light of the new clause.
Hon. Members across the Committee are committed, as are the Government, to ensuring that women, families and babies receive the care and support they need. We know that the vast majority of births are safe and that there are outstanding examples of care in the NHS. However, where things do go wrong, it can have a devastating impact on women and their families.
That is why the Government launched the national investigation into NHS maternity and neonatal care, chaired by the noble Lady Baroness Amos. Baroness Amos brought the findings from past reviews, local rapid reviews and new evidence from families and staff together into one clear national set of recommendations, which as we heard was published last week. The Government also launched the maternity and neonatal taskforce, chaired personally by the Secretary of State, which will translate Baroness Amos’s recommendations into action.
As we heard, Baroness Amos recommended the appointment of a statutory maternity and neonatal commissioner. We have accepted that recommendation, and I know there is support for it across the House. To be clear, the Secretary of State stated last week that we are committed to putting the role on a “statutory basis” as soon as possible.
I am afraid I cannot give the hon. Member for North Shropshire a more detailed timetable at the moment, because we are currently looking at options to legislate at pace, including potentially through this Bill, subject to discussions through the usual channels, while also—this is crucial—giving the taskforce the opportunity to shape the scope of the role. That was one of Baroness Amos’s urgent actions, and we accept it as a crucial first step in overseeing systemic improvements to care and outcomes and earning back the trust of women and families.
The maternity and neonatal commissioner will champion the voices of families and drive forward that necessary change. The Secretary of State will remain accountable to Parliament for maternity services. The role will be discussed urgently with the taskforce and will have a relentless focus on driving those improvements, which will include co-chairing the taskforce.
As the Committee knows, these are complex matters. The Government, having accepted the Baroness Amos’s recommendation, intend to legislate as soon as practicable. Our immediate priority is to work quickly through the taskforce to define the scope and responsibilities of the role. I know that the hon. Member for North Shropshire will not press the new clause, but I commit to keeping in touch with her and other hon. Members as this work progresses.
Dr Johnson
We talked about clause 1—on the abolition of NHS England—at the beginning of the Bill. The Minister was keen at that time to take unelected individuals out of the picture and create accountability by returning things to democratic control through the abolition of NHS England and putting them back in the Secretary of State’s hands. However, this proposal essentially does the reverse with maternity care, taking it out of the hands of Ministers and the Secretary of State and putting it into the hands of a commissioner. Could the Minister explain that?
Karin Smyth
I am sorry, but I did not get the end of that sentence. However, I think the hon. Lady was saying that the Bill essentially abolishes NHS England. Again, as I have said repeatedly, nobody is opposing that. As is well known, the recommendations on the maternity commissioner have come through a separate process. Given the need for public assurance and to earn back the trust of women and families, as well as—I think the hon. Lady said this herself—the shocking revelations that have come through some of this work, Baroness Amos recommended a maternity and neonatal commissioner to drive through these changes and give confidence to the system. That is why we are going to accept her recommendation. Accountability for maternity services obviously remains with the Secretary of State, who will be co-chairing the taskforce. I hope that addresses the comments the hon. Lady made.
On new clause 13, we know that the vast majority of births are safe, but the devastating trauma experienced by many through failures in care must be brought to an end. The CQC has an important role in assessing whether patients are receiving safe, effective and high-quality care, and it is essential that it can do that objectively and independent of Government. It is therefore not appropriate to impose a duty on the Secretary of State to ensure particular ratings.
Dr Chambers
I would not always object to that, because the whole point of the new clause is that such a contract would come to Parliament and then might well be approved if it turned out to be the best system and in our national interest. The thrust of all three new clauses is to ensure that we do not get exposed and make ourselves vulnerable, which could affect the functioning of the NHS and compromise people’s data. A future Government could set up their own AI system in the UK. How would data be used by that system? We are looking at future-proofing people’s privacy and future-proofing the ability of our country to deliver a service properly.
There is also an economic opportunity. We should always prioritise domestic suppliers where possible, and even cultivate them, and help them to innovate and develop, because spending potentially tens of millions of pounds with foreign companies will not do anything to grow our own economy. Given the world-beating talent in our country, we see no reason why the long-term effect of domestic options to foreign systems could not be developed with sufficient Government support. As such, where a contract is signed with a foreign supplier, new clause 4 would require the Secretary of State to take steps to support domestic alternatives. We recognise the complexities involved with NHS procurement, and our new clauses represent one vision built on the core principles of domestic resilience and digital sovereignty.
I have a few questions for the Minister, which I would appreciate some comments on. How do the Government intend to build trust in the single patient record to make sure that it is not undermined, rather like the federated data platform has been? Does the Minister agree that the poor reputation of Palantir and distrust has been an important element in the slow roll-out of the federated data platform? Has she considered undertaking a risk assessment with a national security focus of current NHS digital and tech contracts? Does she agree that, in an ever more turbulent world, building domestic capability in this area is central to the security of our country?
Does the Minister agree that the domestic life sciences and tech sector is more than capable of developing and scaling many of the systems that we rely on foreign companies for at the moment? The Government have very much positioned AI and technology as the NHS’s white knight. We agree that the potential is huge, but do the Government not think that the NHS needs a long-term digital strategy to support a joined-up development and roll-out of these systems and technology? An analogy to this is how the defence investment plan and future defence procurement can help prioritise and boost economic growth in the UK. We think this is another way that economic growth could be nurtured.
Dr Johnson
I rise to discuss new clauses 3 to 5 and 43, which I am sure that the Whips will not let me forget. I understand the sentiment behind the Liberal Democrat new clauses. The hon. Member for Winchester is keen to ensure that uses of NHS data are limited to uses for which people can consent, uses in relation to their care or specifically approved research. Having heard examples of this data being tracked or leaked by accident, the hon. Gentleman is keen to ensure that that does not happen. He is particularly concerned about the risk of that happening in another jurisdiction where we have less control of the system. I am not sure that the new clauses have been properly thought through, however.
New clause 3 says:
“Within six months of the passing of this Act, the Secretary of State must conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside of the UK.”
That is “all contracts”. In subsection (2), it says that the Secretary of State must “pay particular regard” to contracts with technology companies, but not only to those. I am being a bit pedantic here, but has the hon. Member for Winchester considered the wording of “all contracts”? The NHS does not just provide drugs and medical technology; it provides bedding, blankets, pillows, bananas for people to eat at lunchtime, bedpans and loo roll. There is a whole range of things procured as supplies by the NHS that may or may not be procured from overseas. It would be cumbersome and completely unnecessary to include all of those.
Even with the tech companies themselves, there is a risk for small contracts for small pieces of tech to create a huge amount of bureaucracy. I am not sure that it would specifically improve data quality or data protection. It is reasonable that the Minister would consider risk assessments, and I hope that she would automatically consider them before contracts that are particularly sensitive or contain patient data, but I am not sure that the new clause works.
Moving on to new clauses 4 and 5, the hon. Member talked about Palantir. It may even have been his intention for these new clauses to target one specific American firm, but the actual impact would erect costly barriers to trade. The NHS contracts IT functions to firms based in other countries when the business case is strong. It uses Microsoft, an American company that offers software, cloud services and Outlook for emails; Oracle for standardising and automating financial processes; Sectra, a Swedish company, for transferring medical images and reports; and Dedalus, an Italian company, for migrating services to the cloud. To echo the point made by the hon. Member for Bury St Edmunds and Stowmarket, should the NHS prioritise a British company over an international company if the service has better functionality and a lower cost and is safe?
The hon. Member for Winchester spoke about the vibrant life sciences and tech sector in this country, but if we close off our markets to those from overseas, will others not do the same? Would he want those life sciences companies to be unable to export? There is a barrier to free trade here.
Dr Chambers
This is not about closing off markets or shutting off the potential to use foreign companies if they are most appropriate. It is about prioritising and investing in UK technology and our economy to solve some of our domestic problems while also providing security. Saying that we are closing off domestic markets is misunderstanding the thrust of the new clause.
Dr Johnson
I think it is about balance. I agree that we need to ensure that the data is kept safely. Using British technology where we can is a good thing, but we have to be reasonable about it. For example, there are alternatives to Microsoft Outlook, but how much more would that cost the NHS and how much would it affect patient care? There is a balance to be struck. I understand what the hon. Gentleman is trying to do in protecting our data. That is an extremely important issue, and I am sure the Minister will tell us about the work she is doing to ensure our data is kept safe.
New clause 43, in my name, is about private providers’ data. We often do freedom of information requests about, for example, surgical procedures, but one in 10 procedures are performed in private settings and are not subject to FOI, which means that less data is available to the public. Data from private independent providers is less transparent than that of standard NHS provision. This is a probing amendment to find out the Minister’s thoughts about how to ensure people can access transparent data on operations performed in local independent hospitals, particularly as the Government have signalled their intention towards more and more of those being provided.
Edward Argar
My questions will be very brief. I am conscious that, given that these are mostly Liberal Democrat new clauses, for once I will be asking the hon. Member for Winchester for a response, not the Minister.
New clause 4 would require that contracts be laid before Parliament. I would be grateful if the hon. Gentleman can tell the Committee how many such contracts he thinks would end up being laid before the House in any given year, based on historical data, and therefore how much parliamentary time that would take up. Does he envisage that being handled by an affirmative or negative statutory instrument? What will the process be?
I can see what the hon. Gentleman is trying to do, but I have a certain wariness, along the lines of that expressed by the hon. Member for Bury St Edmunds and Stowmarket. Although it is important that we have appropriate protections and scrutiny, when we are procuring services and technology for the NHS we should be looking for the most effective and best tools that have those safeguards but can do the job that eminent surgeons and clinicians need them to do in order to do their work for patients.
Health Bill (Twelfth sitting)
Caroline Johnson ExcerptsTuesday 7th July 2026
(2 months, 1 week ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 7 July 2026 - (7 Jul 2026)
Helen Morgan
The amendment was tabled by my hon. Friend the Member for Wells and Mendip Hills (Tessa Munt) on behalf of the approximately 1.2 million people in England who live with myalgic encephalomyelitis, because five years after the introduction of National Institute for Health and Care Excellence guideline NG206, little has changed. Service provision according to NG206 remains patchy and poor, with many patients having traumatic experiences. The amendment would require a period to be set in which integrated care boards and other health bodies must comply with the guideline, and the Secretary of State must publish an annual statement on compliance with NG206 across the NHS in England.
The introduction of the guideline after sustained campaigning represented a major reform after years in which ME was treated as a psychiatric condition and patients were pushed to follow graduated exercise therapy. Often, GET had disastrous consequences, precipitating serious deteriorations that patients never recovered from. Credit is due to the hon. Member for Washington and Gateshead South (Mrs Hodgson), the current Minister for Public Health and Prevention, for her determination when in opposition to bring about the change.
In a written answer published last week, the Minister for Public Health and Prevention confirmed that all ICBs have a statutory obligation to ensure sufficient care provision for their population, but the experience of those with ME is that that obligation is far from being fulfilled. In some ICBs, no services for ME are commissioned; in others, the provider has a history of providing services that reflect not NG206, but the old and condemned approach of GET. Some services are provided out of psychiatry departments, which is a huge red flag for those with ME, and information on the quality of services is patchy. Results from a big survey of more than 5,000 people with ME or long covid in late 2025 painted a bleak picture: more than half said that they had been disbelieved by an NHS healthcare official, one in three had been made to feel that their ME was their own fault, and almost two in five had had an encounter with a clinician that was traumatic or traumatising.
Five years after its introduction, NG206 is far from being complied with, and so members of the ME community—approximately 1.2 million people, as I said—are desperately asking that something be done to address the situation. The amendment represents a route that offers hope for many long-neglected and mistreated people. I do not intend to press the amendment to a vote, but I hope that the Minister will be able to reassure us about improving the consistency of provision for people with ME.
Moving to the clause generally, we broadly support the intention, but think that more safeguards need to be built into the principle, given the powers that are being handed to the Secretary of State. The clause makes provision for the period for compliance with a NICE recommendation, but gives no detail of how that will work in practice or how often the Secretary of State will change the standard three-month rule that NICE requires. No ceiling is put on the compliance period, no criteria govern when the period may be extended, and there is no duty to consult or set out reasoning.
What will the process be when the Secretary of State intervenes in the period of time for compliance with a NICE recommendation? We thought that there would be some mix of evidence requirements, consultation, statement of reasons, impact assessment and some kind of parliamentary scrutiny. The Secretary of State should at least have to set out their reasoning why the new power has been used. The value of the current requirement is almost entirely due to the compliance period being short and fixed. The three-month rule gives a positive NICE recommendation practical force. A power to lengthen or vary that period without constraint weakens the requirement in substance while leaving it formally intact. The right is not removed but its timing is made discretionary. For a patient awaiting treatment, that does not amount to the same thing.
A variation power is not new. Since the introduction of the budget impact test in 2017, NHS England has been able to apply to NICE to extend the funding period for medicines with a budget impact above a defined threshold, but, importantly, that period is criteria-based, triggered by a defined financial threshold, subject to a defined process and time-limited in effect. We are not overtly opposed to the power in principle, but more safeguards should be built into the criteria for its application. I would be grateful for some guidance from the Minister on that.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I have sympathy with the principle behind amendment 58, in the name of the hon. Member for Wells and Mendip Hills. The hon. Member for North Shropshire is right to say that individuals with ME have not always received the best quality care. In many cases, ME is a debilitating and incredibly frustrating condition, and around 10% to 25% of sufferers have severe ME, meaning that they are housebound or bedbound. We know that some patients are sadly not believed by medical professionals.
In 2021, NICE said that most medical students have little or no training on the condition. The Government have previously committed to increasing the uptake of ME modules among NHS professionals. What progress has been made on that in the last couple of years? The Government also committed in the ME/CFS action plan to develop and run a public awareness initiative, with implementation expected by May this year. Has the Department developed that initiative yet? If not, what is responsible for the delay? It is not marked as complete on the Government website.
The amendment would put guidance for medical professionals into legislation, though, and my concerns about that are twofold. First, it may slow down improvements in the future. If individuals have to legally follow that guidance, how can they innovate and improve treatment without having to come back to Parliament for more primary legislation? That will take time and may mean that people with ME get worse rather than better care in the short term.
The requirement would also limit clinical judgment. A patient may have a particular set of symptoms or conditions or be on a particular set of medications that mean that the doctor or clinician looking after them needs to vary from the guidance. NICE intends the guidance to be just that, guidance, not law, but if guidance becomes law, the doctor or clinician will not be able to vary from it. My concern is that the amendment would be overly restrictive. Although it is well-intentioned, and it is a good idea to ensure that guidance is followed where possible, it would be too rigid. I therefore do not support the amendment, while continuing to support the aim of better treatment.
Clause 58 amends the Health and Social Care Act 2012 by inserting a new section 237(8A), which states:
“Provision made under subsection (8)(b) may include provision about the period within which a recommendation is to be complied with (including provision for the period to be determined by NICE or the Secretary of State).”
At the moment, NICE technology appraisals check the value of a product, whether a drug or a technology, then NICE makes a recommendation. It is then supposed to be the case that within 90 days or three months, ICBs ensure that those technologies are available, but we know that in the real world it can take longer—sometimes 12 to 24 months—for some things to become available. That could be because technology needs to be bought or training needs to take place.
I understand why there could be variation and why the Government may want to consider varying the period, but it is not clear why they need to do so in legislation, because it is possible now to vary the period on an individual basis. For example, the Government imposed a five-year limit rather than a 90-day limit for the introduction of hybrid closed loop systems for diabetes, because that is a technology that requires proper training and they were never going to be rolled out in such a short period. The other product that notably has a longer time is tirzepatide, which is more commonly known as Mounjaro. I suspect that that is down to cost, but I am not certain.
Why do the Government want to change the 90 days? The patient’s right to treatment with a NICE-approved product within 90 days will become a right to getting the product when the Secretary of State says so. That is not really a right at all, because it does not give patients any comfort and may mean that products are received later. The Government have put this power into the Bill, so they clearly intend to use it. Given that they have the power to vary on an individual basis, why do they need the power to vary on a blanket basis? Do they intend to extend the 90-day limit across the board? If so, by how much? There is no ceiling. The Committee received written evidence from Henry Burkitt from Oxygen Strategy, who made the point that there is no ceiling, no maximum time, no duty to consult and no necessity for the Secretary of State or NICE to give reasons why a delay has occurred.
The life sciences industry talks about how it wants products to be rolled out. When it is investing and doing research in this country, it wants to see new products rolled out as quickly as possible once they have been approved, and the clause is a sign that roll-out might be delayed. I understand that the Government might want to be able to vary on certain products, but they already can; why do they want to vary on a more general basis? It is presumably to slow down roll-outs, but by how much?
Gregory Stafford (Farnham and Bordon) (Con)
On a point of order, Sir Roger. I am a parliamentary patron and champion of Action on ME. I feel I ought to put that on the record, as we have an amendment on ME.
Karin Smyth
Of course, patient safety is what we need to get right. I will come on to that point, but there is a lot to get through with this clause. We can see its importance from the number of organisations and channels that exist. I have said that before, and I am sure we have all struggled as constituency MPs to support our constituents—either patients or staff—through the system and to understand the best route forward on patient safety. We all have the same aim, and we should be clear that the issue is how best to achieve that aim. My hon. Friend is absolutely right. The test is about impact, learning and making the system and the culture change.
My hon. Friend the Member for Lewisham East asked me about confidence, and the fear that staff sometimes have about speaking up, which is obviously an important part of that landscape. We want to make sure that we take forward the learning on both those points into the new body.
The new framework ensures that the essential characteristics of safety investigations are preserved. The commission will have a flexible power to investigate qualifying incidents that have or may have implications for patient safety, with a clear statutory purpose of identifying risks and improving systems and practices. We are maintaining the principle of safe space and introducing strong safeguards in the process, so that staff and the public can trust that they can speak of their experiences openly, without fear or favour, to provide learnings for the system.
We have included protections for safe space materials and restrictions on disclosure, including within the regulatory functions of the CQC, and limits on the use of reports in legal proceedings. That is designed to support openness and candour, and to provide confidence in the impartiality and independence of patient safety investigations. There are clear mechanisms for transparency and accountability, including the publication of reports, requirements to respond to recommendations, and oversight through a statutory review of the commission’s investigatory functions.
Clause 59 also provides the commission with the necessary powers to carry out investigations effectively, including powers to require information, enter premises and co-ordinate with other bodies while maintaining appropriate protections such as legal privilege and safeguards against self-incrimination. Although the commission will decide which incidents to investigate, the clause preserves a power for the Secretary of State to direct it to investigate a specific qualifying incident or category of incidents. That ensures that where issues of significant public concern arise, or where urgent scrutiny is needed or there is particular risk, there is a clear mechanism to ensure that issues are investigated.
The struggles of the Care Quality Commission have been well documented. We will only commence these provisions when we are satisfied that the CQC has improved. The CQC has been supported and held to account to recover its effectiveness, and we will continue to support it and work closely with the newly appointed chair on its journey to rebuild. We will work closely with the CQC to ensure its readiness to receive the investigations functions from the Health Services Safety Investigations Body. Maintaining a centre of excellence for investigations will be integral to the CQC’s culture. Without the clause, the opportunity to deliver the ambitions of the 10-year health plan would not be realised, nor would the broader patient safety landscape, as set out in the Dash review, be fully addressed. It is therefore a necessary and integral reform.
Clause 60 makes provision for the transfer of property rights and liabilities from the Health Services Safety Investigations Body to the Care Quality Commission in connection with the abolition of the former and the assumption of its functions by the latter. It is a key technical provision to ensure an orderly and legally complete transition between the two bodies. Where functions are transferred between public bodies, it is essential that all associated assets, obligations and legal arrangements are also transferred in a way that ensures continuity and legal certainty. The clause provides the statutory mechanism to achieve that.
The clause provides a flexible framework to enable the continuation of HSSIB’s actions and ongoing matters, including legal proceedings, and ensures that references to HSSIB in existing documents are treated as references to the Care Quality Commission to avoid legal uncertainty. The clause provides for staff protections equivalent to TUPE and allows for shared ownership or use of property where needed, supporting a smooth and effective transition.
The overall effect of the clause is to enable a smooth, comprehensive and legally robust transfer of HSSIB’s property rights and liabilities to the Care Quality Commission, ensuring continuity of function and avoiding disruption to ongoing operations. Without the provision, there would be risk of legal uncertainty and operational disruption during the transfer process.
Clause 61 is a necessary and practical provision. At its core, it provides a power through regulations for His Majesty’s Treasury to ensure that transfers made from HSSIB to the CQC are delivered smoothly and on a tax-neutral basis. Like the equivalent provision for the NHS England transfer in clause 3, it allows the Treasury, by regulations, to vary the way in which relevant tax legislation applies in relation to anything transferred under a transfer scheme or anything done in connection with such a transfer. That will ensure that the tax consequences of the transfer can be properly aligned with the policy intention of a smooth and orderly transition.
Importantly, the scope of the clause is limited to specified “relevant taxes”, including income tax, corporation tax, capital gains tax, VAT, stamp duty and stamp duty reserve tax. As with clause 3, without this power there is a risk that the transfers could trigger unintended tax liabilities that would divert public money away from frontline services and undermine the policy intent of the legislation. Clause 61 therefore protects value for money and ensures that organisational change does not come with avoidable fiscal cost.
Clauses 59 to 61 and schedule 8 are necessary to strengthen the framework for patient safety investigations and ensure a more coherent and, crucially, effective system for learning from incidents across health services to make all our constituents and patients safer. I therefore commend them to the Committee.
Dr Johnson
These clauses are about patient safety. As has been pointed out this morning, patient safety is the absolute key here: that is well recognised across the House, among the public and across the national health service. Before going any further, I declare an interest as a patient of the NHS, a member of the British Medical Association, a member of the Royal College of Paediatrics and Child Health and a consultant paediatrician.
When I was interviewed in 2012 for my current consultant role, I was asked to deliver a presentation about how I could demonstrate to the trust board that the paediatric services in the hospital were safe. The first question I posed—Members will be pleased to know that I will not go through the whole presentation—was: “What is safe?” Are football stadiums safe? Is the London underground safe? Are aeroplanes safe? Broadly, yes, I think we would say they are safe, but they have not been without incident or safety issues.
Healthcare is similar. It involves millions of people, clinical judgment, human decision making and huge variability in the way that patients can present with different symptoms for different problems at different times. Is healthcare safe? Yes, it is safe. Again, however, we know from the many reports we have read that there is a long way to go to make it better and we need to prepare for that. We need to make sure that we design out room for error—that we design processes that limit the opportunities for error—use technology to limit the risk of error, and train people in a way that reduces the risk of error.
One of the key factors in that work is accepting that where there is human decision making, mistakes can happen, and that we need to identify and learn from those mistakes. One of the main ways of doing that is striking a balance between accountability and blame. If there is insufficient accountability, there can be an unclear escalation process, such that people do not know who to go to when they identify a problem. There can be a careless culture, which can develop in places where there is not enough accountability. However, if there is too much focus on fault and determining whose fault something is, we can get a blame culture. That can lead to a failure for people to come forward and therefore to a failure to learn from mistakes. It can lead to a culture of cover-up, whereby people try to avoid getting either themselves or their colleagues into trouble.
That is where HSSIB comes in because, like the air accidents investigation branch and the similar bodies for rail and shipping, it provides a safe space. That safe space is important in ensuring that people can speak up freely without fear, and know that we can get to the bottom of a problem and understand why and how something went wrong, because that is how we fix it.
At the time that HSSIB was established, there was consensus about it. The General Medical Council said:
“We support the creation of a ‘safe space’ approach to investigation. This is consistent with our guidance to doctors about their responsibilities to learn from mistakes and reflect on their practice, and their duty to take part in systems of quality assurance and quality improvement to promote patient safety.”
The British Medical Association told Parliament:
“We welcome the establishment of the HSSIB…Doctors must feel able to report errors and reflect on their own mistakes openly, without the fear of these reflections being used against them at a later stage. Only then can true improvements to patient safety be made.”
Similarly, NHS Providers told Parliament:
“NHS Providers welcomes the creation of the HSSIB as an opportunity to develop a just culture in the NHS and a focus on learning…For the HSSIB to succeed in contributing to improved patient safety, any investigations associated with it must be carried out independently and without conflict of interest, and be perceived as such.”
Indeed, the Minister for Secondary Care herself is on the record as having said:
“HSSIB is a really important new body…It must absolutely be built on the highest standards of trust when it comes to the wider system and the general public.”––[Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 564-565.]
I think that I have demonstrated that the creation of HSSIB was a matter of consensus and it was confirmed that it was the right thing to do.
In order to work, HSSIB needed to be independent and without conflict of interest. NHS staff backed it, the providers backed it, the patients backed it and even the Minister backed it. That is what makes the Government’s plans for HSSIB so perplexing. I am not aware of a single royal college or union that supports folding it into the CQC.
Essentially, Ministers have said that this is being done because of the Dash review. “The Dash review says so,” they argue, “so that’s what we’re going to do.” I have huge respect for people who say, “I’ve asked for some experts’ advice, and they have given it, and therefore I should follow it.” However, Ministers also commissioned the report by Lord Darzi, which said that
“a top-down reorganisation of NHS England and integrated care boards is neither necessary nor desirable”,
and yet here we are, doing exactly that. It is perfectly possible for Ministers to take one report as gospel and another as guidance. I would be grateful if the Minister could explain that.
The other reason given for this measure is that it will declutter the landscape, yet few people outside Government seem to think that HSSIB is responsible for cluttering the landscape. For example, the Health Foundation wrote in its submission that
“the government needs to do more to explain how the abolition of HSSIB and transfer of its functions to CQC will meet its aim of reducing complexity and, most importantly, maintain the essential focus on improving patient safety.”
Dr Danny Chambers (Winchester) (LD)
This subject is of particular interest to me. For quite a few years I was a trustee of a charity that supported evidence-based medicine and quality improvement. The hon. Lady talked about a no-blame culture. We now tend to use the term “just culture” but it is the same kind of thing: we must have a safe space for people to come forward, like in the airline industry. We want to encourage reporting not only of mistakes but of near misses so that improvements can be delivered without tragic incidents having to take place. If we are to create a culture in which people will come forward to admit even potential mistakes and near misses, they cannot in any way fear punitive punishment under regulations. Does the hon. Lady agree that folding HSSIB into the CQC will make it difficult to create a culture in which people feel confident enough to want to come forward with and overtly discuss mistakes and errors?
Dr Johnson
The hon. Gentleman is right. When someone comes forward, they need to have trust in the system. If they think that coming forward will harm their job or career, or perhaps their colleagues’, they may be more reluctant to do so. There is a difference between a mistake and a reckless act. If people behave recklessly and badly, that needs to be dealt with for the sake of accountability, but if an individual is aware of a mistake, or aware of a loophole through which a mistake could have been made if only something else had not happened at that moment, they need to come forward and say so. It would be much more difficult for them to do so if there was a culture of fear.
Dr Benneyworth made it clear to the Committee that
“we are still working in a culture of fear”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 24, Q40.]
and that makes it difficult for people to come forward. People come forward now because they know that HSSIB is independent, but they will be less likely to come forward when HSSIB is an office in the CQC that is independent in name only. The Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), said that
“people cannot sit at desks near other people who are making decisions and at the same time be perceived as entirely independent. The perception of independence cannot be legislated for—the perception is everything”.—[Official Report, 1 June 2026; Vol. 786, c. 915.]
Gregory Stafford
As my hon. Friend said earlier, the problem comes when this new body within the CQC has to investigate the CQC. In the oral evidence session, I asked Dr Dash what would happen if the problem was CQC, and she gave what is probably the most extraordinary answer out of the many extraordinary answers she gave. It is worth repeating:
“Well, we then have to deal with that as a problem. That is the same as saying, ‘What happens if the problem is this organisation or that one?’…What if the GMC is a problem? What if the Nursing and Midwifery Council is a problem?”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 8, Q9.]
She did not answer my question at all. In fact, she entirely sidestepped it. How can we have confidence in the Government’s proposal if the architect of the procedure cannot answer the most basic questions about the investigatory framework?
Dr Johnson
My hon. Friend is absolutely right. That answer was quite shocking, really. The pause before it and the reaction was remarkable. The purpose of HSSIB is to investigate without fear or favour, and to enable people to come forward in a safe way, but if it was folded into the CQC, as the regulator, and the problem was the regulator, how would it investigate itself? How would it make recommendations to itself? What if it thinks the board that it works for is incompetent? Is it going to tell its boss that it is incompetent? How does that work? No one seemed to know the answer.
It also seems that Ministers have not thought about how the HSSIB unit will be vulnerable to political pressure. Under the Bill as drafted, the Government are planning to direct the “vast majority”—according to the impact assessment—of the investigations, and the quality board is going to have some influence over the recommendations, again under the direction of the Secretary of State.
The Liberal Democrats have tabled amendment 5, which would require the appointment of a committee. That idea is well intentioned, and we recognise the same problems and the same flaws in the Government’s approach, but I do not think it is enough to solve the problem. Even if the law says that the oversight of the investigative units will remain operationally independent, I just do not see how that is possible. I can see that the hon. Member for North Shropshire is trying to help by creating something better than what the Government have produced, but I do not think it is enough.
We have also tabled some amendments, including new clause 42, which would ensure that there is some operational independence in the choice of investigation by requiring the Secretary of State to adequately fund and resource patient safety investigations, including some of those initiated by this unit within the CQC.
Amendment 55 is a probing amendment. We noticed that much of the legislation has been lifted and shifted from the previous Act, but some things are missing, including national security grounds. We want to understand why that ground has not been included in the Bill. Very occasionally, health events have national security connotations—the Salisbury chemical weapons attack, for example. In such circumstances, restrictions on investigatory capabilities could be necessary. I do not know—I was just interested in why the Government have chosen deliberately to remove that particular clause.
Amendment 56 would allow
“the Commission to recoup charges in excess of the costs incurred in providing assistance.”
The HSSIB programme is world-leading. People look at it from across the globe, and some have asked for training or information on it, for which we have been able not just to recoup costs but actually charge. I do not understand why the Government have removed that provision, because it is an opportunity for them to get extra money without taking it off people in taxes. Do the Government want HSSIB to lose its international standing, or do they want British taxpayers to subsidise training for foreign health services? It is not clear. I would be grateful if the Minister explained that.
We need to come back to what the hon. Member for Bury St Edmunds and Stowmarket said at the beginning: what is the purpose? The purpose is patient safety.
Sojan Joseph (Ashford) (Lab)
The point about patient safety is absolutely important, as every Bill Committee member would agree. The number of patient safety incidents has been going up for the last 10 years. Between 2015 and 2022, there was a 62% increase in patient safety incidents in this country, and since the creation of HSSIB, the number of incidents has again gone up. Does the hon. Member agree that the CQC, which has access to all patient records and all documentation in any healthcare settings in real time, would be able to monitor the improvement and progress that each provider is making following the learning from each incident? That would be important and helpful, as the HSSIB has limited ability to look into documentation and clinical notes.
Dr Johnson
I thank the hon. Gentleman for that intervention, but I think this comes to part of the problem. When producing a list of faults—of things that are wrong with the service—and saying, “We need to improve the culture; it needs to be better”, we need to ask, “Okay, but how? What will be the deliverable, measurable way of doing that? How will we go about improving things?” For example, let us say that there is a problem with patients with aortic dissection, so how will we prevent that? The benefit of HSSIB is that it produces a plan, the plan is implemented and patients are safer. Part of this is about the delivery plan.
As for the other part, the hon. Member talked about monitoring progress, but that is not the job of HSSIB. If a mistake or an event happens, it is investigated by HSSIB—HSSIB produces a set of investigations based on understanding how and why it happened, because of the safe space—and then those recommendations are put forward to the Government. The Government then, ideally, implement those changes. The Minister is there to ensure that those are implemented. It will be her job to ensure, having decided which recommendations are to be implemented, that that is done fully and properly. It is a separate function. The CQC is a regulator, HSSIB is an investigator, and the Minister is there to ensure that things are delivered properly.
Going back to patient safety, at the end of my interview, I essentially told the panel, “I cannot tell you that anything is 100% safe”. The assurances that can be provided are that the staff and equipment are available, that training is available for people to do the job, and that processes are in place to identify shortcomings and learn from them, so that they are not repeated. That is key: to find the learning and spread it more widely. As the hon. Gentleman said, implementation is a challenge. It is possible to implement this on an individual basis or to implement a lesson in a unit that has had an error or mistake. Spreading it more widely, so that this is heard in every unit across the country, is more challenging. Fundamentally, I do not think I have heard anything from any of the Ministers, and I do not think it is in the Dash report either, to explain why the Government believe that rolling HSSIB into the CQC with all the problems that it might cause—the risk of it suing itself over whether the safe space is available or not—makes patients any safer.
Edward Argar (Melton and Syston) (Con)
I am particularly keen to speak on clauses 59 to 63, because HSSIB was a key part of the Health and Care Act 2022, which I took through as a Minister. At that time, I was grateful for not only the fearless and tough questioning from the now Minister, who was on the Opposition Benches, but for her support. She said:
“HSSIB is a really important new body”––[Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 564.]
She also said that it is a
“new and important body, which we are all desperate to ensure works well.”––[Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 566.]
It is fair to say that it does work well, as my hon. Friend the Member for Farnham and Bordon set out clearly in his detailed remarks. The thread running through his remarks, which is particularly important in this context, was trust. People who have had something go wrong and have reported a problem need to trust that it will be looked at independently and dispassionately.
I fear that what is proposed here results from a deeply misguided decision, which has at the heart of its logic a fundamental flaw. As the hon. Member for North Shropshire set out, the decision fails to recognise that HSSIB’s role is fundamentally different from the role of CQC. It is an independent investigator; it is not a regulator or an enforcer, yet that somehow seems to be conflated in what the Government are trying to do here. They have simply failed to make a logical case for the change.
The hon. Member for Bury St Edmunds and Stowmarket, who I always listen to with great interest on these matters, highlighted that patient safety should be at the heart of this legislation. That is absolutely right, but patient safety goes hand in hand with the confidence of those working in the system to speak out and put forward evidence that will improve patient safety. It is not an either/or; one is complementary to the other. It is important that this safe space remains, because that provides the conditions in which patient safety can be improved.
In her evidence during the first session of this Committee, Dr Dash stated that she found more than 150 organisations operating in this space when she undertook her review. However, in Hansard, she went on to say:
“I was asked by the Department of Health and Social Care to look at that landscape. I was asked to focus on six organisations”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 5, Q2.]
Only six out of 150? That does not ring true. That is not a tidying-up of the landscape but a very narrow focus. When the Minister comes to her concluding remarks, can she answer who specifically determined those six organisations for Dr Dash and told her to look only at those, ignoring the other 144-plus organisations? We all know that what a review comes up with is, to a large degree, determined by the scope set for it. By picking a mere six out of 150-plus organisations, I fear there is a risk that the scope has effectively, to a degree, stacked the outcome of what would be looked at and what would be concluded.
Before addressing specific concerns about the approach being adopted with the abolition of HSSIB, I want to highlight a real challenge with—even if one accepted the premise, which I do not—where it is proposed the functions are transferred to, as my hon. Friend the Member for Farnham and Bordon set out.
Dr Dash said in her evidence that the CQC
“still has a way to go, and we all need to acknowledge that.”
She went on to say:
“I would have hoped that, by now, many of those challenges had been addressed. Some of them have been, but some of them have struggled.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 4, Q2.]
We are talking about moving an effective organisation into another organisation which, quite apart from whether the merger is appropriate given their different remits, is—by the review author’s own admission in evidence—basically not in a fit state to receive those new functions. I think that has been tacitly acknowledged by the Minister in saying it will only be done at an appropriate time, when the CQC is ready. Therefore, why make those changes at all? At the moment, it does not look like the CQC will be ready, at least in the near future, based on the evidence we have heard.
Dr Johnson
My right hon. Friend will be aware that it is not the only thing that the CQC is being asked to take on. It is also being asked to take on the regulation of event healthcare, which is another new function for the CQC, all at a time when, as he says, it has its own difficulties to manage.
Edward Argar
My hon. Friend the shadow Minister is right to highlight, for want of a better way of putting it, the cumulative challenges that will potentially be piled on the CQC, on top of the pre-existing challenges with how that organisation is functioning.
I read with great care the Adjournment debate that took place last night in the Chamber, which has been referred to by a number of hon. Members, in the name of my hon. Friend the Member for Harwich and North Essex, and I pay tribute to him for his work in this space. I worked closely with him in the context of the passage of the Health and Care Act 2022, and I know that the issue of patient safety is fundamental to what he seeks to improve and achieve in this House. I agree with him: I fear the Dash review simply fails to make the case for those changes. Also, as hon. Members have set out, it sadly appears to contain a number of errors and assumptions that are inaccurate, which I will turn to in a moment.
The fundamental challenge is to establish a way for people to feel confident and trusting in challenging a culture of denial and blame. We have seen this most recently in the context of maternity failings and scandals. The need for that safe space, and for an organisation able to challenge the institutions, is very clear, and I fear that this change actually weakens the ability to do that. Dr Dash’s review, I fear, fails to fully recognise just how important the safe space concept is—not just in how it is drafted and framed legally but, as my hon. Friend the Member for Farnham and Bordon said, in how it is perceived by those who need to use it. The CQC, of course, has a legal duty to act on information it receives, but that risks being conflated here.
I saw this illustrated last night, for example, in the Adjournment debate, in a comment made by the Minister’s colleague, the Under-Secretary of State for Health and Social Care, the hon. Member for Birmingham Edgbaston (Preet Kaur Gill), when she was responding to my hon. Friend the Member for Harwich and North Essex. She was talking about the criteria for disclosing protected information outside the investigative function. She said:
“Those criteria set a high bar for any disclosure—as high as it is currently with HSSIB—and the CQC will publish further guidance setting out much more detail.”
This is the key point. She went on to say:
“As the Bill sets out, the CQC will appoint a responsible person who will decide whether the case matches the criteria and whether it warrants information sharing outside the safe space.”
And this is the crux of it:
“That person is likely to be the CQC’s chief executive officer.”—[Official Report, 6 July 2026; Vol. 789, c. 147.]
That is an inherent conflict. If the person who is the head of the regulatory body is making the decision on whether information should be disclosed by HSSIB in its folded-in form, that will do nothing to inspire confidence in disclosure and the safe space provisions. I fear that drives a coach and horses through some of the arguments being made that there are sufficient safeguards within this merger to ensure HSSIB can continue as it has done thus far.
The crux of some of Dr Dash’s arguments appears to be that there are, as the Minister also alluded to, too many recommendations being made and that it is a complex landscape. Yet HSSIB, as my hon. Friend the Member for Harwich and North Essex set out yesterday, has made 56. He went on to say that the 30 or so public inquiries and other investigations have delivered 1,400, so it simply does not follow that HSSIB is the problem in that complex landscape.
What was made very clear by, again, my hon. Friend the Member for Farnham and Bordon is that, of course, the concern is not the recommendations. It is not the organisation making the recommendations that is responsible for the fact that they are not implemented. It is the NHS itself, its inertia, its unwillingness and the Department’s unwillingness to take them forward in a coherent fashion—to drive the recommendations through and monitor whether they have been delivered on by the NHS.
Dr Johnson
On pages 8 and 9 of the Dash review, Dr Dash talks about this. She states:
“Recommendations are…focused on inputs, rather than outputs or outcomes, and fail to…balance…risks within organisations and across systems…the existence of so many recommendations causes considerable confusion for staff. They result in more clinical staff moving into supervisory roles to check that other…staff are adhering to the recommendations. The overwhelming majority of recommendations lack data as to the cost of implementation or the expected impact.”
She recognised, did she not, that there was a problem with people being asked to check up on one another’s work and check up on their work? But the recommendations do not deal with that, perhaps because the scope, as my right hon. Friend has described, is so narrow.
Joe Robertson
It is, of course. I have been focusing on public perception, and my right hon. Friend is absolutely correct that that is only one part of it—an important part of it. Probably, the most important part is what actually happens, and that requires the NHS to learn and improve, which is very unlikely to be improved by this proposal.
Dr Johnson
My hon. Friend is making a very important case about the importance of the perception of independence and the safe space actually being safe. There is a risk that people feel that they will be hounded or—
Health Bill (Tenth sitting)
Caroline Johnson ExcerptsThursday 2nd July 2026
(2 months, 2 weeks ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 1 July 2026 - (2 Jul 2026)
Dr Chambers
Amendments 60 and 61 would introduce a primary care investment standard that required integrated care boards to increase spending on primary care services at least in line with the growth of their total programme healthcare funding. We have discussed the importance of primary care in previous sittings, so I will be brief now, because we have a lot to get through.
The primary care investment standard would be similar to the mental health investment standard. It would set a clear benchmark to which to hold the Secretary of State. Primary care is the very frontline of a health service, and it is vital to stop the rest of the health system becoming overburdened, with issues such as corridor care and long ambulance handovers often a direct result of the system’s failure properly to shift resources and focus into primary care and community care, so that we can catch diseases early and prevent people from going into hospital.
If people cannot get GP or dentist appointments, they turn up to A&E. That transfers the load to what is not only not the most efficient part of the NHS for dealing with routine issues, but the most expensive part of the NHS. That is hugely expensive, as well as not ideal for the individual. Although more than 90% of patients’ direct experience with the NHS is through primary care and GP practices, less than 10% of the NHS budget in England is spent on primary care.
Despite years of all Governments promising to shift patient care out of hospitals into the community, the proportion of the NHS budget spent on general practice has fallen to its lowest point in the past 10 years. The Royal College of General Practitioners’ 2025 practice manager survey revealed that although 61% of practice managers said that they need to expand the GP workforce to meet their patients’ needs, 62% said that the lack of funding in general practice is a major barrier preventing them from hiring the number of GPs they need.
It has been revealed that 22 out of 27 of the first round of neighbourhood health centres are already doing some of those functions; they are simply being rebadged and slightly expanded. We know that in the NHS, money is key, and there are constant important and competing demands for the limited amount of funding. Protecting funding streams for primary care would ensure that the Government actually provided the funds to back up their ambition of shifting care into the community. The benchmark that amendments 60 and 61 would set for the Government is modest, but it would have a huge impact if we could successfully transform the NHS by shifting care into the community. We hope that the Government will view this as a spend-to-save initiative as well. One question is always where the money comes from, but having fewer demands on A&E, the most expensive part of the NHS, would save money in the long run.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
The amendments would introduce a primary care investment standard, requiring the ICBs to increase spending on primary care services at least in line with the growth of the total funding that they receive. The Secretary of State would be able to implement financial penalties if ICBs failed to comply.
As the hon. Member for Winchester said, we do not need to talk about the importance of primary care, because we all know it is very important and quite efficient. The Darzi report said that primary care is one of the most financially efficient parts of the NHS. The challenge is that demand is increasing across the whole system, and unless overall funding is increased, then giving primary care a bigger share must mean giving somebody else a smaller one.
My other concern is about how the hon. Gentleman thinks this will be measured. Is measuring inputs rather than outputs really the right way to run the health service? We have tested almost to destruction the idea of just giving more and more money, which I suppose is why the Government have introduced this Bill: to try to reform things and make them more efficient. We can argue about whether they are doing that well or not, but that is the thrust of what they are trying to do.
I think the idea behind the amendments is interesting, but I would be interested to hear more about how the hon. Member thinks the standard would work, and in particular whether he thinks it could be justified if there was huge unmet demand in the secondary care or mental health sector. The balance of need may change over time, and if it does, then legislating for a set proportion to go on this or that type of care, rather than on delivering this or that type of outcome, might not be the right approach.
Edward Argar (Melton and Syston) (Con)
It is a pleasure, as always, to serve under your chairship, Ms Lewell.
I am grateful to the hon. Member for Winchester for his explanation of amendments 60 and 61. Like my hon. Friend the shadow Minister, I entirely understand what he is seeking to achieve, and also how important general practice is. Access to appointments with a general practitioner or at a practice is one of the most significant issues in Melton Mowbray. Despite the fantastic work that doctors are doing to try to manage that, the pressure continues to be intense, which on occasion is causing real anxiety for patients. Equally, I can see what the hon. Gentleman and the hon. Member for Epsom and Ewell (Helen Maguire) are trying to achieve by kick-starting a shift away from acute settings and towards front-loading—for want of a better way of putting it—people’s treatment in the NHS. As he said, Governments of many different complexions have tried to achieve that shift; what he is trying to do is give it a bit of oomph.
I can entirely see where the hon. Gentleman is coming from, but I do have some concerns, one of which was articulated well by my hon. Friend the shadow Minister, which is that the amendments are very much focused on inputs rather than outcomes. With the Health and Care Act 2022, we sought to shift the focus more towards outcomes, and I think the Minister is also seeking to move it towards outcomes rather than purely inputs—she will correct me if I am wrong—so I do worry about that.
Like my hon. Friend, I also have a slight concern about the effect of amendment 60 on the flexibility to address local circumstances and—for want of a better way of putting it—the discretion available to ICBs in determining the local health priorities. The Bill moves us away from the conception of ICBs in the 2022 Act, under which they were essentially mapped on to an upper-tier local authority geography, so that those delivering social care mapped directly on to the same geography and better integrated with it. With the removal of local authority reps and their potential replacement with representatives of a mayoral authority, and with ICBs covering much larger areas, we see a fracturing of the link with social care provision, and also perhaps a lot of local mapping and a local focus from the ICBs. None the less, my concern is that taking a prescriptive approach in primary legislation could further reduce ICBs’ ability to flex in order to address local needs. I can entirely see what the hon. Gentleman is getting at, and we all want to see primary care—general practice and dentistry—getting the funding it needs to address needs, but I am not convinced that the amendment will not have potential unintended consequences.
On amendment 61, I can again see what the hon. Gentleman and the hon. Member for Epsom and Ewell are trying to do: give the shift teeth and make sure that ICBs look at it. The risk is that if they fail to achieve it, they will face financial penalties, which risks compounding the financial challenges they face and potentially reducing the available funds for primary care, mental health and a range of other healthcare services in the vicinity. I get where the hon. Gentleman is coming from and I share the objective, but I have concerns about how it would work in practice and whether it would be overly prescriptive.
Dr Chambers
I would happily speak for several hours on the multifaceted reasons why young people in particular are struggling with mental health. One of my passions is ensuring that people get intervention and support before they require clinical care, but at the moment that is not happening. For a whole variety of societal reasons, including young people applying for 300 or 400 jobs and not even getting a response, more and more people are ending up on mental health waiting lists.
The mental health investment standard has been widely hailed for bringing about positive change in the health service. It protects funds and provides certainty for services that are seeing dramatically rising demand and, importantly, it provides certainty about future finances. Placing it on a statutory footing in primary legislation would make it more transparent and prevent it from becoming a political football. It would also help to stop the watering down of targets that seems to have happened over the last few years. Claire Murdoch, NHS England’s national mental health director, essentially resigned over those changes.
To pick up on the point made by the hon. Member for Bury St Edmunds and Stowmarket, the Milburn report and the report by the Children’s Commissioner this week showed that the number of children referred to mental health services in England has risen by over 10% in just one year—it is now at more than a million. The pressures on NHS services and funding are clear. If funding is not protected, there is a real risk that it will be cut due to competing demands.
One thing I found when speaking to staff at Winchester’s A&E department is that when mental health patients turn up, having been unable to get support and often having already been on a waiting list, sometimes for more than 18 months, the average time they spend in A&E is more than 18 hours, during which some of them require constant supervision. So, we are badly supporting people with mental health issues in the most expensive part of the NHS. We cannot afford to let the mental health crisis in this country continue slipping out of control, and funding for NHS mental health services is an essential part of stopping that.
New clause 33 would require the Secretary of State to
“conduct and publish an annual review into the number and length of delays for patients’ receipt of mental health treatment across rural and urban areas.”
Something I found interesting growing up on a farm and working as a vet is the almost unrecognised mental health issues in rural areas. That is partly because many people who work in rural vocations have minimal contact with people outside their workplace. Sometimes the vet and the postman might be the only people that a farmer sees in one, two or three weeks. There are a lot of questions about why disparities in accessing treatment in rural versus urban areas exist. Alternative approaches are needed, and some of the ideas floated have included mental health support officers for rural GP surgeries, or training vets up as mental health first aiders, because they might be a point of contact for a farmer and recognise when they are struggling.
Different communities require help in different ways, and farming communities often feel overlooked. They are vital for keeping the nation fed and fit and healthy, but they have a job that involves working from before 5 or 6 in the morning until late at night. If services are provided that do not fit with that person’s lifestyle and job restrictions, they can often struggle to access them, which, when coupled with having virtually no mobile signal and poor broadband, means that people in rural areas are sometimes cut off in more ways than one.
The Mental Health Act 2025 had a fairly limited focus on providing care to those with the most acute mental health problems. We need to look at preventive measures to ensure that people are supported through difficult times in their lives. These new clauses will require a report from local authorities so that we can ensure that they are providing tailored support to those in need. The Liberal Democrats strongly believe that early intervention and preventive services are key to tackling to mental health issues. These new clauses would urge mental health service providers to look beyond putting out the fire. This is about moving from crisis management to ensuring that people are supported in their local communities so that they do not reach the point of crisis. We need to treat mental health as seriously as we treat physical health. I know the Minister agrees with that; we think these new clauses will enable the Government to deliver on that ambition.
Dr Johnson
Amendments 9 and 10 have some similar issues to the last two Liberal Democrat amendments. They referred to the primary care investment, while these amendments refer to the mental health investment standard, which seeks to define the proportion of NHS money spent on mental health and maintaining it at a static position. Essentially, similar arguments apply.
In 2016, the mental health investment standard was brought in, albeit not on a statutory footing, to ensure that mental health got the attention it deserved and that the resources provided to it were higher, because the number of people with mental health problems was increasing. There was good sense to that.
However, the challenges to the NHS evolve over time. If the standard were to be fixed in statute, what effect would that have? Would that create an upper limit on spending on mental health at a time when mental health was increasing in prevalence as a problem? Would it increase the lower threshold when the reverse was the case? The Government need flexibility. I would hope that the Government make the right decisions, but that is the democratic process, and they need the flexibility to make the decisions that are appropriate for the time, rather than having this fixed in place.
If we look at current waiting list figures on the Government’s referral to treatment dashboard, in general, the number of people waiting has risen in the last month for which figures are available. If we look in particular at people who require an admission to hospital for a procedure or operation, the numbers are higher over the last month, and also over the last year, for all types of admissions. Not all mental health figures are covered in the dashboard, but those that are have improved slightly in the last month. The point I am making is that things fluctuate over time, and the Government need flexibility to deal with that.
Let me turn to new clauses 33 and 34. As a rural MP, I have some sympathy with the point that the hon. Member for Winchester made about rural healthcare. It is more difficult to get to the major, tertiary centres that provide the most up-to-date treatments. People might have to travel quite long distances to get to the doctors they need to see or to visit in-patients. Of course, those individuals also face transport costs, as we discussed in a previous sitting.
I note for the record that I am a member of the Royal College of Paediatrics and Child Health and the British Medical Association, and an NHS consultant paediatrician. Last week, the Children’s Commissioner published a report that found that 60,000 children were waiting for more than two years for support; the Royal College of Paediatrics and Child Health has also sounded the alarm about the number of children attending A&E because of mental health service issues. In that sort of the situation, the Government might want to move money from A&E services to mental health support to prevent A&E admissions. They may also need to do the reverse, in order to treat those A&E admissions in the first place. Flexibility is required.
New clause 34 would create a duty for the Secretary of State and any relevant body or authority carrying out functions under this Act or the Mental Health Act 2025 to
“promote mental health wellbeing among the people of England.”
That is a statement of his job, and a statement of the obvious; if the Minister is responsible for the mental health services of the country, of course he has a duty to make sure that they do their jobs properly.
It is a nice amendment—it is one of those things that it is politically difficult to vote against—but I would ask the hon. Member for Winchester what practical effect he thinks it would have on mental health. Does he think the Secretary of State is not thinking about mental health? I do not sit on the same side of the House as the Secretary of State, but I think he is interested in mental health and wants to do his best job. Does the hon. Member for Winchester think that is not the case? What does he think the new clause would achieve in practice?
Karin Smyth
These clauses will make a series of vital changes to the NHS financial framework following the abolition of NHS England, strengthening funding arrangements and financial accountability. First, clause 43 will enable funding to flow to integrated care boards following the abolition of NHS England while simplifying the powers to direct how resources are used. The first change in new section 223G will transfer the responsibility to fund integrated care boards from NHS England to the Secretary of State, maintaining continuity of allocations and allowing in-year adjustments where needed.
We will also simplify the existing power in new section 223GA to direct integrated care boards in how resources are used, making it clearer and easier to use. That will ensure that safeguards can be applied consistently, such as the ability to recover funding where there is a failure to comply with a direction. Transparency will be maintained through the requirement to publish directions.
The clause will also introduce new section 223GB, setting how the direction powers in new section 223GA can be used in relation to expenditure on service integration across health and social care. At present, service integration funding must be placed in a pooled budget with local authorities, even if that is not the most effective approach. The current legislation allows for only one model, even where that may introduce unnecessary bureaucracy or delay. The clause will remove that mandatory requirement, giving the Secretary of State discretion each year on whether integration funding should be pooled.
That will not remove pooled budgets; they will remain the default where they deliver better outcomes, and local areas will still be able to enter section 75 agreements voluntarily. This clause will introduce proportionate flexibility and enable the Secretary of State to decide, transparently and through published directions, whether funding should be pooled in particular circumstances. That will ensure that we can act quickly when needed, for example in responding to urgent pressures, so that the Secretary of State is not constrained by a blanket legal requirement that does not always add value.
Clause 43 will also make necessary consequential changes following the transfer of functions from NHS England to the Secretary of State. That will include replacing “NHS England” with “The Secretary of State” in section 223GC, which concerns the power to give directions about integrated care board expenditure limits, and repealing section 223K on quality payments, as the Secretary of State can use other powers to deliver payments for quality improvement purposes.
Having set out a clearer and more streamlined framework for allocating and directing NHS resources, we now turn to how integrated care boards and providers will be held accountable for managing those resources. Clause 44 will omit sections 223M and 223N from the National Health Service Act 2006, which require each integrated care board and its partner NHS trust and foundation trust to balance their finances collectively. By removing sections 223M and 223N, we will ensure that one organisation’s deficit can no longer be obscured by another’s surplus, while preserving the Secretary of State’s ability to set joint financial objectives for integrated care boards and their partner trusts where system-wide alignment is needed.
If we are to achieve the ambitious aim set out in the 10-year health plan, of getting most providers to achieve a surplus by 2029-30, we must place the onus back on individual organisations. Each NHS organisation should be unambiguously accountable for managing its own finances, rather than relying on collective system balances to absorb overspends.
Importantly, that does not mean abandoning collaboration. Clause 44 amends section 223L of the National Health Service Act 2006 to enable the Secretary of State to set joint financial objectives for integrated care boards and their partner NHS trusts and foundation trusts, where local system-wide alignment is genuinely required.
This approach supports the wider policy direction for ICBs to operate as strategic commissioners. With clearer organisation and financial accountability, ICBs can focus on population health outcomes, prioritising prevention, reducing health inequalities, shaping services around need, and driving better value for money through more effective commissioning.
These clauses make a clearer, more disciplined framework, where individual accountability is strengthened, ambiguity is reduced and national oversight is more coherent, while retaining targeted tools to support collaboration where it adds value. I therefore commend clauses 43 and 44 to the Committee.
Dr Johnson
Clause 43 is particularly long: it runs to almost two pages of text. Essentially, clause 43 transfers the responsibility for funding ICBs, and deciding how they use the resources, from NHS England to the Secretary of State. In many cases, that is consistent with the Government’s plan to abolish NHS England, take decisions and responsibility in-house, and get some more control.
One thing that does not make sense to me is that the Government are talking about devolving control and decision making, yet this clause gives the Secretary of State powers to control spending, direct how ICBs spend money in different areas, and penalise them if they do not do what they are told. The Minister has also talked in this Committee about a vision for the future in which ICBs are consistent with mayoral authority areas, and mayors sitting on ICBs to provide some sort of democratic accountability. But how can mayors be held democratically accountable if they are, or might be, overruled by the Secretary of State? How does the Minister see that working?
Also, greater financial intervention powers for the Secretary of State, if used, could expose ICB budgets to short-term political pressure, such as funding for a specific health area that has received celebrity or media attention. How would the Minister guard against that?
If the Secretary of State is able to contest financial decisions taken by ICBs, will that slow down decision making and make things more “sticky”? Essentially, the changes seem to go against the Government’s stated aim of a more devolved and autonomous operating model for the health service. I would be grateful for the Minister’s comments on that.
Clause 44 is a little shorter. It essentially makes changes to the joint duties of ICBs and providers. Some of those changes are again necessitated by the abolition of NHS England; keeping some of the sections would result in overlapping systems, so those make more sense. But the duties requiring ICBs and their partner trusts to achieve overall system balance are repealed. That goes against the collaborative principle behind the creation of integrated care systems, and makes it more difficult to manage financial pressures across a geographical footprint. If, in a particular year, there is financial pressure in one area of an ICB but less so in another, it is not able to transfer things so easily between those areas. How does the Minister expect that to work?
Clause 44 also allows the Secretary of State to set objectives for “one or more” partners. Is that discretionary or are there criteria for it? If it is discretionary, what would prevent the Secretary of State from selectively choosing which trusts are bound by joint objectives and which are not? How will that decision be made? How will trusts know whether it is likely to be made, or in what circumstances it could be made? This could undermine consistency of treatment across different ICBs and trusts. I will be interested in the Minister’s comments on those points.
Gregory Stafford
While I agree with the points made by the hon. Member for Winchester, I note the irony that he is talking about how he wants more independence in this clause, whereas the amendments he tabled previously would have taken independence away from the ICBs—but hey, ‘twas ever thus with the Liberal Democrats.
On the new powers in clause 43, we have previously discussed the power of the Secretary of State to direct how ICBs use and manage both financial and other resources, impose expenditure limits, require approval of local decisions and compel repayment of funds where directions are not followed. These provisions substantially weaken the operational independence of ICBs, transforming them from organisations that are intended to exercise local strategic leadership, as my hon. Friend the Member for Sleaford and North Hykeham said, into bodies primarily responsible for implementing centrally determined priorities. Such centralisation risks diminishing the flexibility required to respond to local, demographic, clinical and population health challenges.
The timing of these legislative changes also raises significant concerns, because they coincide with the abolition of NHS England, the redistribution of its functions and the requirement for ICBs to reduce their operating costs by at least 50%--and, in some cases, even more than that. Collectively, those reforms represent one of the most significant reorganisations of NHS governance. However, there remains little clarity regarding which responsibilities will remain with the ICBs.
The clause makes it even less certain which responsibilities will transfer to regional teams or providers, and how accountability will operate across the system. Introducing substantially enhanced ministerial powers before the future operating model is fully defined, as we have discussed with regional mayors and other bodies, will essentially risk creating uncertainty, duplication and potentially gaps in oversight.
Dr Johnson
My hon. Friend is talking about uncertainty. Essentially, those powers could not be used at all to direct or they could be used to micromanage. It is not clear what the intent is.
Gregory Stafford
My hon. Friend is right, and I have mentioned that in relation to other clauses. I am perhaps a cynic in my belief that if stuff is being written into legislation, that probably means that the Department has some idea of what it wants to use those powers for. It would be useful to hear from the Minister what her and the Department’s intentions are for these powers. How directing or otherwise will they be of ICBs?
Specifically, proposed new section 223GB to the NHS Act 2006, relating to service integration, also exposes that inherent contradiction. It enables the Secretary of State to require ICBs to allocate designated funding into pooled budgets with local authorities, and at the same time to impose centrally approved spending plans and performance objectives. It is not possible to take the clause forward without having some clarity on exactly how those powers are going to be used in future.
As my hon. Friend the Member for Sleaford and North Hykeham said, clause 44 is shorter. She covered most of the points that I was going to make, but I think the Government should explain how effective oversight of the system-wide financial discipline that we have talked about will be maintained in the absence of the provisions omitted from the 2006 Act and the Health and Care Act 2022 by the clause.
Dr Johnson
I note that proposed new section 223GA to the 2006 Act, inserted by clause 43, includes the duty to “publish any directions” but there is no timing for that. Does my hon. Friend agree that it is important to understand how soon after the direction is made we should expect the Minister to publish it?
Gregory Stafford
My hon. Friend is right again: there is a lack of clarity in these two clauses, as I have highlighted. I am sure the Minister, having heard my hon. Friend’s question, will respond when she gets her moment.
Karin Smyth
Clause 45 adds an additional purpose to those already listed in the Health and Social Care Act 2012 under which the Secretary of State can set or modify conditions in the provider licence. It will allow the Secretary of State, who will be responsible for licensing following the abolition of NHS England, to set licence conditions that promote or secure compliance with statutory obligations.
The NHS provider licence was first introduced in 2013 for NHS foundation trusts and in 2014 for eligible independent providers of NHS-funded care. It set clear rules and expectations around a range of matters, such as pricing and governance, for providers of NHS services. It also provided a mechanism for regulatory action when failures occurred at those organisations.
Licence conditions can be set only for specific purposes set out in legislation; the additional purpose does not change the existing licence conditions. The Secretary of State will be able to add or modify licence conditions only following a statutory consultation.
This additional purpose will allow the Secretary of State to hold providers to account when they are not meeting their legal obligations; for example, when they are not following procurement rules. As with other conditions in the licence, it means that we can use guidance to influence provider behaviour in these areas. The change is necessary and forms an important part of the Secretary of State’s powers to intervene where providers are not meeting expectations.
Clause 46 clarifies the methods by which the Secretary of State can serve certain notices relating to changes in the regulation of healthcare services. It brings existing requirements up to date with modern methods of communication, reducing administrative burden.
As the Committee already discussed when considering the abolition of NHS England, the Bill will transfer functions relating to the provider licence and the payment scheme from NHS England to the Secretary of State. When changes are proposed to these documents, NHS England must consult those affected and must notify all relevant organisations of the consultation. Currently, that notice cannot be delivered by email without the agreement of the organisation receiving it—without that agreement, it must be posted.
That process is out of step with the modern, digital-first approach set out in the 10-year health plan. Technology has evolved since those requirements were set, and we no longer communicate predominately through the postal system. The changes in the clause allow for rapid communication to ensure that the notice reaches the appropriate person promptly.
The clause brings the method by which the Secretary of State can deliver notices up to date with modern methods of communication to ensure that everyone affected has the chance to participate in the consultation in a timely way. I am sure all hon. Members agree that that is necessary, so I commend clauses 45 and 46 to the Committee.
Dr Johnson
Clause 45 makes technical changes to the licence conditions, allowing the Secretary of State to use those conditions as a tool to ensure compliance with legal requirements beyond those in the Health and Social Care Act 2012. That power is somewhat open-ended, which reduces certainty for providers, particularly independent ones, as they will not be able to easily anticipate what additional legal duties might be folded into the licence. The Minister said that there would be a consultation, but does she have any more details on how long the consultation process will be, or on how much notice of changes providers can expect? Like other clauses in the Bill, despite the Government’s discussion of devolution, the clause introduces another centralising power.
Clause 46 is about the specifics of to whom legal documents can be served and through what mechanism. I understand the Minister’s argument on the need for modernisation, but everyone will have had emails that were bounced by spam filters or the like. How will she ensure that the emails are not just sent but received, so that there is a fair playing field for everyone?
Gregory Stafford
I understand the purpose of clauses 45 and 46, as there is clear public interest in ensuring that providers that hold licences in our health and care system comply with the law. Patients, taxpayers and staff are entitled to expect high standards, proper governance and accountability. Where a provider delivers vital public services, it is reasonable for the licensing scheme to help to uphold those obligations. In that sense, the intention of the clauses is good.
My hon. Friend the Member for Sleaford and North Hykeham outlined a number of questions for the Minister. Could the Minister explain in more detail how clause 46, which essentially provides for the enforcement of the provisions in clause 45, will operate in practice?
Dr Chambers
I agree that there is no need for carers to see irrelevant or extremely historical information in the single patient record. Currently, however, there are a lot of carers who, for various reasons, such as not having legal power of attorney, cannot access the information that they need.
We also sometimes find that the people who are carers, who are potentially the spouse of the patient and are themselves elderly—because a lot of people receiving care are elderly—do not understand the information that they are being given. There can be a situation where the person providing care does not fully understand why the patient is getting some medication, or the best way to treat them. We hear that quite a lot.
We understand that the Bill is not designed to set out all the specifics of what the single patient record will look like—that key point was made in the interventions by the hon. Members for Farnham and Bordon and for Ashford. However, although we do not know exactly what it will look like, as it is being created, drafted and thought through, we would love the Minister to confirm to us that carers will be able to see the appropriate parts of the single patient records of those they care for, so that they can oversee their medical care and flag any issues.
There are some specific advantages to having a single patient record when travelling between hospital trusts. For example, being able to quickly see what historical medication the patient has had, especially when it comes to antimicrobials, and the results of tests that were performed in other hospitals and healthcare settings, is absolutely vital to ensure that we do not allow antimicrobial resistance to increase at an unnecessary pace. Often, patients do not understand the type of antibiotic they are on, or remember the name of it, and that is a specific but big issue, because it can generate antimicrobial resistance. There are a few more issues that I could speak to, but I will sit down.
Dr Johnson
I rise to talk about amendment 8. I essentially understand what the hon. Member for Winchester is trying to do—to make sure that carers are provided with the information that they need to provide the best possible care—and I think we would all agree with that ambition. However, I have a couple of questions for him. The Bill, as drafted, discusses “making” information
“available to people other than a patient on the patient’s behalf”.
I am not quite clear why would that not encompass a nominated carer.
My hon. Friend the Member for Farnham and Bordon made an important point about privacy. The single patient record will encompass a patient’s entire medical history, medical notes and medical information, but every person who provides that patient with medical or social care does not need to see all of that, and in some cases, the patient may not want them to. My hon. Friend gave a good example of that; another example would be an elderly lady who does not want her carer to see that she had a termination at 23. There are lots of things that are private to people that they do not want others to see. I am interested in the Minister’s comments on this issue. Access to the record is seen as a binary choice, but in some respects, it needs to be a much more nuanced affair than that, while still allowing someone access to the areas of the record that are required for them to complete their duties.
Dr Chambers
The hon. Lady is making very good points. The whole thrust of the argument is that there is little detail around how the single patient record will be created and implemented. This is a perfect opportunity to work out how we can empower carers while preserving patient confidentiality where necessary. If we do not focus on that in the early stages of the SPR’s implementation, before it has even been designed, we will miss the opportunity to ensure that carers have an easy way to get the right information. We should not miss that opportunity.
Dr Johnson
I understand the hon. Member’s point, but we need to start with the patient at the centre and ask what is best for patient care. It is about what the patient wants to share with their carers. The patient may make an informed decision not to share information that is potentially useful, but if they have capacity, they are free to do that. It is about starting with the patient.
I have huge sympathy with the principle of what the hon. Gentleman is trying to achieve, but I am not sure that that is not already included in proposed new section 250E(2)(c)(i) of the NHS Act 2006, which mentions “making” information
“available to people other than a patient on the patient’s behalf”.
The important thing is that patients make the decision if they have the capacity to do so, or that someone acting with power of attorney has done so on their behalf.
Amendment 65, which is also in this group, talks about support needs. I have some sympathy with that as well. When I see a patient in clinic—I am a paediatrician, so they are all children—I look at the notes, which say they have a particular issue, and I go out into the waiting room and call the child’s name. There is nothing on the record, necessarily, to tell me that the patient and the mum are deaf, or that the other parent is deaf and may not be able to hear me calling them in the waiting room. So I have sympathy with the idea that the record would flag up reasonable adjustment needs; I think there is a place for that.
There is something called the reasonable adjustment flag on the NHS Spine, and perhaps the answer is to use that rather better than is happening at the moment. With carers, as the hon. Member for Winchester said, or with parents or legal guardians looking after children, we should consider whether reasonable adjustments also need to be made for the parent, guardian or carer who is likely to bring the patient to be seen.
Gregory Stafford
As I expressed in my intervention on the hon. Member for Winchester, I have a lot of sympathy for what he is trying to achieve with amendment 8. Whether by accident or design, he has allowed us to have a real think about—
Gregory Stafford
I will be charitable and take him at his word. We have opened a vital conversation about who will have access to this record, how it will be shared, which bits of it will be shared, and how we ensure that the laudable aim of a single patient record—to ensure that a clinician treating a patient has all the vital facts in front of them—is balanced with that patient’s privacy. As the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham said, we must make sure that the patient is put at the centre of this.
We need to look at the amendment under that microscope of scrutiny. We must use our role as legislators to ensure that gaps in legislation are closed so that loopholes cannot be exploited. I am fully in favour of the Government’s intention on that. However, I have some concerns about privacy and access, and amendment 8 potentially highlights those.
The amendment provides for a nominated carer to access a patient’s record, but who nominates the carer? Is it always the patient, and how will that consent be verified and continually checked so that if the patient wishes to remove consent for the carer to see their record for whatever reason, there is a way of doing so? What protections exist for vulnerable patients who may feel pressured or even coerced into granting access? If circumstances change, how easily can that access be withdrawn, by whom and through what process?
Although I am not being critical specifically of the amendment, the Government will need to think about those questions when they introduce the single patient record. It is not as simple as saying, “Here is a wonderful record and everyone can access it,” because it will contain some of the most sensitive information an individual holds, including details of their physical and mental health.
I entirely accept that carers often play a vital role in supporting patients, but unrestricted or poorly governed access could undermine patient confidentiality and therefore trust in the system. I am sympathetic to the concerns of the hon. Member for Winchester and think that, not just in relation to this amendment but as the record is pulled together, we really need to consider these vital issues.
On amendment 65, like the shadow Minister, I have a lot of sympathy with the point about reasonable adjustments. We need to be careful when deciding as legislators the purpose of the single patient record. Is it simply a repository of treatments, illnesses, conditions and so on, or does it give a wider commentary on those conditions and treatments? In the example given by the shadow Minister, knowing that someone has hearing difficulties would be useful, but is the single patient record the appropriate place for that? I do not know the answer, but we need to discuss and decide that, because there is a danger of scope creep. If we try to make it all things to all men and women, it could lose the stated purpose, which is to ensure that a clinician has the full facts when dealing with a patient.
Dr Johnson
I understand what my hon. Friend is saying; he is making a very good speech. I wonder whether he agrees that one of the challenges for us as legislators, in looking at all the amendments on the single patient record, and indeed at the single patient record itself, is that while the principle of a single patient record might be a good, it is all about the devil in the detail and the delivery. We do not have a delivery plan or a vision of more of the detail relating to how it will look, so it is difficult to make judgments on many of the clauses.
Karin Smyth
I agree with the hon. Member for Farnham and Bordon that, through this amendment, the hon. Member for Winchester has given us an opportunity to think. I am grateful to him for this chance to talk about carers and this important issue. I am a carer of an older person, and for those of us who are carers, it is helpful to have some discussion about this area. Carers play a vital role and we are committed to ensuring that they have the support they need. We are of course very grateful for all the work that they do.
The Bill already includes a power that permits regulations to make patient information available to people other than patients on the patient’s behalf. As the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham, said, that can include carers, and it is our intention to do so. We want to ensure that carers who act on behalf of the people they care for get the full benefit from the single patient record.
NHS proxy access already allows for people other than patients—which includes carers, parents or care home staff—to manage the health and care of someone they care for. Setting up proxy access requires the consent and involvement of the individual and the person they care for. We will set out in regulations how proxy access will work for the single patient record, as in the existing NHS position.
The single patient record will be developed on two priority care pathways in maternity and frailty, which will initially be delivered through local arrangements. Some clinicians and patients will be able to view and manage additional elements of care, such as proxy access for carers, earlier than others. For those reasons, I ask the hon. Member for Winchester to withdraw his amendment.
We have had some helpful comments about some other concerns.
Dr Johnson
Will the Minister confirm whether the intention of the Government is to separate parts of the record out so that people can give consent for part of the record to be shared, but not the complete record, where they have reasons to want extra privacy?
Karin Smyth
The hon. Lady knows that we are talking about an enabling power in the Bill. All the details will be brought forward in regulations, through discussions and consultation. We will discuss that more broadly as we talk about the wider clause.
One of the key issues I have been asked about is protecting vulnerable people. Patients will access a single patient record through the NHS app, and NHS England has published guidance on clinical safety, safeguarding and the NHS app, which provides advice on minimising the risk to those where there may be challenges or potential risks. We will adopt a similar approach to the single patient record. Clinicians will be able to redact information that is too sensitive to share, and we will agree a protocol with professional bodies on how that will be applied. I am sure that we will discuss that in more detail, because it is an important area to get right.
Health Bill (Eleventh sitting)
Caroline Johnson ExcerptsThursday 2nd July 2026
(2 months, 2 weeks ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 1 July 2026 - (2 Jul 2026)
Dr Chambers
The hon. Gentleman makes an interesting point. I suppose this is another chance to use the developing single patient record to ensure that we close the gap. The record could be formed in such a way, and the process put in place, to ensure equity in the system, with mandatory markers.
Amendment 72, also tabled by my hon. Friend the Member for Epsom and Ewell, would require prior membership of the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record. It would also require the Secretary of State to publish a report on making prior armed forces membership visible on the single patient record.
There are just over 1.85 million armed forces veterans in the UK, 13.6% of them women and 86.4% men. The transition from serving in the armed forces to civilian life can mean that many of those individuals struggle with mental health issues, such as post-traumatic stress disorder. The issues are often specific to the service the individuals have given. Some stats show that more than half of England’s Army veterans have some sort of health problem. I should point out that veterans do not only have mental health problems. Specific back and knee problems are much more common among infantry soldiers because of the type of training they have done over many years.
The amendment seeks to make prior armed forces membership visible to all relevant healthcare workers, and to make the Secretary of State consult on the merits of doing so, so that when a GP is treating a patient, they are aware of that person’s service history without having to ask about it specifically.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I have a couple of questions about amendment 71 for the hon. Member for Winchester. First, can he comment on why the amendment refers to firearms, which have stricter licensing conditions than shotguns? Also, the GP should be aware, because all relevant medical information should filter back to them, that the person has a firearms licence, which, as I say, has stricter criteria. It is essentially harder to get a firearms licence than a shotgun licence. I am interested to hear the hon. Gentleman’s thoughts on that.
On amendment 72, I have a large veteran population in my constituency, and I am very grateful to all those who have put their lives on the line to keep us safe, both today and in the past. I can see that there may be benefits to the amendment in respect of the delivery of the armed forces covenant and aspects of veterans’ care, but I am curious about how it is written. Proposed new subsection (3A) of proposed new section 250E of the National Health Service Act 2006 says that
“regulations must make provision for prior membership…to be visible to all relevant healthcare workers under the establishment of a single patient record”,
but proposed new subsection (3B) requires a report on the potential merits of doing that. It seems slightly counterintuitive to do it and then decide whether it is a good idea, rather than decide whether it is a good idea, consider the pros and cons, and then do it afterwards. I am interested to understand why the hon. Gentleman thinks the amendment is drafted in that way.
Gregory Stafford
It is a pleasure to serve under your chairmanship again, Ms Lewell. On amendment 71, I ought to declare that I am a supporter of the Countryside Alliance. Although I do not own a shotgun myself, I represent a large shooting community and I have been on a shoot relatively recently, but without a gun, so I did not shoot anything.
As I alluded to in my intervention on the hon. Member for Winchester, I spoke on this issue in Westminster Hall some months ago, when it was clear to me that there was a significant level of cross-party support for the idea of mandatory markers for GPs. As mandatory markers for firearms licensing are technically a Home Office issue rather than a Department of Health and Social Care one, the Under-Secretary of State for the Home Department, the hon. Member for Dover and Deal (Mike Tapp), responded to that debate, but he was unable to reassure us that provision would be made. I did not understand the arguments he made, because I think mandatory markers are probably the way forward. Given that they are supported by organisations such as the British Association for Shooting and Conservation and the Countryside Alliance—organisations that one might not have expected to be in favour of them—the Government should look into the idea.
There would clearly be a benefit to the proposal in amendment 71. If a patient who holds a firearms licence presents a serious medical risk because of a mental health crisis, suicidal ideation or behaviour that raises concerns about risks to themselves or others, an immediately visible marker would help clinicians to make informed decisions and take the appropriate safeguarding action. But a firearms licence is obviously not a medical condition, nor is it health information in any traditional sense. This goes back to the point I made in the debate on a previous amendment, about how broad the information that we keep on the single patient record will be. The inclusion of such a marker across the single patient record could lead to issues relating, as we talked about in previous debates, to who would want to see that information.
For example, there may be people out there who are not in favour of recreational shooting, and someone may hold a firearms license for recreational shooting. Of course, section 2 firearms licences, especially for shotguns, are often held by farmers and people involved in conservation, and for all sorts of other reasons, including the control of pest populations. But if someone has a licence for recreational use, there may be people who, for whatever reason, find that to be against their own beliefs and opinions. That might lead to a patient being subjected to a level of intrusion or bias, or perhaps not receiving the care they deserve, because someone has made an assumption about what they are like based on that information. We need to be careful about that.
Dr Johnson
Before my hon. Friend moves on, may I ask him about security? It might also be possible for someone who looked at the records to identify where guns are kept. That information is currently is more protected than that.
Gregory Stafford
I thank my hon. Friend for that helpful intervention; I had not appreciated that. If that is true, the security and safety of the individual who holds the firearms licence, and indeed of anybody else in the vicinity, is paramount, and we generally would not want people to know precisely where guns are held, because that could be a security risk. I think the hon. Member for Winchester has the best of intentions, but the consequences have not been fully thought through.
The Minister for Secondary Care (Karin Smyth)
Wherever possible, the single patient record will build on source records such as GP records. As such, it will include relevant patient information and, where appropriate, digital markers such as those suggested in the amendments. We have had some useful discussion as a result of the amendments, but such considerations are generally operational, and legislation is neither necessary nor practical.
On amendment 71, Members will know that the Government have been doing significant work in support of a digital medical marker for firearms. Medical information for firearms licensing provided by the applicant has been a mandatory requirement for every firearm and shotgun licence application since November 2021, as we have heard, when the new statutory guidance for chief officers of police on firearms licensing was introduced. When any individual applies for a firearms licence, the applicant’s doctor must provide details of any relevant medical conditions, such as depression, dementia, mental health conditions or drug or alcohol abuse.
A digital maker is placed on the GP patient record when a certificate is granted, and a GP can alert the police if a licence holder has a relevant medical condition. The digital marker automatically flags to the GP if a patient is suffering from a relevant medical condition and is a firearms certificate holder. It is true that the marker is not legally mandated, but it is supported by the British Medical Association and the Royal College of General Practitioners, and the former issues guidance to GPs about the firearms marker.
GPs already have professional duties to consider patient and public safety, and existing firearms licensing arrangements support GPs to share relevant concerns with the police where appropriate, while the responsibility for licensing decisions rests with the police. Data shows that, since its introduction in 2023, the marker is being used and that GPs are notifying police of medical issues that have arisen. There is nothing to suggest that the system is not effective.
Dr Johnson
Is it not also the case that anyone who is aware that an employee or relative has a licence and is concerned about their mental health can make such a report?
Karin Smyth
I am afraid I do not know the answer to the hon. Lady’s question, but if it is relevant, I will try to get back to her on it.
People applying for a licence must now indicate whether they have seen a medical practitioner other than their GP. The Government also intend to make a statutory instrument to require licence holders to inform the police if they consult a third-party medical practitioner who is not their GP.
The single patient record will build on and connect with information from GP source records where appropriate; no new provision is needed for that to happen. That process should be agreed as part of operational arrangements with the profession, in line with the current approach to markers in the GP record. If it is agreed that it would be beneficial for health and care professionals to have wider access to the firearms marker, the single patient record could facilitate that, but we do not intend to fill the Bill with detailed operational requirements such as that.
We do not believe that the SPR is the appropriate vehicle for having a debate about regulations requiring a report on the merits of a mandatory marker. As the hon. Member for Farnham and Bordon said, we should not expand the clearly defined scope of the single patient record—the scope is limited to direct care—to include a debate about what is stored more generally in NHS records. For those reasons, I ask the hon. Member for Winchester to withdraw amendment 71.
On amendment 72, as I have already outlined, the single patient record will build on and connect with existing source records, such as GP or hospital records, wherever possible. Where a person’s status as a military veteran is recorded, it will be possible to make that information available in the single patient record. Therefore, the provisions already ensure that the information is made available, where veterans opt to have that status recorded—that addresses some of the other issues raised by the hon. Member for Farnham and Bordon. There is no need to make any statutory requirement to ensure that staff have that information and consider any necessary adjustments or potential treatment options that may be relevant to ensure safe and effective care.
In addition, the clause contains powers to make regulations to allow people involved in the provision of an individual’s direct care, including that of any veteran after they have left the military, to access their single patient record. We want the single patient record to improve the accessibility and effectiveness of care for everyone. That includes making sure that military veterans can access necessary support and that staff can provide them with appropriate care. Furthermore, duties in the Armed Forces Act 2006 require the NHS and local authorities to have due regard to the armed forces covenant, which, of course, I fully support. For those reasons, I ask the hon. Member for Winchester not to press amendment 72.
Helen Morgan
Amendment 70, tabled by my hon. Friend the Member for Epsom and Ewell, would require the Secretary of State to prepare and publish a risk assessment on the potential for digital exclusion under the establishment of a single patient record. I declare an interest as the current chair of the all-party parliamentary group on digital communities.
I hope that we Liberal Democrats have been clear that overall, we are supportive of the single patient record; it is important that every patient can access their own health records. Under the SPR, however there is a risk that people belonging to already vulnerable groups will be digitally excluded from accessing their health information. Research commissioned by Ofcom suggests that 2.8 million people—5% of the UK population—do not have access to the internet at all. Although age is a predictor for a person not having access to the internet at home, especially if they are over 85, more than half of such people are younger than 75.
Amendment 70 would ensure that the Secretary of State assesses the potential for digital exclusion with relevant stakeholders, including patient groups, and that the assessment is laid before Parliament. It would also ensure that the Secretary of State takes into consideration the risk of exclusion for those lacking access to a suitable electronic device or suitable broadband connectivity, including people who have disabilities, who belong to socially excluded groups or who lack digital skills.
Dr Johnson
Amendment 70, as the hon. Member for North Shropshire said, would require the Secretary of State to publish a risk assessment on the potential for digital exclusion in the single patient record. That is important because, as our lives become more electronic and online, there are people who are getting left behind. That could be because they have a disability that prevents or makes it more difficult for them to access online facilities, because they do not have the resources, because they live an area of the country that is less well served by digital or broadband provision, or because they are elderly and have decided that they will not get involved in the digital world.
In fact, according to the Good Things Foundation, 7.9 million people in the UK lack basic digital skills and 1.6 million adults do not have a smartphone, tablet or laptop. Of those with no basic digital skills, 77% are over 65. People need more healthcare as they get older, yet those individuals have fewer digital skills, so this issue needs to be addressed. The NHS Alliance published a report on digital inclusion in March 2026, which found that rural and coastal areas typically have higher levels of digital exclusion than urban areas.
Lincolnshire ICB, which covers the area that I represent, estimates that 21.3% of Lincolnshire’s population live in the most digitally deprived areas. The ICB has a digital inclusion strategy for 2025 to 2028, which includes efforts to try to reduce digital exclusion; I am interested in the Minister’s thoughts on how she might expand that sort of initiative across the country.
The Government’s equality impact assessment for the single patient record recognises that digital exclusion is a significant challenge in several groups with particular protected characteristics and other characteristics. I am interested in learning more from the Minister about how she intends to mitigate that challenge. In many ways, digital availability is a good thing, and it makes things much easier for many people—I am not knocking it in any way—but we need to ensure that people do not get left behind.
I understand that NHS England is supporting public libraries to signpost users to the NHS website and help them navigate it. What will happen to that support as NHS England gets abolished? Does the Minister intend the Department of Health and Social Care to provide something similar?
Amendment 49, tabled in my name, is basically about public awareness. Although we get immersed in what we are doing here, the public are not necessarily following every word that is said in Committee or in this House—or even necessarily every word that appears in the press—so when the single patient record is launched, it is important that they are aware of it, and in particular, aware of their rights.
We have talked about whether a person might want to let a carer see the single patient record or whether they might want to let someone see part but not all of the record. If the record goes live before people are aware of their rights and abilities in relation to it, they might find that things are available to people, or can be viewed by people, who they would not have wished to see them, which could lead to a number of problems. The amendment would allow people to be more aware of the single patient record for a period of time before it is brought in to try to make sure that that sort of problem is mitigated, and I am interested to understand the Minister’s view on it.
Joe Robertson (Isle of Wight East) (Con)
It is a pleasure to serve with you in the Chair, Ms Lewell. I wish to speak on this aspect of the single patient record. Although I support the general intention and aim of the single patient record, I have some wider concerns about how it will be implemented. I will restrict my remarks to the issues related to this group of amendments, and particularly amendment 49 in the name of the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham.
Plainly, most people—I would probably include myself in this—are not immediately familiar with all the ins and outs of how their medical records are kept and used, and why should they be? However, they have some pretty clear views on what they expect, whether that is confidentiality or their records being used and stored in such a way that does not inadvertently act as a barrier to accessing healthcare in an efficient and timely way. That is why the Government have introduced these proposals, which I mainly support.
Edward Argar (Melton and Syston) (Con)
I want to speak primarily to amendment 49, in the name of my hon. Friend the Member for Sleaford and North Hykeham, the shadow Minister, and to agree with what my hon. Friend the Member for Farnham and Bordon has just said. Sadly, there will be a large number of people who do not follow the debates in this House or this Committee in great detail, however fascinating they may be. That is perfectly understandable.
The single patient record has genuine potential. It has the potential to put all the different bits of data in one place, so that when, for example, someone is blue-lighted to hospital, their consultant or the doctors treating them in A&E can access the information they need about their medical history and any medications they are on, which could improve clinical outcomes for patients.
I can entirely see the potential of the single patient record, but I am also conscious of the genuine concern among those of our constituents who are aware of this about what it might mean in practical terms for them and their data—it is important to remember that it is their data. They will have concerns, as my hon. Friend the Member for Farnham and Bordon set out, about who can access it, what safeguards are in place, whether they can opt out, and a range of other legitimate questions about how it will work.
I have to say that amendment 49, tabled by my hon. Friend the Member for Sleaford and North Hykeham, is not unreasonable. It would give the Government an opportunity to reassure our constituents and bring them along on this journey, rather than leaving questions unanswered or just addressing them in a Q&A on a Government webpage. People have genuine questions, and in many cases I am confident that the Minister will be able to allay those concerns or put them to rest, but some campaign of that sort is needed.
Such campaigns happen regularly on a range of subjects. The Department of Health and Social Care spends a significant amount of money on public health and awareness campaigns, and His Majesty’s Revenue and Customs spends a large amount of money on reminding everyone to get their tax returns in on time, in the lead up to that, or to remind them of the penalties if they do not. Government do that day in, day out across a range of services and where major changes are being made.
The Government have a genuine opportunity to accept amendment 49, which will help them to bring the people we serve on this journey, and potentially help to realise the benefits and allay people’s concerns. I genuinely hope that the Minister will be able to accept the amendment or will commit to take it away, look at it, engage with my hon. Friend the shadow Minister and possibly bring back a Government amendment that does exactly this on Report.
Dr Johnson
I am advised to declare that, although I am not a licence holder of a shotgun or a rifle, my husband has both a shotgun and a firearms licence.
Karin Smyth
I am grateful to hon. Members for this debate. Meaningful public engagement will be key to the success of the single patient record—we absolutely understand that—in building awareness and in designing the system. It has to have digital inclusion at its heart, but adding statutory requirements for public awareness campaigns and risk assessments is not the way forward. Amendment 49 seeks to put such a requirement on a statutory footing. I want to reassure the Committee and all Members: as the right hon. Member for Melton and Syston said, public awareness is absolutely key and will be integral to success. Work is already under way to ensure that we do that; we do not need to wait, nor should we be constrained by the proposed amendment.
In 2024, we began extensive public engagement on the use of data across health and social care, which showed strong support for the single patient record. We have heard that most people felt it was
“long overdue and a necessary step towards better care”.
The public engagement findings indicated support to progress at pace on the concept of a single patient record, to resolve the frustrations that patients and the public have when they have to repeat their story at multiple health and care settings.
As we move towards our ambition to give all patients in England access to a core set of their data through the single patient record from 2028, we will maintain a sustained drumbeat—as they say in the jargon—of public communications to raise awareness of the single patient record. We have heard some examples of where the Government do that well. Of course we want to learn from such examples across the country and from previous Government campaigns that have worked well, to explain the benefits and safeguards in plain English, and to signpost accessible information and feedback routes for patients and the public. I heard the comments made about people who may be excluded or have particular disabilities, including some older people—from conversations with my own constituents, it is often older people or those with multiple disabilities who can have their experience enhanced. We should make no assumptions about who does or does not feel excluded in this space; we need to learn from them all.
Furthermore, we have already published public-facing single patient record information and a dedicated feedback route. We will continue to co-create plain English, easy-read and translated materials, frequently asked questions and “voices heard/action taken” updates with public panels and patient groups ahead of roll-out. We will build on what we learn from that ongoing work as we develop the regulations. For those reasons, I respectfully ask the hon. Member for Sleaford and North Hykeham not to move amendment 49.
On the lead amendment, moved by the hon. Member for North Shropshire, we recognise, as I hope I have assured the Committee, that digital inclusion is an important issue. To quote another Member, we are eager to get it right, and we are taking it very seriously. Digital inclusion is a key driver in addressing health inequalities, supporting individuals and empowering people to better manage their health, which is at the heart of our 10-year plan. It is a system-wide issue, and one that the health and care system is taking action to address. We have considered this as part of the equality impact assessment of the single patient record provisions in the Bill, and will continue to keep those issues and potential mitigations under consideration throughout the development and implementation of the SPR. Therefore, although we agree with the aim of the amendment, we do not consider it necessary. Indeed, it would duplicate work that has already been done.
The Chair
We will vote on amendment 49 later if the hon. Member for Sleaford and North Hykeham wishes to.
Dr Johnson
I beg to move amendment 48, in clause 47, page 36, line 1, at end insert—
“(4A) Regulations may not be laid under this section unless the Secretary of State has published a plan setting out the measures to be taken to prevent clinicians and other persons involved in the provision of health care or social care from accessing patient information made available through the system otherwise than for the purposes of the care of the patient concerned (an ‘inappropriate access prevention plan’).
(4B) The inappropriate access prevention plan must include—
(a) a description of the technical controls to be applied to restrict access to patient information to those with a legitimate care relationship with the patient;
(b) the system of audit logging to be applied to record each instance of access to patient information, including the identity of the person accessing the information and the time and circumstances of access;
(c) the sanctions applicable to persons who access patient information without lawful authority or without a legitimate care relationship with the patient;
(d) the arrangements for detecting and investigating suspected cases of inappropriate access; and
(e) the role of the Care Quality Commission, the Information Commissioner and any other regulatory body in enforcing compliance with access controls.
(4C) The Secretary of State must lay the inappropriate access prevention plan before both Houses of Parliament.”
This amendment prevents the Secretary of State from making regulations to establish the single patient record unless a plan to prevent inappropriate access by clinicians and other care workers has first been published and laid before Parliament.
Amendment 48 would prevent the Secretary of State from
“making regulations to establish the single patient record unless a plan to prevent inappropriate access by clinicians and other care workers has first been published and laid before Parliament.”
This is about trust. It is about people being able to trust that the records that will now be more widely available will remain confidential and be looked at only by those who need to look at them.
We have seen that people can be uniquely nosey when it comes to accessing medical records. For example, 48 staff members at the University Hospitals of Liverpool Group were found to have looked at the records of those involved in the Southport attack without any medical basis to do so. Almost a dozen staff members were sacked from the Nottingham University Hospitals trust because they had looked at the records of the victims in Nottingham. It is important that we address this, because it is happening already and needs to be tackled.
Paul Arnold, the chief executive of the Information Commissioner’s Office, said that trust is being “jeopardised”. The amendment seeks to ensure that proper thought goes into making sure that people cannot access records they should not be able to look at—for example, those of the Prime Minister or members of the Royal family—before the single patient record is live and can be used. We have Public Department 1 for HMRC; is there an intention to have something similar to close off records to reduce their accessibility where the public may be particularly nosey, either because of the person’s job or because of an event such as a terrorist attack, where we have seen people look at records when they should not have? There were reports that staff at The London Clinic, a private clinic, had been trying to sell records of the Princess of Wales online, so there are examples where this has happened before.
In addition, it is important that people know what the penalties are for deliberately misusing these records. My final question for the Minister is this. If a record has been viewed and there is a data log of it having been viewed, how long will that data log last for? Will it last for six months or a year, or will I be able to look back in 10 years’ time and see who accessed my records today? It is a case of understanding the Minister’s intentions and pushing the Government to ensure that these records are truly private to those who need to see them, not accessible to anyone who just happens to be curious.
Sojan Joseph
I declare that I am a registered nurse. I have worked in the NHS for many years, and I have used patient records throughout my career. The Nursing and Midwifery Council code requires nurses, midwives and nursing associates to respect patient confidentiality, share information appropriately and ensure that patients are informed about how their information is used. That is the existing system, and every nurse, midwife and nursing associate has to follow the code of practice. A similar code is there for the General Medical Council for doctors, and all other registered professionals follow those codes.
On top of that, information governance in the NHS ensures that patient data is handled legally, securely and ethically, providing a framework for data protection and confidentiality. We have numerous different digital systems in the health system currently. Before anyone gets access to those digital systems and patient records, they all have to go through information governance and data protection training. They are then given access to patient records. That is the existing system.
The shadow Minister, the hon. Member for Sleaford and North Hykeham, has just mentioned the Nottingham incident, which is a good example. It is a clear example of where those who accessed the records were able to be identified. There is a clear audit trail, and I have my own experience of taking people through disciplinary proceedings for accessing patients’ notes when it was not relevant to those staff. The existing patient data systems do have provisions to safeguard and monitor who is accessing patient records.
Dr Johnson
I understand what the hon. Gentleman is saying, which is that there are processes in place already and that the fact that someone got sacked for looking at the records is a sign that the systems work to an extent. However, does the fact that they could look at them at all suggest that the systems are not working well enough? Because it is a computerised system, there are methods for identifying whether someone is likely to need to look at that record. By knowing the profession of the person looking at it, and the department they are in, the computer can help to limit the number of people who look at those records when they should not.
Sojan Joseph
I agree that we are never going to have 100% proof. There will always be people accessing records. What I am talking about is the existing system, which does have provisions. What we need to strengthen is the training and the audit trail. All staff who do the training are aware that they are not supposed to check patients’ records unless it is relevant to them. Those who access records inappropriately should be identified and action should be taken.
Just because we are moving to a single patient record system, it does not mean that everybody is going to access everything they want. People working in the healthcare system are given access based on their role. Not everybody is able to access everything. Systems are in place, and we need to strengthen those systems and the training. We should not be scaremongering by saying that, because we are moving to a single patient record, everybody will be able to see their records.
Edward Argar
The hon. Member for Ashford made his point very clearly about what happens when something goes wrong and someone behaves inappropriately—the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham, has highlighted some very concerning recent incidents—and was right to highlight the ability to follow an audit trail and take action. He is also right to highlight the importance of training.
However, taking action once inappropriate access is known, and then following the audit trail, deals essentially with the consequences rather than preventing it from happening in the first place. That is why amendment 48, and particularly proposed new section 250E(4B)(a) of the National Health Service Act 2006, is important. It describes the technical controls. That goes beyond the audit process and what happens after something has gone wrong. It is about what can be done to build safeguards into the system to make it much harder for anyone to circumvent their obligations, and to build those technical safeguards into the overall design of the single patient record. That is a reasonable ask, because such incidents, while hopefully rare, as the hon. Member for Ashford alluded to, do happen and understandably cause concern.
The challenge is that there is potentially a lot more information in one place, rather than being held in different pots, trusts or GP surgeries. For those inclined to break their legal obligations and behave outside the rules, the potential opportunity to access a wider range of information is more significant. The design of the record needs to have those technical safeguards strengthened and built in.
Dr Johnson
If we use the example of Southport, the people who could access those records worked in the Liverpool trust, because that is where the records were stored. With the single patient record, as planned, people would be able to access those records from across the country, if they had a clinical reason to do so. However, someone behaving badly could also potentially do so, even if they did not have a reason.
Edward Argar
That is the challenge. The Minister knows her brief very well—if I may say, I hope that whatever happens in a few weeks’ time, she retains it. She is that rare thing among Ministers in Government: someone who comes to their position with a hinterland of knowledge, experience and interest, which she has demonstrated through her period in office thus far. I hope that she retains her role, because continuity of Ministers in Government is a good thing.
Can the Minister reassure us on the shadow Minister’s point, which is one that I have been seeking to make? Can she reassure us that the system will include barriers to prevent whoever builds and operates it—whether a third party or someone internal—from having inappropriate access to the records? The data must be ringfenced and protected, so that it does not go out of the country and cannot be accessed by those who are technically running or providing the platform. Even within the social care system, there must be very clear and technical restrictions on who can access the records for legitimate purposes, as the hon. Member for Ashford has highlighted. I think that would just reassure people.
As I said in response to previous amendments, I think the potential of the single patient record to improve clinical outcomes in care is very significant, but we need to bring people with us. I suspect that if anyone can reassure us on those points, it is the Minister.
Gregory Stafford
Before I was rudely interrupted by the fire alarm—I am not taking it as a hint, much to the Minister’s disappointment—I was saying that this is a unique system and that with the unique benefits come unique risks. I was trying to answer the points made by the hon. Member for Ashford.
As my hon. Friend the Member for Sleaford and North Hykeham and my right hon. Friend the Member for Melton and Syston have mentioned, we already know that despite the regulations, whether they are from professional regulators or the ICO, people will get round the system. One of the biggest concerns that patients will raise is not simply whether patient records will be accessed by nefarious people from outside, such as cyber-hackers, hostile states and so on, but whether they are secure from inappropriate access by people who have access to the system. As my hon. Friend the Member for Sleaford and North Hykeham pointed out, those people could be situated anywhere across the country. Patient records should be accessed only where there is a clear clinical, professional need. The public rightly expect robust safeguards, strong audit trails and meaningful consequences where the rules are breached. Amendment 48 raises that important issue. The Minister should explain how inappropriate access will be prevented, how misuse will be detected and what sanctions will apply when the standards are not met.
My hon. Friends have already mentioned a number of cases and I pick another one: the unfortunate case of the three-year-old boy who was hospitalised after being attacked by a crocodile at a zoo. Cambridge University Hospitals trust is currently investigating 40 members of staff who appear to have accessed that boy’s medical records inappropriately.
While we would always hope that that would not happen, unfortunately it clearly does. This single patient record means that someone will potentially be able to look at patients’ records regarding anything and from anywhere in the country. My hon. Friend the Member for Sleaford and North Hykeham slightly generously described some people as “nosey”. Along with those who have an actual ulterior motive, that presents a real challenge. I say to the hon. Member for Ashford that just because the current system is in place to protect patient records as they currently exist, that should not be a bar to making sure that we make the system even more robust given its potential risks.
It goes directly to proposed new section 250F(4B)(b) of the National Health Service Act 2006, which is the system of audit logging to be applied to each record, so that every time someone accesses a patient record or part of that patient record, the identity of the person obtaining that information should be recorded. I believe that the patient should be able to easily see, hopefully in real time, who has been accessing their record and at what time.
We on this side have mentioned a number of big events: that poor boy with the crocodile, terrorist attacks in Southport and so on. I suspect that those data breaches have been identified because they were big events. People have gone out to check that nobody has been inappropriately accessing those records. I worry that every patient record will potentially be available to every single person, and I doubt that there will be an ability to check every single person proactively rather than reactively. That means patients need access themselves to look at their record and see who has been accessing it. If the name of the person who has accessed the record, or the organisation they belong to is available, patients can say, “Well, there is Mr Smith, my child’s paediatrician, and that is fine. However, who is this guy from elsewhere in the country who has looked at the record?” They can then raise that. That is absolutely vital.
Dr Johnson
My hon. Friend is making a very important point. Does he also think that it is possible for the system to have some designs built into it that identify that someone from another area of the country, or from another department or different profession is unexpectedly looking at results? Perhaps AI could help with this.
Gregory Stafford
My hon. Friend is right. I will not sit here and propose a solution to this problem, but what her amendment does is ensure that the Government look at this and present a plan before both Houses of Parliament, before we get to a single patient record.
I have now touched on the nefarious and the nosey. I think there is also a case of inadvertent access. With this new system, despite what the professional regulators might think, and despite the best training from the Information Commissioner’s Office, there will be occasions in a new system where people do not understand the limits of what they are allowed to look at or the appropriateness of access. There could well be inadvertent access to these systems. Again, the Government need to have a plan and system in place to ensure that there is not inadvertent, non-nefarious access to patient records as well. That is why I am very supportive of amendment 48.
To make sure that this system is trusted by patients, we need to have the highest level of safeguarding possible, both from external attacks and from internal misuse. My hon. Friend’s amendment goes a long way to putting some of that trust in place.
Karin Smyth
This is another important discussion to have on the record to give patients and the public confidence as we introduce the vital single patient record. I start by stating that the security and privacy of people’s health data is paramount, and we will build the strongest safeguards possible into the record. Members from across the House have asked how those safeguards will be built into how the system is designed and operated, which is what we are doing.
It will operate on a roles-based access control model, similar to other NHS patient record systems where access to patient information is restricted to the authorised user only. The single patient record will go a step further by applying advanced cloud-based audit and oversight capabilities, enabling near real-time monitoring of system access and detection of unusual or inappropriate patterns. That will allow NHS security teams to track and detect access patterns, and to quickly intervene if specific records are accessed by staff who have no clinical relationship with the patient in question.
The single patient record will ensure that just because a clinician has permission to view a specific patient record, that does not mean they are authorised to do so without a clinical need. The security and access arrangements will be set out in the regulations themselves, which will be debated, rightly, in Parliament. Therefore, it is not necessary to set them out in a plan beforehand.
Furthermore, there are already existing enforcement arrangements that provide sanctions for inappropriate access to patient data, which will also include accessing the single patient record. I commend my hon. Friend the Member for Ashford for his extremely helpful intervention, in which he highlighted his own experience in this field. Some of the examples that we heard again today, including Southport, Nottingham, the recent case in Cambridge and others, are truly shocking to people. Clearly, that should never happen, but sadly it has. As my hon. Friend rightly outlined, there are provisions in place for training people on information governance and tracking when that happens.
Additionally, I want to be clear that the Computer Misuse Act 1990 makes it an offence to use a computer to access information in an unauthorised manner, such as a person accessing information without a legitimate reason. Inappropriate or unauthorised access to health records—often referred to as snooping—is a serious offence that can lead to severe penalties, including dismissal, criminal prosecution and financial penalties. Regulated healthcare professionals, such as doctors, nurses and pharmacies, can be reported to their respective professional bodies, which can result in them being struck off in serious cases.
The information commissioner also has powers to investigate and take action against infringements of data protection legislation, which can include monetary penalties, enforcement notices, undertakings, prosecutions and reprimands. Furthermore, patients have a right to access data that is held about them under the data protection legislation, and those rights will continue to apply to the single patient record. For those reasons, I ask the hon. Member for Sleaford and North Hykeham to withdraw her amendment.
Dr Johnson
We think this is an important issue, so we would like to divide the Committee.
Question put, That the amendment be made.
Dr Johnson
Clause 47 amends the existing legislation to facilitate the single patient record. We have heard about the many benefits that it may bring, for example for patients who find themselves telling the same story again and again and having to repeat themselves because caregivers cannot see the records that they need to see. That can be frustrating and sometimes very distressing for patients.
I caution the Minister against saying that the single patient record will completely fix that issue, because from a clinical perspective, particularly in certain presentations, hearing the story again from the individual can be helpful for a diagnosis, but the principle is a good one, and it will make things easier for clinicians, particularly if the patient is in an area away from home. Records may be kept in a particular geographical location or hospital, and if someone is away on holiday and they come in, we may not have access to their records. In paediatrics, we often give the parents of children with complex problems letters to carry that have the necessary information in them. That would not be necessary if the record were more accessible, so there are benefits to the single patient record.
There are, however, a lot of questions about it. One problem is that the single patient record has not really been designed yet, so we are being asked to approve something that is a hazy vision in the distance. On 1 June, the Minister said that
“although the Bill establishes the legal framework for the SPR, much of the detail will be in secondary legislation.”—[Official Report, 1 June 2026; Vol. 786, c. 957.]
I appreciate that it will be subject to the affirmative procedure, but we are being asked to make a decision now on something that is unfortunately very woolly.
Will the Minister reassure us that she will address the following questions in the secondary legislation? Who will have permission to edit the information in the single patient record? When will they have access to it? Will it tell us who has edited it—will there be a record of who, when and where? If the record is not accurate when it is edited, how will that be addressed? How will people know that it is inaccurate, and how will it be improved? In 2025, Healthwatch reported that 23% of adults who had seen their medical records reported inaccuracies or missing details, 12% said they had been refused treatment because of inaccurate information, and 10% said they had received inappropriate medication as a result. This is important. In recent years, there have been several incidents of patients dying after doctors used incorrect medical histories and prescribed medication that they should not have. This information needs to be available, but also accurate. I am interested in what the Minister has to say about that.
The other question is: what is going to happen to the records people have now? I am 48. I am sure the Minister is much younger than that, but we have records: our vaccination records, our childhood records, and records of any admissions or treatment we have had. Will those be added to the single patient record, or will the SPR start from day zero and go forwards? If it does, how will people access their historical records? If it goes backwards, what provision has been made to ensure that the data that is input is accurate, and for the cost and personnel required to do it?
Is the intention that the SPR will be one-size-fits-all? The Secretary of State talked about people not being asked to have a one-size-fits-all but being able to access the various systems around the country, but there are so many different systems. In my own practice, if I want to look at the notes of somebody I am caring for, I go to Evolve, where the notes are scanned in and I can look at the pages one at a time. If I want to look at blood results, I go to ICE, which is a different system where I can see the test results. If I want to look at the films of an X-ray, they are on a different computer system again. If I want to follow the patient’s pathway through the hospital, see when their next appointment is with me or see who is next in my clinic, I go on to e-Track. There is a different system for maternity, and there is Symphony in A&E.
Each hospital trust has a lot of different computer systems and information, and they do not all use the same systems, as I know having rotated through a number of hospitals during my training. How will the single patient record work with that? Will people be able to access all those different systems, and will they need to be trained to use them, or will there be a homogeneous system—and if so, what does the Minister envisage that looking like?
The Government say the single patient record will be more efficient, reduce the number of A&E attendances and hospital admissions, and make £20 million in annual savings to the NHS. Those are quite small margins compared with the scale of the project. Is the Minister satisfied that the savings will not be obliterated by the cost of the project running away?
The other thing is the public view of this. Polling published in January 2025 by the Tony Blair Institute found that 69% of people are willing for their anonymised data to be used to help plan NHS delivery, 71% are willing for it to be used for research into drugs and new treatments, and 75% are willing for it to be used for speeding up and making better diagnoses. There is an amendment—amendment 11—that make data available only for patient care, but patient audit and research can be quite important. Does the Minister have any comments on how audits and patient research might be used in a clinical context to improve care using anonymised or non-anonymised data?
Proposed new section 250E(3) of the National Health Service Act 2006 says:
“The regulations may provide that the processing of information in accordance with the regulations does not breach any obligation of confidence owed by the person processing the information.”
As one of my hon. Friends said earlier this afternoon, if the Government put a clause into a Bill, they normally have a reason for wanting to use it. Can the Minister expand on the circumstances in which they might want, in essence, to bypass patient confidentiality in pursuit of that provision?
In addition, the regulations may make information
“available to people involved in the provision to patients of health care or social care anywhere in the British Islands,”
which means it will not all be provided in England, and it will not necessarily all be provided within the United Kingdom. Will there be reciprocal arrangements with the self-governing territories? If not, how will the Government ensure that the data is properly protected once it has been shared?
I also want to mention cyber-security. On 30 June—just earlier this week—it was reported that the UK healthcare sector experienced a tenfold increase in attacks during January to May 2026 compared with the whole of 2025, recording 264,000 individual events compared with just 27,000 in 2025. In June 2026, Bedfordshire hospitals NHS foundation trust revealed that data relating to 33,000 hospital patients was stolen and shared online two years ago. Mid and South Essex NHS foundation trust reported the theft of 2,380 records in the same attack. The Secretary of State said earlier in June that
“the situation with the single patient record is…different from that of the federated data platform, because it is likely that we will let a series of contracts to de-risk the delivery of the single patient record.”—[Official Report, 1 June 2026; Vol. 786, c. 891.]
That suggests that the Government are aware of the problem but have not yet nailed down the detail of how to contract the delivery of the single patient record or worked out how they are going to keep data safe once they have. How can patients have confidence when their health data—their most personal data—is on the line and the Government have not yet made the key decisions for protecting it? Does the Minister have any comments on that?
What will happen to private providers? The Government are increasingly using private healthcare providers to try to improve the waiting lists, but will they have access to the single patient record? If they will, will they have to contribute to it financially or get it for free? How will the data be protected if it is not in NHS hands and not necessarily under the same regulation? What plans do the Government have to monetise the data? In December 2025, the then Under-Secretary of State for Health, Innovation and Safety, the hon. Member for Glasgow South West (Dr Ahmed), was reported in the Financial Times as having said that the UK should make money from patient data for the
“benefit of the Treasury coffers”.
Can the Minister expand on her Department’s plans to monetise patient data? Can she guarantee that personal data will not be exposed or leaked?
Can the Minister give assurances that the tendering process for contracts to set up and run the single patient record will be fair and transparent? It has been said that companies that donated to Labour before the general election were awarded contracts worth almost £138 million during this Government’s first year. It has also been reported that Peter Mandelson had links to Palantir, which secured a £240 million deal with the Ministry of Defence. It is important that people have confidence in the contracts. Does the first person to get a contract get locked in? Once the system is set up with one provider, will it be prohibitively difficult to change provider? Will the contracts become more and more expensive as time goes on because of the difficulties in redesigning a system? Who will own the intellectual property of the system that is designed? Will it be the Government or the private company? If it is the private company, how will that work going forwards?
The other question is: can we trust this Labour Government to deliver this? In 2005, the previous Labour Government launched a digitisation project called the NHS national programme for IT. In 2007, the Public Accounts Committee found that the Government had not sought to keep a detailed record of expenditure and there was no evidence that officials had carried out an examination to see whether the benefits exceeded the cost. The Father of the House, my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), described the project as
“one of the biggest IT disasters of all time”.
Costs ballooned to more than £9 billion, leading a member of the PAC to say in 2013 that it was one of the
“worst and most expensive contracting fiascos”
in the history of the public sector. How will the Minister convince the House and the public that the contract is being provided fairly, that it will be useful, that it will deliver what it said it would at the prices it said it would, that the data will be held securely once it is delivered, and that provisions will be in place to record access, decide who gets access and limit access?
Who gets access to sexual health records is particularly important. At the moment, sexual health records are kept separate. If someone attends a sexual health clinic specifically for sexual health screening, those records do not appear in their general medical record, in order not to disincentivise people from attending those sorts of appointments. If everything will be in one single patient care record, will sexual health records appear within that record? That is an important issue; indeed, it was raised during the Committee’s evidence sessions, when it seemed that the Government had not yet made a decision.
Dave Robertson (Lichfield) (Lab)
As ever, it is a pleasure to see you in the Chair, Ms Lewell. I have listened very carefully to people’s speeches, and it is important to say that we are debating that clause 47 stand part of the Bill. The clause creates the single patient record and, while many Opposition Members have justifiably and understandably asked how we will do this right and what safeguards we will have, it is important that what we are debating is that the clause stand part of the Bill.
The clause creates the single patient record, and it creates the overarching ability for the NHS to use data better than it currently does. I am not a data scientist. I am a physicist by training, and I taught physics and worked in trade unions for a long time. Because of my training and my use of data, every group of people I have ever worked with invariably came up with nicknames for me, which usually boil down to “Data Dave”. There is something so valuable about being able to use aggregated values to tell us something that we do not already know.
One of the most valuable things we may get from this is that, when a clinician talks to a patient and they say or present something that does not match what is on the single patient record, it will raise a red flag that leads the clinician to realise something they would not have realised if they did not have access to notes previously taken elsewhere. I genuinely think that is one of the most valuable things that will come from this.
On a wider stage, the ability to aggregate data and properly track what is going on within the health service, and for people to be able to track what is going on with their care, with a wider view of what is going on, will be so valuable to clinicians and wider afield.
Dr Johnson
I am interested in what the hon. Gentleman is saying. Does he agree that, in many ways, the NHS dataset will be one of the most valuable datasets in the world, not only to patients themselves—in terms of the value to them and their privacy—but in the ability to analyse it and perhaps understand parts of medicine that we do not understand at the moment and so improve patient care?
Dave Robertson
I am not entirely certain that I want to agree with “one of” the most valuable datasets in the world; I think it could potentially be the most valuable dataset in the world.
We know that the NHS is the largest healthcare provider in the world. We know that the data is potentially very valuable. Creating this will allow our NHS to be at the forefront of managing how it works, in a way that no other health system will be able to, and certainly to a scale that no other health system anywhere in the world will be able to. That obviously comes with risks.
I have been listening carefully, and it is important that we tease out those risks and make sure that we stay as red hot as we can on all the issues that hon. Members have raised. I go back to the salient point of whether this clause should stand part. I fully support that this measure should be part of the Bill and that we should be moving in this direction.
I have spoken about the more global ideas and the reasons why, intellectually, I think this is a good idea, but let me take an example from my home county of Staffordshire up in the west midlands. There are reports that one hospital in Staffordshire uses 450 different electronic systems, which is absolutely bananas.
For so long, we have not had a single patient record. We have not had one unifying system. Over a cup of tea with the Minister a couple of days ago, I got very excited and started talking about primary keys because, although I am not a data scientist, I like the use of data. I do not think we need to get into a situation where there is a single primary key that is instantly recognisable to everybody and where we are necessarily using some machine learning to assess that. That could potentially come later down the line. That is not what the clause is doing, and it would need a much wider discussion than we are currently having.
If we take the example of Staffordshire and its 450 different data systems in one hospital—I do not know that number for certain, although it has been reported to me by two or three colleagues—I cannot imagine the difficulties that the IT team has in trying to get that number of systems to talk to each other. It will be nigh on impossible. All it leads to is delays. All it leads to is people having to reproduce data from one system to another manually. By creating an overarching single patient record, we will force it to happen.
Sojan Joseph
It really surprised me to hear my hon. Friend talk about his experience of 450 systems in the computer system in his local hospital. I was shocked, because as a clinician who previously worked in the NHS, I wanted a system that made patient records readily available so that we could care for patients.
My understanding is that the clause amends the National Health Service Act 2006 to enable the Secretary of State to make regulations to establish a system to make patient information readily available to patients and to those involved in providing health or social care in England. Under the current system, care and treatment across different parts of the NHS are not as co-ordinated as they could and should be. All too often, that means that patients have to repeat their medical history every time they see a different medical professional. The shadow Minister, the hon. Member for Sleaford and North Hykeham, talked about how that can sometimes be useful for getting the diagnosis right, but it can be very traumatising for someone to have to explain the same story again in such a short period of time.
Speaking in the Chamber, I previously gave the example of a mental health patient going to A&E on a Friday. They tell their story to the professionals there and they tell the same story later when a mental health professional comes to see them. When they are admitted into a mental health hospital, they have to explain the same story when going into the ward, and then again to the nurses. Having to repeat their story again and again is traumatising for most patients.
Dr Johnson
My point was that this can sometimes be beneficial. If a clinician sees a young lady who has collapsed at school, she might have fainted or had a fit. There are a lot of different potential causes, such as cardiac syncope, and lots of different potential diagnoses. A lot of the detail in making the diagnosis is in the history. The patient will probably already have been asked their story when they arrived at A&E, but it is still important for a senior clinician to ask for it again.
My caution was against presuming that we can, in all cases, prevent repeated asking of questions. There would clearly be a benefit when there are particularly sensitive pieces of information, about which we need not ask two, three or four times, but we cannot stop all cases in which a patient is asked for the same story.
Sojan Joseph
Absolutely; a single patient record will not stop professionals from asking the necessary questions of patients at any time. Each ward round, the doctors ask the patients how they are feeling. They will have that conversation; that will not stop. We are talking about repeatedly having to tell the story.
The point was highlighted when the Committee heard from Jacob Lant, the chief executive officer of National Voices, a coalition of health and social care charities. In his 15 years of patient and public engagement, the most consistent theme is patients’ frustration at constantly having to retell their story, and the fact that medical notes are not available across different healthcare settings. Not only is that frustrating for patients, but it can also be deeply distressing. Kath Abrahams, the chief executive of Tommy’s, told the Committee that
“Women report constantly having to retell their story—highly sensitive or traumatic experiences of loss—and that repetition can happen across the early pregnancy unit and maternity services.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 66, Q108.]
As medical professionals, we are taught the importance of empathy and understanding, but if the absence of a unified patient record system is aggravating traumatic experiences for patients, we need to address that. The absence of a national unified report can also compromise patient safety and lead to clinicians making decisions based on partial or incomplete information, significantly increasing the risk of error.
We heard evidence of that from the chair of Healthwatch England, who highlighted the risk posed to patients with multiple comorbidities. He said:
“Without a single patient record, we can find that a consultant or a GP has access to only one part of that multiple comorbidity…That can lead to all sorts of unforeseen errors.”
That can result in poor health outcomes, increased hospital admissions and reduced patient trust, which is why he went on to speak about
“the great advantage that we can get from a single patient record.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 49, Q79.]
Experienced mental health patients often move between A&E, GPs and mental health services and have to repeatedly go through that traumatic experience.
I have spoken in the House previously about my deep frustration that the digital records available to me in mental health services in Kent and Medway were incompatible with those used in other parts of the NHS, both locally and across the rest of England. I know that that frustration is shared, so in advance of the Committee’s consideration of clause 47 I spoke to some of my former colleagues, as well as other healthcare professionals in my constituency, to find out what systems are used to record patient information.
Sojan Joseph
My patient record is currently kept by different organisations or providers, which cannot see each other. If I speak to the GP about my blood sugar and then end up in A&E, they cannot see that record. If I go to the mental health service, they cannot see what medication I was taking. When I get discharged back to the GP, he will not get the information on my medication. That is the clinical aspect I am talking about, although I fully understand the hon. Gentleman’s concern. I hope the Minister will address some of those issues.
The responses I collected demonstrate how disparate and fragmented digital record systems are within just one local area. I do not think any of our constituents are aware that their data is kept in different places and that the services do not talk to each other. That is what the Bill is trying to address. All that information will be available for doctors, nurses and any other healthcare providers so that they can see patients’ history and medication and those patients will be more safe. Things will be more transparent. It will be easier for admission to discharge processes.
Dr Johnson
There is no detail in the Bill. As my hon. Friend the Member for Isle of Wight East said, there is nothing in the legislation requiring the computers in his local area to talk to the computers in my local area.
Sojan Joseph
I hope that would be the outcome of this legislation. I will give an example. My constituency is very close to Dover. Lots of travellers go through Ashford, my constituency. We often get patients from Scotland, Manchester or Liverpool, for whom doctors cannot start a treatment because they have to wait 24 hours to 48 hours to get the information from the hospital where the person comes from. I am not saying that the story is the same across the country, but that is what we are experiencing.
Dr Johnson
In the event that someone from Scotland comes into the hon. Gentleman’s hospital near Dover and a doctor wants to look at their healthcare record, does the hon. Gentleman envisage that the doctor will log on to their local system and see the records from Scotland, or that they will have access to the Scottish system to look at the records directly there?
Sojan Joseph
I do not know whether there will be the same system in Scotland, but my understanding is that in the north of England doctors will be able to see the same system. Again, we can hear more detail from the Minister.
A single patient report has the potential to transform patient experience and safety by ensuring continuity of care, by reducing unnecessary repetition, by enabling better informed clinical decisions and the smoother discharge of patients, and by creating a more efficient and joined up healthcare system.
Gregory Stafford
I thank all those who have spoken so far in this debate. I have never seen the hon. Member for Lichfield so animated—Data Dave is clearly alive and well.
As we have discussed, the clause creates the legal power for a single patient record in the UK. It is important to say, as others have, that the Bill does not create the system but gives the Secretary of State the power to create it later through regulation. That does not mean, however, that we should not have a debate about some of the issues that we have raised.
I should state at the start that I support better information sharing when that helps patients receive safer and better care, and I think that the single patient record could well do that. Anyone who has worked in healthcare, as I have, knows the frustration that results from the records not following patients between services. Clinicians can lose valuable time in searching for information, if they can get it at all. As others have said, patients are often asked to repeat the same details over and again—not, as my hon. Friend the Member for Isle of Wight East rightly said, because it gives a richer experience but simply because people do not have the information. Better joined up records have the potential to improve care.
We have, however, been here before. I was a lot younger—we all were—but back in 2002, the national programme for IT, under the last Labour Government, was a £10 billion unmitigated disaster, which the Public Accounts Committee described as
“one of the worst and most expensive contracting fiascos in the history of the public sector.”
I want to make sure that there are safeguards, from both a contracting and a data safety point of view, so that we do not go down that route again. As my hon. Friend the Member for Isle of Wight East clearly outlined, creating such a record is fiendishly complicated from both a technology and patient information point of view and from a data sharing and data protection point of view.
The record could contain some of the most sensitive information about people, so Parliament has the responsibility to make sure that the legal framework is right. We also know that the record will work only if the data in the single patient record is worth the electronic paper that it is electronically printed on. As I am sure the Minister knows from her time in the NHS, the information is getting better but continues to be patchy across the country. Different trusts and organisations record things in different ways. I take my hat off to those who work in clinical coding, as they do one of the most difficult jobs in a trust. Again, we need to make sure that the data is accurate. Someone mentioned AI earlier; I think AI could help with that, but we are still some way off.
I want to canter through my concerns about the breadth of the powers being given under the clause. The Bill allows the Secretary of State to make regulations establishing the system and to decide how it operates. Those regulations may require or authorise the sharing and processing of patient information, decide who can access the information and create enforcement powers and financial penalties. Some of those important questions are not answered in the Bill. Parliament is being asked to approve a broad framework before seeing some of the detail.
My second concern is that the Bill says little about patient choice. There is no clear statement about whether patients will have the right to opt in or out and no explanation of whether patients can restrict access to all or part of their records. There is no mention of whether someone could choose to limit access to particularly sensitive information, such as mental health records, sexual health information or information about substance dependence. There are major questions for public trust but those are left, I would say, entirely to future regulations. We need clarity about them now.
My third concern is the scope of the information that may be included. The definition of “patient information” is extraordinarily broad. It covers information about physical health, mental health, diagnosis, treatment and care, including social care. The definition of “patient” includes people receiving social care or having their care needs assessed. What we do not know from the Bill is exactly how that data will be presented. Will it use language that a patient can understand? Will it talk about having a heart attack, or will it use medical information that a medical professional will need to assess? Or will it include both, so that the patient knows that they have had a heart attack, for example, but the medic can see the precise detail on what sort of transient ischaemic attack it was. We need to understand what the data is recording and at what level of detail.
Dr Johnson
If it is to include both, who will translate it into the simplest form and how much will that cost?
Gregory Stafford
Precisely. These questions need to be thought about when the Government are creating this system.
As hon. Members have described in their speeches and in their amendments, the system could contain much wider information, including highly sensitive information about disability, safeguarding, care assessments, addiction, pregnancy, military service, caring responsibilities and many other personal matters. This is not simply about a hospital record; it is about bringing together health and social care information. That makes it even more important—indeed, essential—that safeguards be clear and robust.
That leads me on to my fourth issue, which is confidentiality. The Bill says that where information is processed under the regulations, doing so will not breach any duty of confidence. I think that that is a significant legal challenge and change. Confidentiality has been one of the foundations of healthcare. Of course there are already situations in which information can and should be shared, but where Parliament is creating a new legal basis for disclosure, it is reasonable to expect strong safeguards alongside it.
That brings me to my next concern. The Bill says that the Secretary of State must have regard to the need for “adequate safeguards”. That is welcome, of course, but the Bill does not say what those safeguards are. There is nothing in it about role-based access controls, audit logs or whether patients would be able to see who had looked at their records. There is nothing about minimum cyber-security standards, about how inappropriate access will be detected or about independent oversight. Those matters may appear later in regulations or in guidance, but they are not guaranteed in the Bill.
Dr Johnson
The clause says that information could be made available
“to people involved in the provision to patients of health care or social care anywhere in the British Islands”.
That implies that the English system will be used to share information with people outside England—in the Isle of Man, the Channel Islands, Scotland, Wales or Northern Ireland—but it does not imply that those areas will necessarily have the same systems to share information with us.
Gregory Stafford
That is an interesting question. I do not know the answer, but perhaps the Minister can pick that up.
The Bill also creates powers for financial penalties. It sets out a process for notices and opportunities to make representations and a right of appeal. Those procedural protections are sensible, but the Bill does not tell us who might be fined or what conduct would trigger a penalty, and it does not set out a maximum penalty level. Those decisions, again, are left to regulations.
It is also important to remember that the Bill does not replace existing data protection law, as I think the Minister outlined in her opening remarks. Organisations will still have to comply with the Data Protection Act and other UK data protection rules. However, the Bill would provide a new statutory basis for processing information through the single patient record. That makes the wording of the Bill especially important. Ultimately, public confidence will determine whether the system succeeds. People are generally willing for information to be shared when it improves their care, but they also expect transparency, security and accountability and expect to know who can see their information and why. Those expectations are entirely reasonable.
There are several questions that I believe the Committee should ask before these powers are granted. Will patients have a genuine choice about participation? Will they be able to restrict access to particularly sensitive parts of their records? Who exactly will be able to access the system? Will patients be able to see a record of who has viewed their information? What minimum standards will apply? How will misuse be identified and punished? What independent oversight will exist? Those are not technical details; they are central to public confidence.
In conclusion, the clause will create a legal framework rather than a system itself. It will give broad powers to establish the single patient record while leaving many of the most important questions to future regulations. Clearly most people support the goal of improving patient care, but because the system will involve some of the most personal information that people have, Parliament should ensure that patient rights, safeguards, transparency and accountability are clearly built into the framework from the beginning. It should ensure that questions are asked now rather than decided on later.
Karin Smyth
Clauses 49 and 50 explain our approach to the transfer of NHS England’s existing data and information functions to the Secretary of State. Slightly counterintuitively, I will start with clause 50 before turning to clause 49.
Clause 50 inserts schedule 7, which takes existing NHS England information functions and transfers them to the Secretary of State for Health and Social Care, as part of a single centre for data and digital policy in the NHS. The schedule also includes changes to existing information functions. This will support the shift from analogue to digital and allow us to make the most of opportunities from data and AI, as set out in the 10-year health plan. The changes will not weaken the fundamental safeguards in place to protect health and care data, nor fundamentally change rules relating to how confidential patient information can be used.
I will now outline some key changes made by the clause. It will ensure that information systems for the NHS are set up, where appropriate, not just for the collection and analysis of data but for processing more generally. This will make it easier to support machine learning and artificial intelligence activities, among other uses of data.
The clause extends the extent of chapter 2 of part 9 of the Health and Social Care Act 2012 to the whole of the UK, and provides for the Secretary of State to establish information systems in the interests of the health service or adult social care in England, or in connection with the provision of care across the British Isles, as NHS England currently can.
The clause enables the Secretary of State to issue guidance to health and social care bodies on the processing of information. It transfers to the Secretary of State NHS England’s powers to require and request information, and such requests will be able specify the form, manner and time within which the information requested is to be provided.
The clause also allows the Secretary of State to publish information obtained in the operation of an information system, including information about service providers. Where NHS England had a duty to publish such information, it is right that the Secretary of State should retain discretion in that regard. Obviously, there may be circumstances in which the publication of data would not be appropriate, and the clause does not give the Secretary of State complete freedom to publish personal information. The Secretary of State may publish personal information without patient consent only where it is for the protection of life or health, or for the protection of public safety or security. It is possible that there could be circumstances—for example, in relation to infectious disease—in which information is published that could lead to an individual being identified. None the less, the change simplifies the process of publication while maintaining a high bar for the publication of personal information.
The Secretary of State’s power to disclose information—for example, to health bodies—other than by publication will be slightly different from NHS England’s current power. The grounds for disclosing personal information will largely mirror the current grounds, with a few additions, including in respect of facilitating clinical trials or other research. This will help to address barriers to data access for research while preserving existing rules on confidentiality. As with his powers of publication, the Secretary of State will also be able to disclose information for the protection of life or health, or for the protection of public safety or security.
The Secretary of State will be bound by certain existing duties on NHS England, including a duty to have regard to any relevant advice from the Confidentiality Advisory Group when publishing or disclosing information in accordance with his data functions. The Secretary of State will retain the regulation-making power to establish an accreditation scheme for information service providers, which will now include a broader range of providers, including public bodies.
Clause 49 permits the Secretary of State to delegate certain functions relating to health and care information. Currently, some of those functions can be delegated by NHSE via arrangements with third parties or under regulations. The clause will insert new section 251ZF, which allows the Secretary of State, by arrangement, to delegate to persons specified in regulations functions relating to information standards.
Information standards help to reduce fragmentation in digital and data services. They include mandatory requirements for how information is recorded, shared, governed and supported by IT. Increasing interoperability and consistency in digital and data is essential to increasing value for money, reducing the burden on staff and, ultimately, improving the quality of care. The continued use of information standards is key to the 10-year health plan’s aim of improving the interoperability of digital and data services across the health and care system. This will provide the Secretary of State with the flexibility to delegate such functions to persons who have the required technical expertise, where necessary.
Clause 49 will also insert new section 277G, which enables the Secretary of State to direct public bodies to exercise a wider range of his information functions, defined as “relevant information functions”. This includes not only information standards but other information functions, such as the Secretary of State’s duty to establish and operate information systems. The measures will provide the Secretary of State with important flexibility to delegate such functions to persons who have the required technical expertise, where necessary.
In all, the changes are necessary not just to effect the transfer of data functions to the Secretary of State but to enable better data use for the benefit of the NHS now and into the future.
Dr Johnson
I have a couple of questions. In lots of ways the provisions derive from clause 1 and the abolition of NHS England. Schedule 7 refers to operating a system in the interests of the health service, which is not the same as operating it in the interests of the patients. Does the Minister have any comments on that? The Nuffield Trust has pointed out that schedule 7 would not pass over to the Secretary of State NHSE’s duty to report to Parliament. Is that because the Minister thinks that duty is duplicated elsewhere and is therefore not necessary?
Under the previous legislation, the Care Quality Commission was slightly stronger and could make a mandatory request that NHS England establish a system, and NHS England had to comply with that unless it related to an existing exception. Now if the CQC makes a request, it goes to the Secretary of State, and whether it is agreed to is then somewhat more optional. Will the Minister say why she needs to change that power?
Helen Morgan
I want to speak to amendment 6, which is tabled in my name, and amendment 7, which is consequential upon it. Amendment 6 would ensure that the CQC and NICE can
“continue to make mandatory requests to the Secretary of State to establish an information system”,
as they currently can with NHS England. At the moment, NHS England has a duty to co-operate with the CQC and NICE, and that is often enough for a collaborative approach that allows the CQC to access the data it needs.
But the duty that applies to NHS England is not being passed on to the Department of Health and Social Care. The CQC raised the issue in written evidence to the Committee, saying that the duty
“has been an important mechanism”
that has
“supported receipt of patient safety incident reports…information sharing between regional teams, and the development of central data sharing solutions.”
The CQC went on:
“Without an equivalent duty, we would be reliant on there being sufficient capacity and willingness within DHSC to share information, with no statutory backstop. This could inhibit our ability to receive the information”
needed
“to keep people who use services safe. Challenges in this area are often cultural and rely on the subjective judgment of individual data controllers as to whether particular data sets can be shared, how these should be used and what the timeliness of sharing should be, leading to protracted piecemeal conversations and delays.”
As we have harrowingly heard over the past week, there is often reluctance to share data, particularly when there is a defensive culture in certain NHS institutions. Our amendment seeks to address the gap. I hope that what I have outlined is an oversight from the Government, not a deliberate attempt to reduce transparency or reduce regulator access to key data. The wider changes in schedule 11 will omit section 288 of the Health and Social Care Act 2012. The Government are dropping this key wider duty in a schedule entitled “Minor and consequential amendments”. We do not think it is minor. It holds major implications for patient safety and transparency.
On a wider note, it seems counterintuitive that the CQC, as regulator, does not have easy access to the data collected nationally in the health service.
Health Bill (Ninth sitting)
Caroline Johnson ExcerptsTuesday 30th June 2026
(2 months, 2 weeks ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 30 June 2026 - (30 Jun 2026)
The Minister for Secondary Care (Karin Smyth)
I will start where I left off. Clause 34 addresses the gap by making it clear where responsibility sits, so that there is no doubt about who must produce the final accounts and ensure that they are completed properly, and about how those accounts should be audited. We think this is a proportionate provision to ensure continuity and clarity on how NHS money has been managed during organisational transition. I commend the clauses to the Committee.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Clause 31 introduces schedule 4, which essentially makes series of amendments to other Acts. It amends the Public Finance and Accountability (Scotland) Act 2000 to remove a cross-reference to other categories, and it amends the Audit and Accountability (Northern Ireland) Order 2003 and the Public Audit (Wales) Act 2004 for similar purposes. It also amends the National Health Service Act 2006 by deleting section 62 and schedule 10, relating to the audit of accounts of NHS foundation trusts, to end the old audit scheme.
Schedule 4 amends section 3 of the Local Audit and Accountability Act 2014 so that foundation trusts are now included in the list of bodies that must keep accounts in the standard way, it amends section 4 to specify which documents count as accounts of foundation trusts for the purpose of auditing, and it amends sections 8 and 10 so that the auditor appointment procedure and the auditor panel’s role now cover foundation trusts.
In addition, schedule 4 rewrites section 13 of the 2014 Act so that if a trust fails to appoint a local auditor, it is the Secretary of State’s job to step in. Previously, that was NHS England’s job; clearly, that needs to change, because NHS England is being abolished. The schedule also amends section 21 so that the auditors’ general duties now apply to foundation trusts too, and it amends section 30, relating to unlawful expenditure and activity, and section 32B, relating to the independence requirement, to remove a now-redundant item from the list.
Schedule 4 also amends schedule 2 to the 2014 Act to formally add foundation trusts to the official list of audited bodies; schedule 5 so that the rules on who can be a local auditor now cover foundation trusts too; schedule 6 to remove an outdated segment from the audit practice code rules; schedule 7 to tidy the reporting rules and extend them to foundation trusts; schedule 9 to realign data matching rules that apply to foundation trusts in the new system; and schedule 11, relating to the disclosure of information, to remove a reference to NHS England, which is no longer necessary because NHS England is being abolished. In general, clause 31 aligns the audit process for accounts of foundation trusts with those of standard trusts and integrated care boards.
Clause 32 removes the need for NHS England to maintain a register of foundation trusts and the fees associated with maintaining it. Section 39 of the NHS Act 2006 requires NHS England to maintain a current register of NHS foundation trusts and specifies what must be in that register. Section 50 states that an NHS foundation trust must pay NHS England a fee that NHS England may determine in respect of exercising its functions under section 39, which relates to keeping the register, and section 39A, relating to a panel for advising governors. Clause 32 deletes sections 39 and 50. The explanatory notes say that the requirement to maintain a register does not need to be transferred to the Secretary of State when NHS England is abolished because, the Government argue, the information will already be available centrally, and there is no need for a fee to keep that in place. That seems sensible to me.
Clause 33 enables the Secretary of State to impose limits on a foundation trust’s annual capital or revenue expenditure. Section 42B of the 2006 Act allows NHS England to make an order imposing a limit on the capital expenditure of a foundation trust in a single year. Section 42C sets out that NHS England must publish guidance about the exercise of its power under section 42B, including about the circumstances in which it is likely to make an order and the method it will use to determine the capital expenditure limit. Clause 33 entirely replaces sections 42B and 42C with rewritten sections, with some notable changes. The wording is changed from “capital expenditure” to “expenditure”. The power is therefore widened from capital expenditure limits to limits on any expenditure—capital and revenue. The Secretary of State replaces NHS England as the entity with the power to impose limits, which makes sense, and the subsection requiring an order to specify the trust, the financial year and so on has been removed in full.
The change gives the Government financial control to stop overspending by NHS foundation trusts. I note that in financial year 2023-24, NHS trusts overspent by £1.2 billion, so presumably this is the Secretary of State getting a tighter grip on spending. In some respects that is sensible, but overspending is often due to staffing costs and day-to-day pressures, not capital expenditure, so there is an argument that the capital limits themselves are not sufficient to deal with the problem. Under the new governance model, the Secretary of State has oversight and responsibility for the health service, and financial control aligns with those changes. The new power could prevent one organisation’s failures from undermining the health service’s wider financial position or impacting other providers.
However, the purpose of foundation trusts is supposed to be that they have greater independence over spending, and the Government have stated that their aim is to create a more devolved and autonomous health system. How does broadening the Secretary of State’s ability to interfere in expenditure devolve power or make foundation trusts more independent? Imposing expenditure limits may control overspending on paper, but it does not address the reasons why it is happening, so limits could lead to a deterioration in the health services delivered by some trusts. What plans does the Minister have to deal with that?
Because the power moves from an arm’s length body to the Secretary of State, interventions could be politically motivated, rather than in the best interests of the NHS. How does the Minister consider that that will be managed?
The power for the Secretary of State to impose expenditure limits at any time during or before the financial year could create uncertainty among trust leadership and undermine long-term planning. If a trust is given a budget for the year, it knows what it has to work with, but if somebody says halfway through the year, “Actually, you are going to have to work with less money than that,” it is very difficult for the board to plan its expenditure, because it is always looking the other way. Why does the Secretary of State need that power? Can the Minister clarify that, if there is a change in the expenditure limit during the year, it will always be revised upwards, and never downwards?
Gregory Stafford (Farnham and Bordon) (Con)
My hon. Friend is making a prescient point. Has she thought about the word “limits”? To me, it is not clear from the clause as drafted—perhaps it is clearer to her—whether that is an overall limit on capital and revenue expenditure, or whether the clause is saying that the Secretary of State could impose limits on individual line items or departments. The word “limits”—plural—suggests that he or she may be able to do that.
Dr Johnson
I do not think the Bill is very clear on that. It says that the Secretary of State
“may by order impose limits on the expenditure that may be incurred by an NHS foundation trust in respect of a single financial year.”
However, it does not say whether that is an overall limit, whether it is for capital or revenue or whether it is a limit on a specific item, so the degree to which the Secretary of State has control is not clear. I presume it is an overall limit and that it is for dealing with budgets, but perhaps the Minister can provide some clarity for my hon. Friend.
Clause 34 requires foundation trusts that have been newly authorised, or that have recently acquired another trust or another foundation trust, to prepare the final accounts for their predecessor trust or foundation trust. It does that by modifying section 36 of the NHS Act 2006 to add new provisions that require foundation trusts to prepare accounts for the final period for which they were an NHS trust, establish that part of schedule 7 and part of the Local Audit and Accountability Act 2014 apply in relation to those accounts, and define the final accounting period. It does the same for section 56AA of the 2006 Act.
Karin Smyth
During the process of producing our 10-year plan, we were clear that, as much as we will reward the best performing providers with new freedoms to innovate, we will not hesitate to act on poor performance, and this group of measures deal with just that: action in the event of a failing provider.
Clause 35 and schedule 5 insert new provisions into the NHS Act 2006 to enable the Secretary of State to, by order, convert a failing foundation trust to an NHS trust. This is intended to take place only in the most critical circumstances, and where it is in the public’s best interest for the Secretary of State to be able to direct the trust about how it should exercise its functions, to address safety or other issues at the trust. Foundation trust status should be a mark of good performance, and there must be a mechanism to remove it when performance is seriously deficient. This deauthorisation power will help to maintain the integrity of the reinvigorated foundation trust status and provide an additional incentive for challenged foundation trusts to improve.
The power to make a conversion order can be used where the foundation trust has failed to comply with a condition of its provider licence or with another legislative requirement. In deciding whether to make a conversion order, the Secretary of State must consider various factors, including the seriousness of the failure, the health and safety of patients, the quality of the provision by the trust of goods and services, the financial position of the trust, and the way the trust is being run.
The conversion power is also subject to two additional requirements. First, the Secretary of State must publish guidance about the matters they will consider in deciding whether to exercise the conversion power, including the factors I just outlined. They must consult on any such guidance before its publication. Secondly, where the Secretary of State proposes to use the power, they must first consult the foundation trust in question, any integrated care boards in the areas in which the trust operates, and any other person to whom the trust provides goods and services, and whom the Secretary of State considers it appropriate to consult.
Clause 35, together with schedule 5, also inserts new schedule 9A into the NHS Act 2006, which sets out the immediate consequences of a conversion order. Deauthorising a foundation trust has no impact on the property it holds, the contracts it has with commissioners and other groups, or the terms of employment of employees. These powers set clear organisational consequences for significant underperformance and allow the Secretary of State the freedom to take action to protect patients in extreme circumstances.
Clause 36 contains another critical power to allow action in the case of a failing foundation trust. It allows the Secretary of State to add conditions to an NHS foundation trust’s provider licence where they consider that the trust will breach its licence conditions due to issues with its governance. The clause is a consequence of abolishing NHS England and makes changes to the powers currently held by NHS England under section 111 of the Health and Social Care Act 2012, to confer them on the Secretary of State, with additional consequential changes reflecting the abolition of councils of governors.
The clause sets clear expectations for a foundation trust through the licence conditions and provides the Secretary of State with a transparent mechanism to take more urgent, targeted enforcement action to address failures of governance. Should the foundation trust breach any conditions imposed via section 111, the Secretary of State may require it to make changes to the executive directors of its board as necessary, including removing or suspending executive directors, replacing executive directors with interims, and preventing the trust from appointing specific individuals. If the foundation trust fails to take those actions, the Secretary of State may implement the changes.
To reassure the Committee, there are clear safeguards underpinning the clause, which can be used only where there is evidence that failures of governance in the foundation trust will cause it to breach the conditions of its licence. Further, acting under section 111 does not preclude the Secretary of State from using their other regulatory powers, including to require the foundation trust to take steps to address a breach of any condition of the licence, or to accept undertakings from the trust to address the breach.
Finally, the section 111 power was originally granted to Monitor in 2012 under transitional arrangements, as it was anticipated that the power could be withdrawn once governors had transitioned into their roles and could hold boards to account without outside intervention. Over 13 years on, that has proven not to be the case. With the abolition of the foundation trust councils of governors, it makes sense to repeal the provisions under sections 112 to 114 of the same Act that made it transitional.
Clause 37 makes changes to the special administration framework to ensure that it continues to function coherently after the abolition of NHS England. The clause makes focused, technical amendments to the Health and Social Care Act 2012 to amend the framework for establishing a mechanism for financial assistance in cases where a provider is subject to a health special administration order under chapter 5 of that Act. It also amends the Act to remove the duty to establish a mechanism for financial assistance to foundation trusts to which a trust special administrator has been appointed. The duty no longer needs to apply to foundation trusts, because the Secretary of State already has the power under provisions in the NHS Act 2006 to provide financial assistance to NHS foundation trusts if needed.
With the abolition of NHS England, the duty to establish a mechanism for financial assistance for independent providers will be retained and conferred on the Secretary of State. It is worth noting that the provisions related to financial assistance in special administration cases, and chapter 5 of the Health and Social Care Act 2012, which sets out the powers and processes for the making of health special administration orders, have not yet been commenced. However, the amendments made by the clause ensure that the special administration regime can operate smoothly if it is ever needed.
The clause does not create new financial support mechanisms, but ensures that existing ones can be used appropriately in the reformed system. In short, clause 37 ensures that the legal framework reflects the new institutional landscape while retaining the ability to act swiftly to safeguard continuity of services during special administration.
Clause 38 makes changes to the trust special administration framework to ensure that it continues to function coherently after the abolition of NHS England. This clause, together with schedule 6, make targeted changes to the trust special administration process set out in the NHS Act 2006 for NHS trusts and NHS foundation trusts as a consequence of the abolition of NHS England. It also aligns more closely the processes between NHS trusts and foundation trusts.
Trust special administration is, and will remain, a last resort mechanism used only in cases of serious failure. It is used to protect patients, stabilise services and put the organisation back on a sustainable footing. Where deemed necessary, a trust special administrator would be appointed to manage the trust and work with relevant key stakeholders to develop recommendations regarding the organisation and its services.
The amendments made by schedule 6 remove functions that currently sit with NHS England and confer the key decision-making functions on the Secretary of State, who will provide clearer lines of accountability and faster decision making when rapid intervention is required. The amendments also simplify the steps involved in the TSA process, with the aim of improving the speed of intervention and providing transparency. They align more closely the processes for trusts and foundation trusts, and set out a simpler process in relation to the administrator’s draft report, consultation and final report. They also require, as is the case now, that key documents and decisions are published and laid before Parliament. That will help ensure proper and meaningful scrutiny of the TSA process and outcomes. It also helps ensure that affected patients, staff and local partners have the opportunity to engage during the process, while maintaining the balance with the need to deliver timely intervention and secure continuity of safe services.
In addition, the amendments in schedule 6 make changes to the role of the Care Quality Commission in trust special administration. The CQC will be able to recommend that a trust special administrator should be appointed. The Secretary of State is also required to consult the CQC before making an order, ensuring that independent expertise on quality and safety informs decisions and that intelligence on service performance is co-ordinated.
The provisions in the Bill ensure that the process remains fit for purpose, proportionate, and aligned across NHS trusts and foundation trusts. They support faster, more coherent decision making in the most serious cases, with the aim of protecting patients and securing sustainable, high-quality services for the future. Taken together, the clauses provide the necessary tools for the Secretary of State to take proportionate, swift and decisive action in the event of provider failure. I therefore commend these clauses to the Committee.
Dr Johnson
Clause 35 essentially establishes the right of the Secretary of State to convert a foundation trust into an NHS trust in certain circumstances. Currently, section 25 of the NHS Act 2006 establishes trusts and introduces schedule 4 of the same Act, which makes provision about NHS trusts. Section 56AA sets out how additional requirements concerning acquisitions of a trust or foundation trust are to work. Clause 35 deletes section 25(2), which specifies that an order in this context is referred to as “an NHS trust order”, and amends subsection (3), so that no order under section 25—previously no “NHS trust order”—can be made until any consultation that has been prescribed is complete.
Clause 35 introduces proposed new section 57B into the 2006 Act, “Conversion of failing NHS foundation trust into NHS trust”, which provides the Secretary of State with the power to convert if the foundation trust breaches its licence or other legal duties. The trigger is broad and includes non-compliance with any statutory requirement. The proposed new section requires an order to specify when it takes effect and also requires the Secretary of State, when deciding to issue an order, to consider among other things
“the seriousness of the failure…the health and safety of patients…the quality of the provision by the trust of goods and services…the financial position of the trust, and…the way that the trust is being run.”
Before making an order, the Secretary of State will be required to consult the trust, any ICB where the trust has facilities and
“any other person to whom the trust provides goods or services…whom the Secretary of State considers it appropriate to consult.”
The proposed new section also provides the Secretary of State with the power, when the conversion order is made, to
“terminate the appointment of the chair or any executive or non-executive director”,
and to
“appoint a person to be the chair or an executive or non-executive director”.
It also time-limits the powers to intervene with management to one year after the order is made.
Clause 35 also introduces proposed new section 57C into the 2006 Act, “Guidance about conversion”, which requires the Secretary of State to publish guidance about matters to be considered when deciding to make an order and requires them to consult persons considered appropriate before publishing or revising guidance. The clause removes “NHS trust order” from section 276 of the 2006 Act, “Index of defined expressions”, and updates schedule 4, so that an NHS trust may be established by an ordinary order under section 25 or a conversion order under proposed new section 57B.
Schedule 5 to the Bill inserts proposed new schedule 9A to the 2006 Act, “Conversion of failing NHS foundation trusts”, which provides that, on conversion, the foundation trust’s chair and directors become the initial chair and directors of the new NHS trust, unless they are removed by the Secretary of State under the procedures we have just talked about. The proposed new schedule initially keeps the board the same size, until new arrangements are made. It provides that the foundation trust’s public dividend capital carries over to the NHS trust and that the conversion does not affect continuity of the body —it will remain the same organisation, just with NHS trust status.
The proposed new schedule provides that the trust’s property and liabilities, including criminal liabilities, continue unaffected. It also provides that existing contracts continue and that the trust remains party to them. It clarifies that those contracts do not automatically become NHS contracts under section 9(1) of the 2006 Act, provides that the trust keeps any corporate memberships that it held before the conversion, and clarifies that the continuity provisions do not affect the Secretary of State’s wider powers to make directions.
The Secretary of State will have a direct power to act where the foundation trust has failed—for instance, where there have been patient safety lapses—and there are clear benefits to that. There are also transparency requirements built in: the Secretary of State must publish guidance and consult before issuing guidance or undertaking conversion, and the power to change the management is limited to a year.
However, the last Labour Government said that independence was central to the success of foundation trusts. In 2005, the then Secretary of State, Patricia Hewitt, said:
“We know that independence from central Government control and greater freedoms are giving NHS foundation trusts the opportunity to innovate new approaches to healthcare and healthcare services, for the benefit of NHS patients.”—[Official Report, 7 November 2005; Vol. 439, c. 5WS.]
The challenge with innovations is that, even with the very best intentions and the very best advice, some will work and some will not. If any failure at all is a reason for trusts to be taken over, will that cause them to be shy about innovating, for fear of their independence being undermined as a result? There is a balance to strike, so I wonder whether the Minister will comment on that.
The change also makes it easy for the Secretary of State to convert a foundation trust for political reasons—for instance, because of pressure from local Members of Parliament. That is a positive in some ways and a negative in others. Again, it could have a chilling effect on the very autonomy and innovation that Ministers want to see, so the question is how they think they will balance that.
The Chair
I do not think that the Minister addressed new clause 26, so does she wish to do so now? [Interruption.] She need not worry about it, I am told.
Dr Johnson
Clause 39 broadens the Secretary of State’s ability to delegate or jointly exercise health service functions with NHS bodies and local government. Currently, section 7A of the National Health Service Act 2006 enables the Secretary of State to arrange for any of their public health functions to be exercised by relevant bodies, such as NHS England, ICBs and local authorities. Section 65Z5 sets out how relevant bodies may jointly exercise delegated functions, and section 65Z6 sets out how funds may be pooled for such purposes. Section 65Z7 sets out that NHS England may issue guidance for exercising functions under those two sections and that relevant bodies must have regard to any guidance. Section 75 then sets out that the Secretary of State can make regulations to enable NHS bodies and local authorities to enter into arrangements related to the delivery of health functions.
Clause 39 deletes section 7A, removing the separate power for the Secretary of State to delegate public health functions. It amends section 65Z5 to create a wider power that allows the Secretary of State to arrange for any health service-related function in England to be exercised by or jointly with relevant bodies, local authorities, combined authorities, combined county authorities or other prescribed persons. It removes outdated references in section 65Z5 linked to NHS England and updates the wording so that arrangements can be made with a wider range of persons and not just bodies.
Clause 39 also replaces section 65Z6 so that where functions are exercised jointly, the parties can use joint committees and pooled funds. It provides that pooled funds can include payments from relevant bodies and the Secretary of State, and can be used for expenditure connected to jointly exercised functions. It amends section 65Z7 so that guidance on joint working and delegation is issued by the Secretary of State rather than NHS England. It makes consequential amendments to provisions on directors of public health and local authority public health functions, reflecting the removal of section 7A. It also makes consequential amendments to section 75 partnership arrangements and the Local Government Act 1974, again removing references to section 7A.
Once again, it is necessary to move functions to the Secretary of State when NHS England is abolished—somebody else needs to do the work. The changes introduce more flexibility for joined-up working between the Secretary of State and other entities in the health system, which could support integration and the shift to place-based care, with localised approaches to prevention, integration and service planning in line with the Government’s 10-year plan.
However, the power is very broad, relating to any function in the health service. The Secretary of State could arrange for functions to be exercised by or jointly with any person prescribed, which could mean anyone. How will it be possible to determine who is responsible for things that have gone wrong when joint committees are established and funds are pooled? The Minister has spoken a number of times during our sittings about the importance of clear accountability. In the event that the work, funds and activities are pooled, how will it be made clear who is responsible and therefore accountable for the activity that occurs?
Melanie Williams, the then president of the Association of Directors of Adult Social Services, told the Health and Social Care Committee that we spend
“a lot of time debating about who pays, rather than having a conversation about how, in the longer term, we can invest in people’s outcomes to enable better health and wellbeing.”
Is it the Government’s intention to decide the allocation of money for social care and health providers, or that whoever they decide will work together?
The Government have said that this is all about the devolution of power. This morning, we discussed the abolition of integrated care partnerships, on which ICBs and local authorities work together on projects that they choose locally. The Government are now introducing another power that will enable the Secretary of State to direct them to work together on things that he or she chooses. That does not sound terribly like the devolution of power. Could the Minister explain that to me?
I shall leave new clause 26 to the Liberal Democrats. Government new clause 20 ensures that there is a complete list of authorities that may be included. I think some were missing from the first iteration. I just make the point that the more actors there are in the mix, the harder it may be to see who is responsible overall. We also need to discuss how to maintain the balance between clinical need and political priorities in the choice of what healthcare is provided.
Dr Danny Chambers (Winchester) (LD)
New clause 26, tabled by my hon. Friend the Member for Oxford West and Abingdon (Layla Moran) and the hon. Member for Worthing West (Dr Cooper), who both sit on the Health and Social Care Committee, would require the Secretary of State to review the arrangements under section 75 of the National Health Service Act 2006 and consider whether to require NHS bodies and local authorities to enter into new arrangements with one another if that is likely to lead to an improvement in how their functions are exercised.
A recurring theme of Health and Social Care Committee inquiries is the impact of financial flows and how they frustrate attempts to deliver truly integrated care—an issue we discussed in earlier sittings. We all recognise that closer arrangements are needed to properly address discharge delays, which directly lead to corridor care or even unnecessary admissions to hospital. It seems that a consensus has been reached, yet the action to back that up is not there. We feel that, through this Bill, the Government are moving away from closer integration.
Melanie Williams, the then president of the Association of Directors of Adult Social Services, told the Health and Social Care Committee that the NHS and local authorities
“spend a lot of time debating about who pays, rather than having a conversation about how, in the longer term, we can invest in people’s outcomes to enable better health and wellbeing.”
She highlighted concerns about the funding of intermediate care and community health services through aftercare under section 117 of the Mental Health Act 1983 and NHS continuing healthcare.
Section 75 of the 2006 Act provides a legal mechanism for NHS bodies and local authorities to pool budgets and jointly commission health and social care services. The Select Committee has heard evidence of positive examples of such arrangements being used to commission integrated services. It also heard that the use of section 75 arrangements is inconsistent.
In October 2023, the Government launched a call for evidence to explore how section 75 could be better utilised to support integration. A summary of responses published in December 2024 identified several areas for improvement, including the need for stronger inter-organisation relationships, clearer governance and financial structures, and better data sharing. The Health and Social Care Committee recommended that the Government expand the use of section 75, including the range of services that it will be used to support.
This Bill is a missed opportunity for the Government to reform or promote the use of section 75 arrangements, or to provide an alternative mechanism that they believe would be more effective in addressing the challenges that funding flows present to the integration of health and care services. That is why the Select Committee suggested this new clause to prompt a review of section 72 and the introduction of guidance to support pooled budgets and jointly commissioned health and social care services.
Karin Smyth
We know that robust finances are an essential part of the health service. The financial accounts related to the NHS are of keen interest to His Majesty’s Treasury and indeed to Parliament. The Government are especially mindful of the keen interest of the Public Accounts Committee in this area. Under current arrangements, NHS England prepares a set of financial accounts for all NHS trusts and foundation trusts, and that is audited by the National Audit Office. That is the point at which the National Audit Office conducts its oversight of NHS providers, with that feeding into the National Audit Office’s assurance over the Department of Health and Social Care group.
The financial accounts for integrated care boards are currently included in the NHS England group accounts, which are presented separately and audited by the National Audit Office. With the abolition of NHS England, the Government intend to reduce central administration costs, so financial reporting needs to be proportionate while balancing stakeholders’ keen interest in financial information related specifically to the NHS. Clause 40 therefore replaces the current consolidated accounts of NHS providers with a single set of consolidated accounts for the NHS covering its trusts, foundation trusts and integrated care boards. That consolidated account will continue to be audited by the National Audit Office.
We believe that bringing the accounts together in this way will assist the public, Parliament and the National Audit Office in scrutinising NHS expenditure. Although it is not covered by the clause, it is important for the Committee to be aware that there will be no change to the current requirement for the Department to publish a Department of Health and Social Care group annual report and accounts that will consolidate the NHS accounts with the core Department and other group bodies—for example, its arm’s length bodies.
However, the Government recognise that only reporting figures for the NHS in the overall Department group would reduce transparency compared with the current structure of NHS financial accounts. The clause therefore seeks to prioritise high quality audited financial accounts information being made available while balancing against administrative costs, both of which are important to the Government.
Clause 41 amends the Secretary of State’s existing power to create a scheme allowing NHS bodies to pool funds to cover property losses and legal claims arising from their healthcare activities. They ensure that when liabilities arise, whether from damage to property, negligence or other claims, there is a clear and consistent mechanism through which those liabilities can be managed and resolved. In doing so, they protect the financial stability of the NHS. The clause updates the legislation for the new landscape by removing NHS England from the arrangements and ensuring that responsibility for administrating the schemes rests appropriately with the Secretary of State.
Although the clause is targeted and technical, its effect is essential in that it ensures continuity and legal clarity and continued effective operation of arrangements that underpin confidence and functionality across the health service. Clause 42 is a necessary technical and structural change that supports the new statutory framework following the abolition of NHS England. It removes provisions in the NHS Act 2006 and the Health and Care Act 2022 that relate specifically to NHS England’s funding and financial responsibilities, which will no longer be required once NHS England ceases to exist. The clause avoids duplication and confusion and ensures that financial accountability is clearly defined in the post NHS England system. Under the reformed framework, the Department is responsible for the overall funding of the NHS and for national financial assurance, while integrated care boards and providers continue to operate within defined statutory financial duties and controls.
Clause 42 plays an important housekeeping role, providing legal clarity and underpinning a more transparent and coherent financial framework that is fit for the NHS future operating model. I therefore commend the clause to the Committee.
Dr Johnson
Clause 40 prepares for the preparation of the annual accounts of NHS trusts and integrated care boards. Existing legislation in section 65Z4 of the NHS Act 2006, “Consolidated accounts for NHS trusts and NHS foundation trusts”, requires NHS England to prepare a set of accounts every financial year and consolidate the accounts of all the trusts and NHS foundation trusts. The Secretary of State can give directions about the content for methods and principles, and the accounts must be accompanied by reports or other information as directed by the Secretary of State. A copy may be sent by NHS England to the Secretary of State and the Comptroller and Auditor General. The latter must then examine and certify those accounts before sending a copy to the Secretary of State and NHS England, and NHS England must then lay a copy of the consolidated accounts and the Comptroller and Auditor General’s report before Parliament. That is how it works at the moment.
Clause 40 rewrites section 65Z4 and the duty to prepare the consolidated accounts every financial year moves to the Secretary of State, and the list of what gets consolidated now includes the ICB accounts. The power to give directions to NHS England about accounts is removed, which is fair enough because there would be no need for it, as the Secretary of State is now preparing them and NHS England will cease to exist. The requirement for the accounts to be accompanied by such reports or other information as the Secretary of State may direct has been removed. The accounts go straight to the Comptroller and Auditor General, who reports back only to the Secretary of State. At the end, the Secretary of State lays the accounts before Parliament. The changes are necessary owing to the abolition of NHS England.
I want to ask about the consolidation, including the ICB accounts, which was not there before, and what impact that will have. Will the accounts be sufficiently detailed so that it is possible to disaggregate that information if people are interested in doing so?
Clause 41 changes which NHS companies can be covered by the scheme that meets certain losses, legal claims and liabilities. Currently, section 71, “Schemes for meeting losses and liabilities etc of certain health service bodies”, of the NHS Act 2006 enables the Secretary of State to establish schemes to meet the losses of NHS England, ICBs, trusts, the National Institute for Health and Care Excellence, the CQC and several other bodies. The list of bodies includes
“(ha) a company formed under section 223 and wholly or partly owned by the Secretary of State or NHS England”.
In the new legislation, clause 41 rewrites paragraph (ha) so that it is
“a company formed under section 223 other than by an integrated care board by virtue of section 223A”.
That narrows the scope of the liability scheme by preventing ICB-created companies from automatically gaining protection, presumably to encourage ICBs to manage risk responsibly.
Health Bill (Eighth sitting)
Caroline Johnson ExcerptsTuesday 30th June 2026
(2 months, 2 weeks ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 30 June 2026 - (30 Jun 2026)
The Minister for Secondary Care (Karin Smyth)
The clause updates the National Health Service Act 2006 to abolish the requirement for integrated care boards and their partner NHS trusts to prepare and publish a joint forward plan and a joint capital resource use plan. The 10-year health plan aims to simplify local healthcare planning, and the Bill delivers that objective by removing legal requirements for integrated care partnerships, integrated care strategies, joint forward plans and joint capital resource use plans. Planning will now begin with the joint strategic needs assessment, developed by health and wellbeing boards. The assessment will inform a new neighbourhood health plan, replacing the joint local health and wellbeing strategy. ICBs will produce population health improvement plans, aligning multiple joint strategic needs assessments, neighbourhood health plans and local priorities across their wider populations. As a result, the planning process will be streamlined and less bureaucratic, and will deliver healthcare for local people based on local planning and strategy. I commend the clause to the Committee.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
As the Minister said, the clause removes the need for ICBs and their partner trusts to produce a joint forward plan. The existing legislation requires ICBs and their partner trusts to prepare a plan setting out how they propose to exercise their functions over five years, which is reviewed and/or revised each financial year.
Joint forward plans address objectives in the Government mandate regarding the ambitions in the NHS long-term plan and planning guidance. Section 14Z52 of the 2006 Act sets out that an ICB and its partner trusts have to prepare such a plan before the start of each financial year and specifies what the plan must give regard to, including the ICB’s discharge of its duties—general duties and financial duties—under other sections of the Act. The plan must also cover steps that will be taken to implement the local health and wellbeing strategy, the particular needs of young people, and the particular needs of victims of abuse. ICBs and their partner trusts must publish the plan and give it to a set of specified authorities, and NHS England may give directions for that. Section 14Z54 sets out that an ICB and its partner trusts must consult people when developing such plans and that health and wellbeing boards must be involved. Section 14Z55 sets out that the relevant health and wellbeing board may give an opinion, and that when it does so, it must provide it to the ICB and its partner trusts.
Section 14Z56 sets out that an ICB and its partner trusts must prepare a joint capital resource use plan before the start of each financial year, and that the period may be determined by direction from the Secretary of State. Section 14Z57 sets out that an ICB and its partner trusts may revise the joint capital resource use plan, but if it is revised significantly, it must be published and given to the list of specified authorities.
Section 14Z58 sets out that an ICB must produce an annual report on how it has discharged its functions. It must explain how it has discharged its duties under other specified sections of the Act, review the extent to which it has exercised its functions in accordance with the forward plan and its capital resource use plan, review the extent to which it has exercised its functions consistently with NHS England’s views, and review steps it has taken to implement any joint local health and wellbeing strategy. The report must include details of expenditure and be given to NHS England by a specified date and then published.
In essence, the clause deletes sections 14Z52 to 14Z57. In some respects, it is legislative plumbing, to remove plans that are no longer necessary. The Government’s impact assessment notes that
“there is some duplication across planning documents. For example, the Joint Forward Plan covered the integration of services, which the Better Care Fund plan also considers, as does the Joint Local Health and Wellbeing Strategy.”
It goes on to note that duplication delivers an administrative burden, as staff
“complete parallel planning returns and fulfil competing data requests,”
so that is a positive aspect of the clause.
Will the Minister please address the following points? Section 14Z52 contains specific requirements to address the particular needs of young people and of victims of abuse. Where do they fall now? The NHS has a large maintenance backlog. What is the new mechanism for transparency of capital prioritisation decisions between the ICBs and the trusts? Can the Minister remind me and the Committee of other areas in which local democracy will be able to input into ICB planning once these planning documents are no longer required?
Under the Government’s strategic commissioning framework, ICBs have to develop population health improvement plans. Essex ICB published a document that is 148 pages long, with a particular focus on inequality. Is the Minister concerned about the length of some of the plans, the time it takes to produce them and the amount of bureaucracy involved, or does she think this is an improvement? What is the key objective in delivering these plans? Do the Government plan to introduce population health improvement plans through legislation? If they do not, Parliament will have scrutiny of the bureaucracy being removed but not of the bureaucracy that the Government replace it with. As the Minister once said:
“Local taxpayers deserve to know how their money is being spent.”—[Official Report, 13 June 2023; Vol. 734, c. 122WH.]
Karin Smyth
I thank the shadow Minister for her comments. I largely agree about legislative plumbing—that is a nice phrase. As she rightly highlights, and as is clear in the explanatory notes and so on, the duplication and administrative burden on all these bodies is considerable. On her question about objectives, we certainly want to streamline that so that ultimately, as well as organisations knowing the objectives they are pursuing, the local population—importantly to her concluding point—can readily see and address that, follow it through and hold people to account. I do think that 150-page documents are not always the easiest to see.
Young people will obviously be part of the joint strategic needs assessment, and ICBs will be mindful of the Government’s wider policy objectives, as we have discussed previously. With regard to maintenance and prioritisation of capital schemes, since coming into office we have already done a huge amount of work to streamline the relationship between NHS England and the Department of Health and Social Care—and, indeed, our friends over at His Majesty’s Treasury—in respect of the approvals process, making better use of capital and making that more transparent at local level so that individual organisations are involved in the prioritisation that comes forward to the ICBs.
Question put and agreed to.
Clause 22 accordingly ordered to stand part of the Bill.
Clause 23
Abolition of integrated care partnerships and strategies
Question proposed, That the clause stand part of the Bill.
Karin Smyth
The clause abolishes the requirement for ICBs and their partner local authorities to form an integrated care partnership. It also abolishes the related requirement for that partnership to prepare and publish an integrated care strategy.
These abolitions address the policy objectives of the 10-year health plan by streamlining the number of plans that must be created by local health systems and supporting key local stakeholders to work together more flexibly and effectively. The changes recognise that in many areas, integrated care partnerships have not had a positive impact on local health outcomes and have come with significant opportunity costs. Alternative planning approaches proposed elsewhere in the Bill and more broadly will enable local health bodies to plan for their patients in a way that is tailored to their strengths. However, I can reassure the Committee that where existing arrangements are working well, nothing in the Bill will prevent local areas from coming together to consider how best to integrate services and plan their approach to tackling the challenges they face. I commend the clause to the Committee.
Dr Johnson
In essence, the clause abolishes integrated care partnerships and strategies, which are where ICBs come together with local authorities to discuss how they can make their services more integrated. We know that many of the challenges facing the NHS are caused by difficulties in social care provision and some of the difficulties in social care provision are caused by issues with health provision, and that if those commissioning services in those two areas work together, we can see an improvement in both.
The Local Government and Public Involvement in Health Act 2007 made changes to local government structures and enhanced public involvement in health services. Section 116 requires local authorities to produce joint strategic needs assessments for the local authority and its partner ICB. When preparing the assessment, the local authority and its partner ICB must
“co-operate with one another…have regard to any guidance issued by the Secretary of State…involve the Local Healthwatch organisation”,
and involve local people and the relevant district councils. I note that later in the Bill we will also come to the abolition of Healthwatch.
Section 116 of the 2007 Act has been modified by the Health and Social Care Act 2012 and the Health and Care Act 2022 to ensure that references match the current NHS structure. For instance, in 2008 there were primary care trusts, rather than ICBs. Section 116ZA of the 2007 Act requires ICBs and local authorities whose areas coincide or overlap to create integrated care partnerships, which consist of a member appointed by the ICB, one from each responsible local authority and any other members that they choose to add; to some extent, they can determine their own procedures.
Section 116ZB of the 2007 Act requires ICBs to prepare an integrated care strategy
“setting out how the assessed needs in relation to its area are to be met by the exercise of functions of…the integrated care board…NHS England, or…the responsible local authorities”.
When developing that integrated care strategy, the integrated care partnerships must have regard to NHS England’s mandate and any guidance issued by the Secretary of State. Clearly, that would now apply only to guidance issued by the Secretary of the State, because NHS England is also being abolished. An integrated care partnership must publish its integrated care strategy and give it to each local authority and partner ICB. Integrated care partnerships must reconsider and, where necessary, revise the strategy each time they receive a new needs assessment.
Clause 23 deletes section 116(5A) of the Local Government and Public Involvement in Health Act 2007. That subsection required the local authorities to give a copy of the needs assessments to the ICBs, which is of course no longer necessary because they are being abolished. Clause 23 also deletes sections 116ZA and 116ZB of the same Act, which established ICBs and defined integrated care strategies respectively.
As Conservatives, we believe that streamlining bureaucracy is sensible, and I am sure that this is a well-intentioned reform. However, a survey conducted by the NHS Alliance in November indicated that a quarter of integrated care system leaders are likely to keep the integrated care partnerships anyway on a non-statutory basis, and 40% plan to fold them into health and wellbeing boards and working partnerships with the authorities. It is not really a ringing endorsement of the policy if a sizeable number of people intend to keep it anyway.
Like many other elements of the Bill, these changes are uncosted—if we read the impact assessment, it says “N/A” for the cost. Clearly, there will be a cost incurred by the abolition of the process, but there will also be an opportunity cost to services if ICBs and commissioners are not working together in the provision of social care as effectively as they were before. That will cost people in social care, and it will cost people in healthcare.
As recognised by the impact assessment that the Government have produced themselves, there is a risk of reduced focus on the wider determinants of health at system level. Committee members on both sides of the House have already stressed the impact that other health determinants can have on the health service and social care, and we have previously considered amendments to that effect.
Overall, it is regrettable that local government does not have the direct feed into ICBs that the design of those integrated care partnerships provided. Whether or not I agree, I can follow the theory or principle behind making the area covered more local, in line with the strategic authority. However, if the Government wanted to do that, I do not understand why they did not decide the mayoral areas first. At the moment, we do not know where the mayors will be, and where they are now is not where the ICBs are. The Government have decided to cut ICB budgets and force mergers before they have decided where the mayoral authorities will be in some cases. Even where there are mayoral authorities already, the Government have not mandated that the ICBs be coherent with them, and, therefore, in many cases, they are not. We have a very confusing pattern emerging, which may require further reorganisation of ICBs to line them up, with a further cost down the line.
Joe Robertson (Isle of Wight East) (Con)
Will my hon. Friend reflect on the fact that, even if the Government get through the combined mayoral authorities they are trying to in this Parliament, there are still great swathes of England where there are no active plans for a mayoral authority at all. Even if the Government get their own way, some areas will not have a mayor for many years—if they get one at all.
Dr Johnson
My hon. Friend is, as ever, correct. The mayors are also not all responsible for health and social care—the local authorities are, in most cases. There could therefore be a mayor directing proceedings with the ICB who is a political opponent of those actually democratically elected to look after social care. ICBs are supposed to be apolitical commissioners accountable to the Secretary of State, but now, instead of working with social care directors, they will work with an elected mayor instead.
I can see a positive to that in terms of democratic accountability, but what happens if they all disagree? There is some incoherence about who is in charge. We have the local authority tasked with delivering social care, which may be led by one political party; the mayor directing the ICB, who may be of a different political party; and the Secretary of State who can also direct the ICB, who may again be of a different political persuasion. How does it work if they disagree? Does the mayor actually have authority, given that the Secretary of State can override them anyway? How does the Minister see that working in practice? It feels like some people will be in power without responsibility and others will have responsibility without the power to exercise it.
Helen Morgan (North Shropshire) (LD)
I will raise some similar concerns about the abolition of integrated care partnerships and integrated care strategies, which clause 23 brings about. Before I do, I should declare my interest as a vice-president of the Local Government Association.
The removal of integrated care partnerships, as well as the extension of ICBs to cover multiple local authorities, raises unanswered questions about the future of social care planning, which is very important to the Liberal Democrats, as the Minister knows. We feel that it removes the voice of charities and others in the voluntary sector who are crucial to meeting the range of needs in health and social care.
Throughout the Bill there is a theme of separating social care and the NHS, at a time when greater integration and closer working are clearly needed. We heard Sir Andrew Dilnot say in evidence that we cannot deal with some of the challenges that arise in the NHS—particularly around flow through hospitals and long waits in corridor care in accident and emergency—without improving the discharge of patients into social care. Separating the organisations that deliver those things is clearly problematic. If we think about it, as the shadow Minister just outlined, we have lost the local authority representative on ICBs. The Bill also changes the way the better care fund is administered. With those changes, we are really concerned about the separation of these two responsibilities.
I want to draw the Minister’s attention to an example in Shropshire. Shropshire council spends almost 80% of its budget on social care. It is an extremely challenged council because of those funding pressures. Shropshire, Telford and Wrekin ICB has also been one of the most financially challenged ICBs. That is partly because of its small scale and its merging with Staffordshire—which, for the record, is unlikely to be the combined mayoral authority that Shropshire ends up in, as is my current understanding, although we are a long way off resolving that problem.
Karin Smyth
Clause 24 abolishes the requirement for health and wellbeing boards to prepare and publish a joint local health and wellbeing strategy. Instead ICBs, local authorities and their partners must work together through the health and wellbeing board to develop a neighbourhood health plan, in line with this Government’s commitment in the 10-year health plan. The neighbourhood health plan should be updated regularly to reflect the needs of the local population, unless all partners consider the existing plan is sufficient.
In developing their neighbourhood health plans, responsible local authorities and partner ICBs must involve the people who live or work in the area of the responsible local authority. The neighbourhood health plan will cover most of the topics previously considered by joint local health and wellbeing strategies, but will also encourage a deep focus on tackling the challenges facing individual neighbourhoods. That may mean applying different geographical focuses to different elements of the plan, to ensure that planners are addressing the real and different needs of the diverse communities they serve.
These plans will outline how the NHS, local government and local partners intend to improve the health of people in their locality and reduce health inequalities through a joined-up neighbourhood health approach. The plans will consider how local services can help realise national NHS priorities, further public service reforms, and improve performance against the adult social care outcomes framework and the local outcomes framework metrics. To support this work, the Government also intend to provide local areas with guidance and we will work with systems to ensure this addresses the needs of local planners and local communities.
Dr Johnson
Clause 24 puts neighbourhood health plans on a statutory basis. Currently, section 116A of the Local Government and Public Involvement in Health Act 2007 requires local authorities and partner ICBs to prepare a joint local health and wellbeing strategy once they have received their integrated care strategy. Essentially, that means that the ICBs and local authorities produce their overall strategy, then it devolves down, and then the joint health and wellbeing strategy looks at how it will be delivered. The local authority and its partners must give regard to the integrated care strategy, the NHS England mandate and any guidance issued by the Secretary of State. The strategy must be published and local people and the local Healthwatch must be involved in its development.
Section 116B of the 2007 Act places a duty on local authorities and partner ICBs to have regard to various strategies when exercising their function, specifically, a joint strategic needs assessment, an integrated care strategy and a joint local health and wellbeing strategy. NHS England also has regard to these when providing healthcare for a specific area.
Clause 24 changes the JLHWS to a neighbourhood health plan. In many ways, that aligns with the shift in the Government’s 10-year health plan from hospital to community. As they have described it, more care in the neighbourhood will allow hospitals to focus on the more specialist care that may be needed, so more people can be cared for closer to home, which seems a reasonable aim.
However, if local authorities and partner ICBs have to give regard to what the centre is doing when developing neighbourhood health plans, to what extent does the Minister envisage that being directed? Local authorities and partner ICBs giving regard to the centre could mean there being a very loose requirement from the centre to provide for the local population, and then they get on with it; it could also be very prescriptive—my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) has talked about the pros and cons of having targets—with a whole litany of targets in the plans. Whether that squares with the Government’s claim to be devolving power, or whether it strikes as a centralising power, depends on how that is done and to what extent the Secretary of State plans to direct it. I would appreciate it if the Minister could talk about that.
As has been said, Sir Andrew Dilnot told the Committee that
“we cannot really address many of the fundamental problems facing the NHS if we do not sort out social care.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 84, Q131.]
The Government have asked Baroness Casey to review social care, but they have developed this measure in the meantime. Is that because they have been talking to her and know that it is the sort of thing that she will recommend—or are they putting the cart before the horse, as my hon. Friend the Member for Farnham and Bordon suggested?
Later in the Committee’s considerations, we will come to Healthwatch, its benefits and the concerns that I and, I am sure, many other Committee members have about its abolition. What mechanisms does the Minister envisage there being for local people—local patients—to contribute to the neighbourhood health plans? A local Healthwatch currently contributes to the equivalent, the joint local health and wellbeing strategy, as a way of ensuring that it captures patient and community voices. How will that be done otherwise?
Some 80% of the Government’s new neighbourhood health centres that will deliver these plans are expected to be funded through public-private partnerships. Does the Minister have any comments on that, particularly in the light of the expensive private finance initiative that the last Labour Government entered into and left us stuck with?
In March 2026, the Government produced a neighbourhood health framework policy paper, which identified the goal of reducing non-elective admissions for those with severe frailty. Given that goal, why are the Government not on track to deliver the fracture liaison service improvements that they promised?
The policy paper also commits to what it calls
“a diversion rate of at least 25% by March 2027 for at least 10 high volume specialties”.
What is a “diversion rate”? It essentially requires more GP referrals to be rejected, so let us be clear about what that means. When someone, either hon. Members or constituents, goes to see their GP, they are referred to a consultant for care; I should declare an interest as a consultant in the NHS. The consultant will then review that referral and decide whether they think it is clinically appropriate to see the patient, whether a different specialty may be more appropriate, or whether they can give advice or make suggestions about treatment that could be given in primary care instead.
When a patient is given an appointment in secondary care, it essentially means that the GP has decided that they clinically need it, and the consultant has decided that they clinically need it too. If the Government want a diversion rate of at least 25% by March 2027 for at least 10 high volume specialties, are they suggesting that patients who the GP and consultant agree clinically need an appointment should not get one? If so, why?
Dr Danny Chambers (Winchester) (LD)
It is an honour to serve under your chairship, Sir Jeremy. I have been itching to speak on this new clause, tabled in the name of my hon. Friend the Member for Epsom and Ewell (Helen Maguire)—I am not sure how to pronounce that, but I am sure it is a very beautiful place; I have never been. It would ensure that a certain range of primary care providers were consulted by integrated care boards in the development of the healthcare plans.
The recent King’s Fund report, as well as many others, showed that over 90% of NHS contact with patients is in primary care in all its forms. New clause 70 relates to new clause 60, also tabled by my hon. Friend, which is about having GP representation on integrated care boards. This is an extension of that, so that dentists, pharmacy contractors and providers of ophthalmic services can all feed into integrated care boards’ healthcare plans. That is how most people come into contact with the NHS, which means that those providers have a close and deep understanding of the healthcare issues facing the demographics in their communities.
Dr Johnson
New clause 70 talks about a certain range of primary care providers being consulted by the ICB. Can the hon. Member clarify whether it is his intention for all providers of those services in a defined area to be consulted, or would it be a representative selection? If it is the latter, how would they be chosen?
Dr Chambers
The hon. Lady makes a good point. The purpose is to ensure that those who are deeply embedded in community care are consulted by the ICBs, so that they do not miss obvious localised issues in their demographics when developing care plans.
Just to give a brief example from a surgery I held recently, Joanne Cook is an occupational therapist who is campaigning for occupational therapists who have received specific training to be able to prescribe, and crucially de-prescribe, medications, in the same way that trained paramedics can. Often, occupational therapists see patients on a daily basis. They give them intimate and regular care, and are even better placed than GPs to notice small changes and adjust medications to keep people out of hospital.
If integrated care boards are not drawing on the experience, knowledge and data from primary care providers in all their forms, any healthcare plans they come up with will not be relevant to those demographics. We will not be keeping people out of hospital or treating them as effectively in the community, and the whole system will not be as efficient or as targeted as it could be. I would appreciate it if the Minister considered accepting the new clause.
Karin Smyth
Clause 25 makes focused but important changes to the accounting and audit arrangements for NHS trusts by amending schedule 4 to the National Health Service Act 2006. It does not put additional burdens on NHS trusts; instead, the aim of the clause is to align the requirements for trusts with the updated accounting arrangements for foundation trusts made elsewhere in the Bill. The changes are needed as a consequence of the abolition of NHS England and the removal of the requirement for foundation trusts to have councils of governors and members.
The amendments the clause makes replicate trusts’ existing duties to keep proper accounts and records about those accounts, and to prepare annual accounts for each financial year. The clause also replicates the Secretary of State’s current power to direct an NHS trust regarding the form of its annual accounts, but extends that power of direction so the Secretary of State may also direct a trust to prepare accounts for a specified period—for example, when part-period accounts are needed. That will help to ensure a consistent approach to financial reporting while retaining the flexibility to keep requirements up to date.
The clause also sets out and strengthens how the audit arrangements for NHS trusts should operate, mirroring the approach for foundation trusts and integrated care boards. It provides that NHS trust annual accounts are audited under the Local Audit and Accountability Act 2014, as is the case currently, but it also provides that part-period accounts may be audited in accordance with that Act where the Secretary of State so directs.
The clause also enables the Comptroller and Auditor General to examine the accounts and related auditor reports, as is currently the case. To reflect the fact that the Secretary of State will have oversight of providers once NHS England is abolished, it requires the accounts and audit reports to be sent to the Secretary of State.
Taken together, these measures support transparency, consistency and robust financial assurance. They will help to reduce unnecessary divergence in accounting requirements across different types of NHS provider, while maintaining clear oversight of public funds. That is consistent with the Bill’s broader intent to support effective governance and clear accountability for providers.
Clause 26 makes minor technical amendments to ensure that the statute book remains clear and coherent as the Bill aligns the approach to audit and accounts across NHS trusts and foundation trusts. It sits alongside the provisions in the Bill that update the arrangements for the audit of foundation trusts following the abolition of NHS England and the removal of the requirement for NHS foundation trusts to have councils of governors and members.
The clause does that by amending or removing outdated transitory provisions relating to the audit of NHS trust accounts in two places: the NHS Act 2006 and the Local Audit and Accountability Act 2014. Clause 26 therefore supports the effective implementation of the wider measures in this part of the Bill by ensuring that the legislation is up to date, accurate and internally consistent. I commend clauses 25 and 26 to the Committee.
Dr Johnson
As has been said, clause 25 specifies how NHS trusts should handle their accounting. Paragraph 11A of schedule 4 to the NHS Act 2006 sets out the current obligations, which are that the trust must keep proper accounts, that the Secretary of State may give directions about how the accounts are held, and that the accounts must be prepared annually, may be examined by the Comptroller and Auditor General, and must be submitted to NHS England.
Clause 25 replaces paragraph 11A entirely. Under the new provisions, the reporting goes to the Secretary of State, instead of NHS England—which seems sensible, because the Government are abolishing NHS England—and the Secretary of State may give directions about “methods and principles”, as well as the “form and content”. The Secretary of State may also give directions about specified periods in which accounts are to be prepared.
Will the Minister explain why those provisions are felt to be necessary? There will be suspicion among some more cynical people that the power to specify periods could be used to be more flattering for the Government, or that methods and principles could be used to change the perception of the position. Can the Minister give an example of where she thinks such periods would be useful, and also say why she thinks it is necessary to enable the Secretary of State to give directions about methods and principles, and form and content, in a way that is not done at the moment?
The exception for charitable trusts of which the NHS is a trustee is being removed. Will the Minister explain why she thinks that is important, and in what situation she thinks that power would be used? Finally, will she say whether the financial directors of NHS trusts have been consulted about these changes? If so, what was their feedback?
Clause 26 tidies up relevant provisions in two pieces of legislation, as the Minister has described.
Karin Smyth
If there are specific examples that are helpful, I will write to the hon. Lady—I am not entirely sure I got the point about charities, but we will pick that up in Hansard.
As I outlined in my opening remarks, these clauses are about standardising the key requirements across the NHS provider landscape in relation to annual and other accounts and records in relation to those, and audit and reporting requirements, including keeping those up to date and having a consistent approach across all NHS provider types. Of course, we worked closely with NHS England colleagues and directors of finance in seeking to bring forward those provisions.
Question put and agreed to.
Clause 25 accordingly ordered to stand part of the Bill.
Clause 26 ordered to stand part of the Bill.
Clause 27
Special Health Authorities: establishment and exercise of functions
Karin Smyth
Clauses 27 and 28 make amendments to the legal framework around special health authorities to give the Secretary of State the flexibility to best manage the reliable delivery of healthcare for patients and the public. As the Committee knows, special health authorities are independent bodies established by the Secretary of State, by order, to perform specific functions. They play a key national role in the health system, carrying out specific functions on behalf of the Secretary of State.
Clause 27 does two key things to the special health authority legal framework. First, it amends section 28 of the NHS Act 2006 to increase the scope of functions that a special health authority could be established to deliver. Currently, the Secretary of State can create a special health authority only for the purpose of exercising functions under the 2006 Act. The clause allows a special health authority to be established to exercise functions under any other Act as well.
Secondly, the clause amends section 29 of the 2006 Act, which currently enables regulations to provide for the functions of a special health authority to be carried out flexibly, by another special health authority or jointly with one or more other special health authorities. That applies only to functions that the Secretary of State has directed the special health authority to exercise under section 7 of the 2006 Act. The clause removes that limitation, so that those arrangements can be made for any functions of the special health authority, not just those that it is directed to carry out under section 7.
These changes are needed because the health and care system is underpinned by a range of statutory functions that do not sit exclusively within the 2006 Act. The Secretary of State needs to be able to establish special health authorities to carry out those wider functions, and to give those functions to existing special health authorities. The clause ensures that the Secretary of State has the modern, adaptable tools required to place specialist functions in the right national body, with the appropriate governance and accountability. Equally, special health authorities need to be able to work with other special health authorities across all their functions in a way that best serves the needs of the wider health and care system.
On occasion, it is necessary for Ministers to merge, alter or abolish special health authorities, either because of changing circumstances or to ensure the smooth and effective running of the system. Clause 28 provides the flexibility to transfer and redeploy staff. It allows regulations to be made to enable staff to be transferred to an integrated care board or another special health authority. These changes ensure that staff can be transferred where they may be needed most, allowing for flexibility to direct resources in the health system.
The clause also allows for arrangements to be made for a special health authority’s staff to be made available to another special health authority, a local authority, the Secretary of State or an integrated care board. That may be necessary during an emergency or to provide specialist support to help an organisation achieve a particular outcome. The clause also allows the Secretary of State to give directions to a special health authority to make staff available to another special health authority or integrated care board or the Secretary of State.
Clause 28 also amends the existing power to make regulations about the sharing of information with other bodies, to allow information to be shared with integrated care boards in addition to the Secretary of State and other special health authorities. That allows for information to be shared across the system so that national and local functions can be successfully fulfilled and supports a more joined-up health system.
Clauses 27 and 28 provide for future-facing updates that will support effective administration and ensure the more reliable delivery of healthcare for patients and the public. I commend them to the Committee.
Dr Johnson
Special health authorities are, in essence, specialist health authorities set up by the Secretary of State, usually to provide an England-wide service of some form. Examples include NHS Blood and Transplant, and the NHS Business Services Authority, which provides NHS pensions—I should declare that I have an NHS pension—admin for prescription exemptions and other such business-type functions. We also have NHS Resolution, which deals with clinical negligence claims, and the NHS Counter Fraud Authority.
In principle, special health authorities are useful in some cases, but they are effectively a form of quango. Can the Minister explain when she thinks the Government might want to set up a special health authority, rather than using a department within the DHSC to deliver the same thing? There are plenty of other nationally delivered services, and although the Government have suggested that some services, such as screening, will become localised as part of the Bill, some things will remain national. Can the Minister give some examples of what the new provision will be used for?
I can see there is provision for flexibility, but the special health authorities would require setting up, and there are set-up costs and costs associated with branding and those sorts of things. How does the Minister envisage those costs being provided for, and when will it be necessary for the Government to use them rather than just using the Department?
Special health authorities have been created, reconfigured and shelved many times. For example, the National Treatment Agency for Substance Misuse became part of Public Health England in 2013, and the NHS Institute for Innovation and Improvement was closed in the same year. The functions of the National Patient Safety Agency went to the NHS Commissioning Board Special Health Authority, later known as NHS England, in 2012 and then to NHS Improvement in 2016. Widening the scope could leave us with more quangos than are necessary.
Which specific functions do the Government plan to move into special health authorities under this widened power? Have the Government just decided that they need this power and are increasing the scope because they are abolishing NHS England without a proper plan? Is this power just to cover themselves in the event that, as they start to make a plan, they find out they need it?
Clause 28 enables the Secretary of State to make regulations for the transfer of staff from one special health authority to another, or to an ICB. Paragraph 3(8) of schedule 6 to the National Health Service Act 2006 states:
“Regulations may provide for the transfer of officers from one Special Health Authority to another”,
or to NHS England,
“and for arrangements under which the services of an officer…are placed at the disposal of another Special Health Authority”,
or NHS England, or a local authority. Paragraph 3(12)(a) states that the Secretary of State may give directions
“to place the services of any of its officers at the disposal of another Special Health Authority”,
or NHS England. Paragraph 13 states:
“Provision may be made by regulations with respect to the recording of information by a Special Health Authority, and the furnishing of information by a Special Health Authority to the Secretary of State, another Special Health Authority”,
or NHS England.
Clause 28 modifies that paragraph such that regulations can now provide for the transfer of an officer to an ICB—that is a new power—as well as a special health authority and a local health authority, but no longer to NHS England because NHS England is being abolished. Regulations can now provide for an officer’s services to be placed at the disposal of the ICB and the Secretary of State, which is a new power, as well as the special health authority or local authority, but no longer NHS England. The clause modifies paragraph 3(12)(a) of schedule 6, so that directions may be given about placing the services of officers at the disposal of the special health authority and, newly, the Secretary of State or an ICB, but not NHS England. As the Minister said, the clause also modifies paragraph 13 of schedule 6, so that a special health authority can be required by regulations to pass information to integrated care boards, which is a new power, but no longer to NHS England.
NHS England is to be abolished, so it is sensible to say that staff can no longer be placed there—that seems an entirely reasonable exercise—but the legislation providing for special health authorities essentially contains open-ended spending power. Remuneration of the special health authority chairman and staff can be determined by the Secretary of State, with the approval of the Treasury. Does the Minister foresee an upper limit to those sorts of salaries?
People will essentially be able to transfer from one special health authority to another, or to an ICB—or be placed at the disposal of another special health authority, an ICB, a local authority or the Secretary of State. Will the Minister talk about the location, pension and salary of those individuals? We heard yesterday that the future Prime Minister, the right hon. Member for Makerfield (Andy Burnham), may want to move a whole load of civil servants from London up to Manchester. That will clearly be within his gift if he becomes Prime Minister, but for individuals who work in one location to be asked to move to another is disruptive to their family and social lives, and involves significant relocation costs. If people are moved in the way that clause 28 describes, particularly by transfer, what choice will they have? What will happen to their pension, salary and other terms and conditions, and will they have a choice of location or not?
Gregory Stafford
Very briefly, on clauses 27 and 28, I am sure the Committee is aware that special health authorities were initially established under the National Health Service Act 1977. Since then the number of special health authorities has expanded and contracted a number of times over the years to leave us with, currently, NHS Blood and Transplant, and the Business Services Authority, which covers pensions, as my hon. Friend the Member for Sleaford and North Hykeham mentioned—I should declare that I have an NHS pension, albeit a very small one—as well as the NHS Litigation Authority, also known as NHS Resolution, and the NHS Counter Fraud Authority.
The mood music and the direction of travel, certainly since 2006, has been to reduce the number of special health authorities. On my reading, clauses 27 and 28 suggest that the Government are potentially looking to expand the number of special health authorities, given the Secretary of State’s direction under clause 27 and the practical steps for staff transfers in clause 28. Is the Minister looking at, for example, a special health authority to deal with artificial intelligence? Clearly that is something the NHS will have to embrace—or deal with, depending on which end of the AI argument one is on—rapidly over the coming years. Is that a potential area for a special health authority? Perhaps the Minister could outline where she sees the special health authorities acting and what their remits might be.
Dr Johnson
This is quite a large group. First, clause 29 introduces schedule 3, which will make changes to the constitution of NHS foundation trusts. Currently, chapter 5 of the National Health Service Act 2006 establishes NHS foundation trusts as public benefit corporations in accordance with schedule 7 to the Act. That schedule, “Constitution of public benefit corporations”, sets out, among other things, the requirements for a constitution, the eligibility for membership, and the council of governors.
Schedule 3 to the Bill, introduced by clause 29, has a number of functions. First, it modifies the 2006 Act so that a foundation trust will no longer be a public benefit corporation, but will now be a body corporate—I would be interested in the Minister’s explanation of that change. It also modifies section 33(4) of the 2006 Act to remove reference to councils of governors, so that trusts no longer need to set those up, and modifies section 37 so that an NHS foundation trust can amend its constitution with the approval of the Secretary of State, where previously, that would have required a vote of more than half the members of the board of directors and more than half the members of the council of governors.
The schedule also deletes section 39A of the 2006 Act, “Panel for advising governors”, because one presumes if there are no governors, they do not need advice. It modifies section 43, “Provision of goods and services”, so that if a foundation trust wishes to raise its non-NHS income by 5% or more, the Secretary of State must approve it—previously that would have required local decision making from more than half of the members of the council of governors. It also deletes section 51A, “Significant transactions”, which states that an NHS foundation trust may enter into significant transactions, as defined in its constitution, only if more than half the members of the council of governors voted to approve it.
The schedule also deletes sections 56(1A), 56A(2), 56B(2) and 57A(2) of the 2006 Act. That means that governors will no longer have to approve a trust merging, being acquired, splitting or being dissolved. The Bill’s explanatory notes say that the Secretary of State will take on those approvals via schedule 11. Schedule 3 also deletes section 59, “Conduct of elections”, section 60, “Voting and standing for election” and section 61, “Representative membership” of the 2006 Act, which set out the democratic machinery for foundation trusts.
Schedule 3 also substitutes schedule 7 to the 2006 Act with an entirely new version. Elements of that new schedule 7 are as follows: the Secretary of State will now be able to appoint, suspend or remove the chair and non-executive directors—previously that was a governor’s role—and they can set the pay, allowances and terms of non-executive directors, and may regulate their tenure. The chief executive will be appointed by the non-executive directors, and the other executives will be appointed by a committee of the chair, the chief executive and non-executive directors, but the Secretary of State may set when those powers may be used. As the council of governors and its membership will be abolished, there are no members, elections or constituencies anywhere in the new schedule. Constitutional amendments will need the Secretary of State’s approval, not the approval of members and governors. The Secretary of State may make regulations on director eligibility, beyond the standard disqualifications. Directors owe a duty to promote the trust’s success, to maximise benefits for the public, with respective interests, duties and registers of interest. Board meetings must be open to the public. Accounts and audits are aligned with NHS trusts and ICBs. The Secretary of State may direct the form, content and timing as we have talked about before. Annual reports and forward financial plans go to the Secretary of State in the form that the Secretary of State decides, and trusts must publish their constitution, register, accounts and annual reports and hold a public meeting on them.
The council of governors was intended to feed in democratic input. Does the Minister have any comment on where democratic input will be held? Will it be solely through the Secretary of State, or is there any intent for local patient voice, now Healthwatch is being abolished too? How will local decision making be informed, and how will they understand their local area, particularly if it is to be directed largely by the Secretary of State?
Removing the council of governors will save money on administration, as noted in the impact assessment. The impact assessment also notes the Secretary of State does not have the ability to intervene in serious instances of foundation trust failure. Could the Minister comment on that?
Foundation trusts were intended to be independent. If the council of governors is removed and many things, as I have listed, are put under the control of the Secretary of State, they become increasingly more like an ordinary NHS trust, pre-foundation. Will they be independent in name only?
Non-executive directors are meant to be there to hold the leaders of the trust to account, but the Secretary of State can now appoint, pay and fire every non-executive director so a foundation trust’s internal watchdog can now be controlled by an elected politician who is potentially quite remote from that area. Does the Minister have any comment on how she sees that working?
Foundation trusts may have failed to increase democratic involvement in so far as there has not been huge interest in some of these elections for chairs of governors. But the answer to that would be a better version of local involvement rather than removing local input entirely.
The theme right across the schedule and the changes I listed is that foundation trusts are looking up to the Minister rather than out to local communities. Many NHS inquiries have reported back that frontline concerns did not reach the highest tiers of leadership. The Government are now closing an independent channel for sounding the alarm. Will the Minister comment on that?
I welcome Government amendment 19 because the idea that you need medical expertise on the board of a trust that delivers medical care seems to me fairly obvious, because otherwise you will get decisions that are not grounded in medical knowledge. I do recognise what the Minister says about it was not having been her intention to demote the voice of clinicians, but that was the effect. This amendment will go some way to correcting that, by having an executive director who is registered medical practitioner or a dentist, and another who is a registered nurse or midwife. Could the Minister be clear if a foundation trust wanted a nurse and a midwife, perhaps because they had a specific issue with the midwifery area, or a medical practitioner and a registered dentist, could they have both?
The Minister suggested that an exemption would be ambulance care, but there are medical practitioners, consultants, with expertise in out of hospital care. Does the Minister feel their expertise is not useful in some way?
I will speak to amendment 36 once it is moved. On clause 30 stand part, that clause removes the requirement for NHS England to consult prospective members or governors of a prospective foundation trust before its authorisation. Getting a new foundation trust without NHS England because it has been abolished is a consequence of earlier clauses that we have already voted on. Therefore, I will not go further on that issue.
Helen Morgan
I had finished speaking, but I will give way and think of something else to say.
Dr Johnson
The civil servants will be under the direction of the Minister, so how does the hon. Lady envisage it working? Presumably, civil servants are there to deliver for their Ministers or Secretary of State? Is she suggesting that makes the decision more impartial? Can she give us some detail on how that will work?
Helen Morgan
As I mentioned in my previous remarks, one imagines that a Secretary of State would set out criteria to ensure that the best people for the job are appointed. We are in a situation where a current Parliament cannot bind a future one, but we do need to set a precedent that political capture of these important leadership roles is not an unintentional consequence of this legislation. I accept that it is unintentional; I think the Secretary of State and the Minister have drafted this legislation with the best of intentions, but this is something we should guard against.
Gregory Stafford
The hon. Gentleman’s intervention neatly brings me to my next point. I have some sympathy for his viewpoint—and apparently the viewpoint expressed to him by governors—that in many cases, if not most, governors do not have the teeth, the influence or the ability to change things in the way they would like. My argument is very similar to the one we will expand on later regarding the abolition of the Healthcare Services Safety Investigations Branch and Healthwatch: the Government’s response to something not working as effectively as it could is to abolish it, but why not give those organisations the teeth—the powers—to achieve the things they were set up to do, unless the hon. Gentleman and the Government feel that there is no need, in Healthwatch’s case, for that level of independent scrutiny or, in governors’ case, that level of independent influence on boards?
There is a fundamental difference here: the Conservatives would take something imperfect and make it better; the Government’s response is to take something imperfect and abolish it. That is the wrong way round.
Dr Johnson
Does my hon. Friend think that this leaves a bit of a gap? The Secretary of State will not have the level of local oversight that the governors had, so how will that local oversight feed into the Secretary of State so that he or she can make the decisions instead?
Gregory Stafford
My hon. Friend is right that there will be a gap in local decision making on these issues. It goes back to that tension I described some moments ago: the Government’s stated intention is to devolve powers locally, but they seem to be pulling so much power up to the Secretary of State that we will lose the ability to make local decisions for the benefit of local populations where appropriate. We have a stated ambition for neighbourhood health, but those neighbourhoods are rapidly expanding in this legislation to become areas of millions of people. Local people who are interested in their local health delivery or local hospital trust would not see that as local decision making, and there is the gap that my hon. Friend describes.
I do not think that amendments 74 and 75 have been moved, so I will not talk about them. Government amendment 19 will require
“NHS foundation trusts to have at least one executive director who is a registered medical practitioner or a registered dentist and another who is a registered nurse or a registered midwife.”
As also stated in the explanatory note, and as the Minister mentioned, regulations may create exception—for example, for ambulance trusts. That is the right decision, and it is important that we have medical experience on foundation trust boards. I am interested in understanding from the Minister, first, why she has chosen a medical practitioner or registered dentist. Does she see some equivalence in their expertise that could be substituted? I have great respect for doctors and for dentists, but they have potentially different clinical expertise. If a foundation trust does no oral healthcare or maxillofacial reconstruction, and does no dentistry or allied specialties, would it really satisfy requirements to have a dentist on the board? Likewise, given that the amendment also refers to a registered nurse or midwife, if a trust has no maternity services, would having a midwife on the board really satisfy the requirement of that trust to have nursing care input? I ask those questions, and I would be interested in the answers.
Likewise, there is the exemption for ambulance trusts. Like my hon. Friend the Member for Sleaford and North Hykeham, I would be interested to understand from the Minister why she thinks ambulance trusts do not need a medical practitioner on their boards, given that they are doing medicine. Plenty of consultants work alongside paramedics and in ambulances, so again I am not quite sure why she is making that exemption. I would be interested to hear from her on that.
I understand the intention behind Liberal Democrat amendment 36. Once again, it is trying to soften the Secretary of State’s power grab over decision making—like the hon. Member for North Shropshire, I am not saying anything against the current Secretary of State, but a future Secretary of State could be different. The aim is to try to temper that in some way. Unfortunately for the hon. Member—I have sympathy for the amendment—the stated intention of the Bill is to pull more power to the Secretary of State. The Minister may surprise me, but I fear that the amendment will not find favour with the Government, because the whole Bill is about pulling more power to the centre, certainly when it comes to appointments, and to the Secretary of State.
However, the Minister should think about how future Secretaries of State may have to go through some process whereby their decisions are checked and justified, especially at local level. If we want local people to have influence and say over their local health systems and trusts, there needs to be some sort of bridging legislation or bridging process to ensure that whatever a Secretary of State decides, it has the confidence and support of local people and local service providers.
Karin Smyth
I will move on, if I may. I think my response will the cover the issues raised in the debate.
On amendment 36 and new clause 59, I note the concern that the Secretary of State could act inappropriately when making appointments to the boards of ICBs and NHS trusts and foundation trusts. We discussed democratic accountability in a previous sitting, and at the end of the day it is up to the British public whom they elect to Parliament and as the governing party.
Transparency and democratic accountability are at the heart of our reforms. It would not be right for the civil service to be given sole legislative responsibility for appointments to NHS trusts, foundation trusts or integrated care boards. Ministers are democratically accountable to Parliament, and civil servants act on their behalf under the Carltona principle. Civil servants serve and advise the Government, and act on behalf of Ministers, but it is for Ministers to take decisions and to be held accountable to Parliament for the performance of the NHS. The civil service will run fair, open and equitable campaigns to fulfil these roles and will recommend appropriate candidates to Ministers.
Ministers are under a duty to comply with public law principles and to act reasonably, and will adhere to the Nolan principles, including objectivity, transparency and integrity, in discharging this function. The practical arrangements for appointments are being developed as part of the transition planning for the integration of NHS England’s functions into the Department, and will be based on these principles. It would therefore be inappropriate to exclude Ministers entirely from the appointments process. I urge hon. Members not to push the amendments to a vote.
The Chair
I think the Minister has finished.
Question put and agreed to.
Clause 29 accordingly ordered to stand part of the Bill.
Amendment made: 19, in schedule 3, page 81, line 10, at end insert—
“(1A) Unless or except to the extent that regulations provide otherwise, the executive directors must include—
(a) at least one person who is a registered medical practitioner or a registered dentist (within the meaning of the Dentists Act 1984), and
(b) at least one other person who is a registered nurse or a registered midwife.”—(Karin Smyth.)
This requires NHS foundation trusts to have at least one executive director who is a registered medical practitioner or a registered dentist and another who is a registered nurse or a registered midwife. Regulations may create exceptions (for example, an exception could be created for ambulance foundation trusts).
Schedule 3, as amended, agreed to.
Clause 30 ordered to stand part of the Bill.
Clause 31
NHS foundation trusts etc: audit of accounts
Question proposed, That the clause stand part of the Bill.
NHS Breast Screening
Caroline Johnson Excerpts(2 months, 2 weeks ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Mr Vickers. I congratulate Gemma Reeves on bringing forward the petition and the hon. Member for North Ayrshire and Arran (Irene Campbell) on introducing this important debate. It has been very moving to hear so many stories from hon. Members on both sides of the House reminding us of the human cost of this disease.
Breast cancer is very common, as other Members have said, affecting one in seven women during their lifetime. The Minister and I have had a number of debates in this Chamber about various diseases and forms of cancer. One of the core principles we often discuss is that early diagnosis saves lives. Cancer Research UK says that 85% of women who live more than 10 years after a diagnosis of breast cancer were diagnosed at stage 1 or 2 —the earlier stages to be diagnosed at. It was for that reason, and on that principle, that the UK introduced the world’s first national screening programme for breast cancer in 1988. Since then, much has changed. In particular, survival rates have improved dramatically. Now, 76.6% live more than 10 years; the figure was very much lower in the 1980s.
There are still some issues with screening, however, as hon. Members have said. One is that women with denser breasts find it more difficult to locate lumps, and when doing mammograms, it can be more difficult to locate cancerous tumours. Will the Minister update the House on what work has been done on using ultrasounds and MRIs to identify tumours in women with denser breasts? I understand that the National Screening Council is looking at this subject in detail. When is it due to report its findings to the Minister, and when does she intends to bring them to the House?
The effectiveness of treatment has improved, but the risk of overtreatment is higher in younger women. The incidence of the disease is increasing in younger and older women: the Cancer Research UK website says that the rate has increased by 12% in women aged between 25 and 49, and by 72% in women aged between 65 and 69. Should younger women therefore now receive screening, and should older women receive more frequent screening?
The cancer plan, which the Government published earlier this year, said that they will engage with manufacturers to look at mammograms that are more accessible to those with a physical disability, who at the moment struggle to receive their screening. Will the Minister update the House on the engagement she has had with manufacturers and on the progress that has been made?
The age trial in Oxford is looking at women aged between 47 and 49, and between 71 and 73—the ages just outside the current range of screening. I understand that early results are due in December 2026. Has the Minister had any indication of the results yet, and is she preparing for any results that come forward? Has she engaged with the people running that important trial?
Community diagnostic centres, which were initiated by the previous Government and rolled out across the country, provide screening close to people’s homes, which makes it much easier for them to attend. Will the Minister update us on how she is improving the number of CDCs available across the country?
The Government have talked about the shifts that they want to produce in healthcare, one of which is about prevention. According to the Cancer Research UK website, 23% of breast cancer cases are preventable. Will the Minister update us on what she is doing to reduce the number of preventable cases of breast cancer?
Many hon. Members have talked about attendance at screening tests. The hon. Member for Epsom and Ewell (Helen Maguire) spoke about some of the reasons why women do not attend screening. It is important that we understand why about a third of women do not attend. It is only by understanding what puts women off and makes them not attend that we can improve the services so that more women do attend. It was sobering to hear how many lives could be saved if more women attended screening. How are we making screening more accessible for women? Are we ensuring that women know that it is happening and that they need it? Do they understand the benefits of it? I would be interested to hear the Minister’s thoughts.
Another shift relates to the digital NHS. AI provides us with a number of ways to improve breast cancer screening and treatment. It could help us to understand who should be invited to screening and how often, and it can help when looking at mammogram scans. A few years ago, the Health and Social Care Committee visited Stanford in California and looked at the AI there. We saw a study comparing two radiology consultants looking at a scan, two AI computers using two different programmes, and a person and an AI computer. It discovered that the person and the AI computer were the most accurate. That can help to reduce the number of people we need in the workforce and, importantly, can improve the accuracy of screening results.
That brings me on to the workforce. We know that the Government have a workforce plan, although its publication has been much delayed. We have been told repeatedly over the past few weeks that it has moved to “imminent” status—imminent being quicker than soon—but we do not know when imminent is. Does that mean it will be published before the summer, or do we need to wait for the new Prime Minister to make a decision? It would be helpful to know that from the Minister. As we heard about radiology and radiotherapy, the workforce is incredibly important. We need a thorough plan, otherwise we will have recommendations from the NSC for screening and no people to provide that care.
I also wanted to raise with the Minister the Lobular Moon Shot Project. We have discussed before the importance of research into lobular breast cancer, which is more difficult to diagnose and treat. The last time we spoke about this, the Minister was looking at research projects that the Government could fund to identify new treatments and ways of screening for this disease, hopefully saving lives. Will she update us on how she is getting along with that?
Much of my time at the moment is spent with another Health Minister—the Minister for Secondary Care, the hon. Member for Bristol South (Karin Smyth)—in Committee Room 9, debating the Health Bill. That is where I will be tomorrow. The Bill relates to one of the important organisational factors in screening. At the moment, screening programmes are generally organised by NHS England, which is being abolished. NHS England and the Department of Health and Social Care wrote a letter in March saying that commissioning responsibility will be directly delegated to ICBs, in the same way that they are currently delegated to NHSE, by the Secretary of State. Does the Minister expect that to cause any disruption to the breast screening programme?
Integrated care boards have had their budgets cut by 50% just as they are asked to take on this work. We know that they are merging and reorganising in cells. The Government’s plans are that they should follow the mayoral authority boundaries, but the mergers that have taken place so far do not follow those boundaries. There is therefore a risk that we will need reorganisation all over again. Does the Minister think that that will have an effect on the screening programme? If so, what is she doing to mitigate that effect to ensure that as many people as possible get the very best screening and we can reduce the number of people suffering from the disease?
The screening programme offers a real opportunity to diagnose, treat early and save lives, but it needs to be delivered well. We need to ensure that the right people get the right type of screening at the right age, and at the right frequency. I will be interested to hear the Minister’s response.
Health Bill (Seventh sitting)
Caroline Johnson ExcerptsThursday 25th June 2026
(2 months, 3 weeks ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 25 June 2026 - (25 Jun 2026)
Edward Argar
My hon. Friend comes to this with significant knowledge from his work on the Health and Social Care Committee. He is absolutely right, but that is a tension and a balance that I fear runs as a thread throughout this legislation, between local decision making and tailoring and the genuine need for a Secretary of State to have effective powers. We lobby Secretaries of State; on occasion I have lobbied the Minister, and she has always been very responsive—she does not always agree with me, but she has always been very responsive to me. As Members of Parliament, we do that on behalf of our communities.
My argument is that ICBs need to be more responsive, even when they do consult, to make it clear that the decision is not predetermined by the board and that they are going through the process. In the context of this clause, that also needs to be true of the Secretary of State: it needs to be not simply a formulaic approach but a genuine engagement and consultation. My question for the Minister, in that context, is about how we make sure of what she is seeking to do in the clause. The Secretary of State or those undertaking commissioning on their behalf must pay heed to something, but how do we make sure that that consultation, engagement and feedback genuinely have some teeth in what emerges in the final decision?
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
My right hon. Friend the Member for Melton and Syston and my hon. Friend the Member for Farnham and Bordon have covered my points so effectively that I will be very brief indeed. How do we ensure that the consultation is not just well meaning and ticking the legal boxes, but actually listened to, so that people’s voices are incorporated into the plans? Also, I appreciate that amendment 28 is a well-meaning intervention, but how do we ensure that all voices are heard in a co-production, not just those who are the most articulate or the most able to engage with a process that they see online?
The Minister for Secondary Care (Karin Smyth)
Patients and the public have a critical role in shaping our health services. I am grateful to the hon. Member for Oxford West and Abingdon for tabling the amendment, as moved by the hon. Member for North Shropshire. I will discuss the amendment with the wider question of whether the clause should stand part of the Bill.
To be clear, the Government are committed to engaging with patients and the public about the services they use. Services shaped together with the people who rely on them are better services. We want to see deep and collaborative ways of working between patients, public and the NHS. Across the country, there are good examples of that from which we want to learn. That is why the clause requires the Secretary of State to involve patients and the public in the planning of commissioning arrangements, the development and consideration of proposals for service change, and decisions that may affect how services are delivered or the range of services available.
The clause is intended to encourage early engagement and meaningful involvement in service change, thereby helping to build legitimacy, trust and better-informed commissioning decisions. As a duty, it covers the entire end-to-end commissioning cycle. I have been a commissioner myself, so although I will not detain the Committee too much on that, it is indeed part of the job of a commissioner to do that at a very early stage.
I also draw attention to the fact that the clause places a statutory duty on the Secretary of State to make arrangements to ensure the involvement of individuals who use or may use health services, together with carers and representatives, where appropriate, in commissioning activity. That duty is purposely broad, covering both existing service users and those who may reasonably rely on services in future, and will support preventive approaches and enable the consideration of wider population health impacts.
We made the deliberate choice to include specific references to carers and representatives, recognising that some individuals may require support to participate effectively in engagement and decision-making processes. That is particularly important where barriers such as disability, communications needs, sometimes age, vulnerability or unequal access may otherwise limit participation. We are ensuring that involvement is inclusive and meaningful, which I think is what all hon. Members want to see.
Specifically on amendment 28, I gently caution against creating an implication of different approaches to patient involvement for different parts of the system, leading to a two-track approach and unnecessary confusion. Instead, we propose a Government commitment to ensure meaningful consultation. We support co-production and will continue to champion it, but we do not think it necessary to put it on the face of the Bill.
The Government support involving patients and the public at every stage, and we recognise that working closely with the people and communities affected by commissioning decisions brings valuable insight into service quality, accessibility, equity and effectiveness. We will use the duties and powers available to Ministers to ensure that that principle is embedded across the work of the NHS. I hope, therefore, that the hon. Member for North Shropshire has some reassurance and will withdraw her amendment. I commend the clause to the Committee.
Dr Johnson
I beg to move amendment 51, in clause 16, page 12, line 10, at end insert—
“(3) The regulations must ensure that integrated care boards may not impose operational policies requiring patients to wait a minimum number of weeks before they may access treatment.”
This amendment would prevent minimum waiting times for NHS treatment.
The Chair
With this it will be convenient to discuss the following:
Amendment 35, in clause 16, page 12, line 10, at end insert—
“(3) Regulations under this section must make provision requiring integrated care boards to make arrangements which ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services.
(4) For the purposes of subsection (3)—
‘community equipment and wheelchair services’ means equipment, aids, home adaptations or appliances provided to support a person’s independence, safety, care or daily living at home or in the community, including hoists, hospital beds, pressure-relieving mattresses, commodes, shower chairs, walking frames, grab rails, ramps, specialist seating, postural support equipment, associated mobility equipment, and wheelchairs.”
This amendment would require the Secretary of State to make regulations which would require integrated care boards to ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services.
Amendment 63, in clause 16, page 12, line 10, at end insert—
“(2A) Regulations under subsection (2) must make provision requiring integrated care boards to—
(a) assess whether sufficient capacity exists to meet current and projected patient demand for cancer treatment, including radiotherapy treatment,
(b) maintain plans to ensure that workforce, equipment and estates capacity are sufficient to reduce waiting times for cancer treatment and improve access to treatment, and
(c) monitor and address geographical variations in access to cancer treatment, including radiotherapy treatment, with a view to reducing inequalities in patient outcomes the provision of satellite units.”
Amendment 52, clause 16, page 12, line 10, at end insert—
“(3) The regulations must include a requirement for the Secretary of State to publish the number of patients validated off of treatment waiting lists each month, and the reason for which they have been removed.”
This amendment would require publication of the number of patients validated off waiting lists each month and the reason for their removal.
Amendment 32, clause 16, page 12, line 22, at end insert—
“14Z45BA Patient choice: community services substituting for consultant-led elective care
(1) The Secretary of State must by regulations make provision to enable patients to make choices in respect of non-consultant-led community services where those services are commissioned as a direct substitute for, or to prevent a referral to, consultant-led elective services.
(2) For the purposes of subsection (1), a service is to be regarded as a direct substitute for, or intended to prevent a referral to, consultant-led elective services if it—
(a) provides assessment, treatment or management for a condition that would otherwise be referred to a secondary care specialist; or
(b) is commissioned by an integrated care board for the purpose of reducing or managing demand on secondary or elective care.
(3) Services to which this section applies include, but are not limited to—
(a) community audiology services;
(b) community glaucoma management and monitoring services; and
(c) Minor eye conditions services.
(4) Regulations made by virtue of this section must ensure that—
(a) patients are offered a choice of any clinically appropriate provider commissioned under a qualifying NHS contract for the relevant service;
(b) no limitation on the number of providers from which a patient may choose is imposed solely on grounds of cost or demand management; and
(c) patients are provided with information enabling them to make an informed choice, including information about waiting times and quality.
(5) An integrated care board must not commission a community service of a kind falling within subsection (2) in a manner which has the effect of restricting patient choice below the standard that would apply to an equivalent consultant-led elective service.”
Clause stand part.
Schedule 2.
New clause 35—Community equipment and wheelchair services: standards, performance and outcomes—
“(1) Each integrated care board must publish standards which apply in its area in relation to the assessment for and supply of community equipment and wheelchair services.
(2) Each integrated care board must monitor its performance against the standards under subsection (1).
(3) Each integrated care board must publish an annual report including—
(a) its performance against the standards under subsection (1),
(b) waiting times for the assessment for and supply of community equipment and wheelchair services,
(c) the number and proportion of people waiting longer than 18 weeks for such equipment or services,
(d) outcomes achieved for people by the provision of community equipment and wheelchair services, and
(e) steps taken by the integrated care board to improve the assessment for, and supply of, community equipment and wheelchair services.
(4) For the purposes of this section—
‘community equipment and wheelchair services’ means equipment, aids, home adaptations or appliances provided to support a person’s independence, safety, care or daily living at home or in the community, including hoists, hospital beds, pressure-relieving mattresses, commodes, shower chairs, walking frames, grab rails, ramps, specialist seating, postural support equipment, associated mobility equipment, and wheelchairs.”
This new clause would require each integrated care board must publish standards which apply in its area in relation to the assessment for and supply of community equipment and wheelchair services and publish an annual report on their adherence to these standards.
Dr Johnson
The Government say they are firmly committed to cutting waiting times and meeting the NHS’ 18-week target. It seems odd that, despite that, it is necessary for me to table an amendment to prevent systems from forcing patients to wait artificially longer for their care through the imposition of minimum waiting times.
Last year, The Times reported that at least eight local ICBs had introduced policies to pay healthcare providers for treatments only once patients have waited 12 weeks or more. I cannot think of any clinical reason why someone should wait for 12 weeks before having any treatment. At the time, the Minister said that while there was
“no formal national policy supporting minimum waits”,
local areas may
“choose to include minimum waiting times in Activity Planning Assumptions to ensure delivery of targets within agreed financial allocations…to support commissioners in managing activity to ensure they can sustainably manage within their budgets”.
I do not understand why we would want to make people wait longer than necessary.
The Royal College of Surgeons has expressed concerns and made clear that minimum waits prolong “pain and anxiety” for those made to wait longer, saying that it is
“counterintuitive…to give commissioners the green light to impose 18-week waits, while simultaneously working to ensure patients begin treatment within 18 weeks.”
Age UK deemed it a “rationing approach” that is
“potentially harmful to the health and wellbeing of older people.”
NHS England has made it clear that ICBs cannot introduce minimum waits of more than 18 weeks—that is longer than the target, so that makes sense—but waits between 12 and 18 weeks are permissible. Will the Minister explain why that is a good idea?
Amendment 51 seeks to ban ICBs from introducing any operational policies requiring patients to wait a minimum number of weeks before they may access treatment. There are safety risks involved in introducing minimum waiting times. They distort clinical priorities and may make patients wait in unnecessary pain and anxiety. Treatment should be delivered when possible, based on clinical needs. If a patient has a high level of clinical need, they might need to be treated earlier than the minimum waiting time because of the suffering they are experiencing.
Minimum waits are not only detrimental to patient experience by forcing people to live in greater pain and discomfort; in some cases, the delay may make the patient’s condition worse, and the treatment they need may be more extensive and even more expensive. Their condition may even become life-limiting or life-threatening as a result of the delay. The introduction of arbitrary minimum waiting times that do not have any relevance to patient clinical need raises worrying issues, clinically, professionally and ethically.
Minimum waits will also hinder the NHS’ ability to cut waiting lists and get waits to within 18 weeks. Some providers will have a list of people who can be available at short notice for a procedure, who they can call on if there is a cancellation on the day. If that person has not waited the minimum, that may be left as a gap, and that operation or appointment may not happen. That is wasted NHS resource.
Each month that goes by, many people are added to the waiting list, and some are removed from it. We are aware that there seem to be a lot of unexplained removals from the waiting list, and that has spiked recently. Among the people treated by NHS providers in April, around 600,000 were treated within eight weeks of referral, versus 74,000 who were treated between 14 and 18 weeks. The introduction of a minimum waiting time will therefore push back many people’s treatment by as much as 10 weeks.
Minimum waits also worsen and entrench postcode lotteries, because patients who have differential waits, based on whether their ICB has decided to implement minimum waiting times, may experience differential levels of care because of where they live. They are also another way of undermining patient choice, because patients may want to be treated in one area or one hospital because of the waiting time. If they all have different minimum waiting times, that distorts patients’ ability to choose.
Minimum waits are also completely contrary to the 10-year plan for health, in which choice and productivity were considered central features, along with the Government’s wider commitment to keep people healthy. I hope the Minister will agree with amendment 51, which would ensure that minimum waiting times cannot be instituted.
Amendment 52 also concerns waiting times. You will no doubt have seen, Dr Huq, the many newspapers articles about the Government fiddling the figures on waiting times, and there has been a spike in removals from waiting lists. People have found themselves removed from lists or going back on lists, or have suddenly found out that their waiting time started more recently than they thought. Amendment 52 would require the Secretary of State to publish the number of patients who are taken off treatment waiting lists each month and why they were removed. It is important that we are able to explain to our constituents why the Government have decided to remove them.
Helen Morgan
I want to speak to amendment 63, tabled by my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron). As hon. Members know, he has campaigned passionately and for a long time on the provision of radiotherapy. His amendment seeks to ensure that there is sufficient and equitable access to radiotherapy. Radiotherapy is required by half of all cancer patients, and it is incredibly cost-effective, but England has fewer radiotherapy machines than comparable European countries, and thousands of people have to travel long distances and over 45 minutes for their treatment, particularly in my hon. Friend’s Cumbria constituency, as he has noted on many occasions.
The Darzi review noted that radiotherapy services are on their knees. They have some of the longest waiting times for treatment and vast parts of the country are classed as radiotherapy deserts, because of lack of accessibility. Radiotherapy currently has the worst 62-day performance of all main cancer treatments, and if we are serious about ensuring that all cancer targets are met by 2029, then we need the infrastructure, people and equipment to deliver them.
Cancer cases are expected to rise 30% by 2040, meaning that radiotherapy centres must be able to keep pace. Importantly, radiotherapy can also be used at an earlier stage in treatment, potentially saving lives, saving money and meeting important waiting time targets. We really ought to be leading the way on this and keeping pace with our European counterparts so that no one is left without the treatment they so desperately need. I add my support to amendment 52, because we do need to build confidence in the reduction of waiting lists, and more transparency around reductions would be helpful.
Gregory Stafford
Amendment 35 has not been moved, but it is very similar to new clause 35, which may be moved and concerns equipment. I will address both together. I think all in this Committee would agree that ensuring timely access to community equipment and wheelchair services is vital for patient independence, dignity and recovery. I have a number of constituents who believe that they are not getting access to that equipment in the time they would expect.
We also need to ensure that we give proper consideration to the efficiency and management of resources. In particular, we should look more closely at what happens after that equipment has been distributed. Too often, items such as crutches, wheelchairs or Zimmer frames are not reviewed after issue or returned when they are no longer needed. We are already seeing a massive financial consequence of that. It was reported last year that the Royal Berkshire NHS foundation trust is losing around £70,000 a year due to patients retaining unused mobility equipment. That might seem like a drop in the ocean for the NHS, but £70,000 could fund another nurse, if we include the on-costs. These things do have consequences.
Despite distributing thousands of items, only 38% of crutches and just 15% of Zimmer frames were returned in 2024. That represents a significant loss of reusable equipment and considerable pressure on NHS resources. It also gets into the mindset of how patients use and value those pieces of equipment and how NHS users think about resources. While I think that we all agree in this Committee that the NHS should be free at the point of use, one of the downsides of that is that patients rarely think about what the cost of their care contributes. I personally think that if people understood how much crutches or medicines cost, they would use them much more usefully. Plenty of times I have spoken to pharmacists in my constituency who tell me that once a patient has unfortunately died, their family then comes to the pharmacy with a sackload of drugs that have never been used. I think that if people understood the cost of those things, they would use them more effectively and with more caution.
This is not an isolated issue but indicative of a wider problem across the system. If we were to introduce firm timelines for provision, we would need to ensure that there is a robust process for recovery, reuse and proper management of that equipment. Therefore, while I am not supportive of amendment 35 or new clause 35, I ask the Government to consider how those proposals could be strengthened by embedding clear expectations about the return and reuse of that equipment so that public funds are used as effectively as possible.
I will now turn to the two amendments in the name of my hon. Friend the Member for Sleaford and North Hykeham. Amendment 51 is important because, while I understand the Government’s intention in clause 16, as my hon. Friend has mentioned, her amendment will prevent any artificial delays in treatment by ensuring patients are seen as soon as clinically appropriate, rather than being required to wait a minimum period. It simply protects the principle that care should be based on medical need—which I think we would all agree on—rather than some administrative target. It helps avoid situations where waiting times are managed on paper rather than reduced in reality. That ultimately safeguards patient outcomes and timely access to care.
Moving on to amendment 52, I add my strong support to this amendment, because it goes to the heart of trust, transparency and patient safety in the health system. I have been speaking to constituents and individuals from across the country who have contacted me after a video I posted on my social media that contributed to the exposure of the removal of 351,000 patients from waiting lists in March of this year. The stories I have heard are deeply troubling. Those include patients who have waited years for potentially life-changing treatment only to receive notification late—or in some cases not at all—that they have been removed from the list. For many it came as a shock, while for some it came after months or years of uncertainty. This is not some trivial administrative matter. I would sum up the Minister, when responding to questions on this point, as: “Nothing to see here, this is what always happens.”
There has been such a significant jump over a period of two months that there has to be something going on here. The experiences of patients who have spoken to me about this suggest that that is happening. For those patients it is the difference between treatment and deterioration, between hope and abandonment. It is also undoubtedly affecting more vulnerable and less technologically savvy pockets of society, such as the elderly.
Dr Johnson
I should say that I am on a waiting list for treatment myself. The validation process seems to involve phoning people to check if they still need treatment, which after a long period is perhaps not an unreasonable thing to do. However, if they then say yes, they are phoned again a few weeks later; and if they say yes again, they are again phoned a few weeks after that. That puts pressure on people to say, “Okay”. If they are then asked, for example: “Would you be happy to see the consultant so that he can check that you are still listed for the right procedure, given that your condition may have changed and you may want to do something else?” it feels entirely unreasonable to say anything other than “Yes” to that. Would my hon. Friend be surprised to hear that when some people do that they find that they do indeed need the same procedure, but that their waiting time has now gone back down to zero?
Gregory Stafford
My hon. Friend makes two important points. First, of course there has to be a validation process. There has been for a long time, and I do not think that anyone is objecting to that. However, it is a question of how it is being articulated and the people it is focused on. It is being focused on vulnerable people. I have anecdotal evidence from conversations with a significant number of people since I posted that social media video that they feel pressured into coming off the lists. It does not help that trusts have financial incentives to take people off lists. Earlier this month, the Health Service Journal said that three trusts are earning more than £1 million in having people taken off lists. There is no problem with giving trusts a financial reward to do due diligence and validate the lists, but there is potentially a perverse incentive for trusts to try to knock people off them.
Gregory Stafford
The hon. Gentleman is entirely correct, and I think I said some moments ago that I am not against a validation of the list—I think I even said that I am not against some sort of financial incentive to clear the list. My concern is the extraordinary jump in the baseline in the last month or so: 351,000 people have been removed from the list for no apparent reason.
While I have been having anecdotal discussions with patients, my hon. Friend the Member for Sleaford and North Hykeham has been doing something a little more robust. It would be interesting to see the outcome of her endeavours and researches and to find out exactly what is happening in those areas. Anyone with a modicum of inquiry and common sense would say that the significant jump that we have seen in a single month deserves at least a level of interrogation, which the hon. Member for Bury St Edmunds and Stowmarket is not allowing in his comments.
Dr Johnson
Does my hon. Friend agree that when somebody—particularly a vulnerable person—receives a call asking them whether they would be prepared to see a consultant to see whether they still need treatment, they are aware of all the noise in the media? They are aware that other people are waiting. People do not want to waste NHS resources. The first time, they may think it is a routine process but, when they receive the second or third call, they may start to think to themselves, “They are trying to tell me that they want to do something else. Maybe I don’t need it as much as other people.” They feel obliged and pressurised into saying they do not need the procedure when they do.
Gregory Stafford
My hon. Friend is absolutely right. The danger in this process—especially the multiple instances of chasing within a period of weeks, which sometimes happens—is that pressure is put on patients. Again, I know anecdotally from patients who have been speaking to me that those who are most compliant—if I can put it like that—and do not want to make a fuss are generally older and vulnerable people, who feel that they are perhaps causing an inconvenience to the system. They see people with, in their view, more serious conditions or a greater need. We need to be very careful about creating perverse incentives, financial or otherwise, to try to take some of those people off the list. As I say, the significant jump that we have seen deserves more scrutiny and inquiry, and that is why I am very supportive of my hon. Friend’s amendment.
We need to understand whether patients are being removed because they no longer require treatment, as the hon. Member for Bury St Edmunds and Stowmarket said—which is, of course, entirely appropriate—or just to improve targets, present an improved picture of waiting lists, and unlock the financial benefits tied to performance metrics. There is a troubling echo here. We saw similar practices in the 2000s when patients were removed or reclassified in ways that reduced waiting list numbers without genuinely improving access to care; it damaged confidence in the system then and it risks doing so now. What concerns me most is that we may be repeating that pattern. If the Government find they cannot meet their waiting list targets, there is a real danger that the pressure to do so will translate into decisions that, intentionally or not, compromise patient safety and fairness.
Gregory Stafford
There have been a number of reports of situations where people have not received care and have died because of that, so I do not see the hon. Member’s point. I think that, with amendment 52, my hon. Friend the Member for Sleaford and North Hykeham is trying to ensure that when the statistics are published, we can scrutinise the reasons behind them. The hon. Member for Ashford may be entirely right; let us imagine that is the case, and there is no gamifying or pressure going on. Why not allow the public to see that? Why not put to bed the HSJ stories that say there is something fishy going on? He should welcome that level of transparency and scrutiny to back up his argument if he is correct.
Dr Johnson
The hon. Member for Ashford talks about social media and social media comments. I wonder if, where the DHSC or the Government have put that waiting lists are falling, my hon. Friend has read any of the comments that come in from the general public below such proclamations.
Gregory Stafford
My hon. Friend tempts me to be political; I will rise to that briefly. Yes, I have seen them and she is right. There is a clear concern that when the Government make all these proclamations about how brilliant the NHS has suddenly become, the reality on the ground does not meet that for many patients. However—I am being gentle now—that is probably not exclusively a problem with this Government. My right hon. Friend the Member for Melton and Syston might kill me, but I am sure other Governments have done something similar.
I will go back to amendment 52 because I think it is really important. Let me be clear: it would not prevent people being removed where appropriate; it would simply require the Government to be honest about why. It requires the Secretary of State to publish the number of patients removed from waiting lists each month and, crucially, the reasons why. If everything is being done properly there should be nothing to fear from such transparency, but if there are problems, sunlight is the best disinfectant and the amendment is exactly what we need. We owe it to our constituents and to every patient in the country to ensure that waiting lists are not improved just on paper, or in a press release, or in a social media tweet, or at the expense of the care of real people but actually improved.
If we are to strengthen patient choice, particularly in relation to community services that substitute for or prevent hospital admission and treatment, there are some good measures in clause 16. However, as my hon. Friend the Member for Sleaford and North Hykeham said, there are concerns, so I hope the Minister will be able to pick those up in her comments when she winds up.
Karin Smyth
There are a number of amendments in the group. Amendment 35 was not moved but as the hon. Member for Farnham and Bordon spoke to it, I will comment on that amendment, which is in the name of my hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis). Community equipment and wheelchair services are really important to us and—to allay the concerns of the hon. Member for Farnham and Bordon—that is why the medium-term planning framework requires that, from this year, all ICBs and community health services must actively manage and reduce waits over 18 weeks and develop a plan to eliminate all 52-week waits. I assure the Committee that we will hold the ICBs for their performance. The community health services situation report has a specific monitoring line, covering children and young people and covering adults, for the wheelchair, orthotics, prosthetics and equipment category. We intend to continue that work following NHS England’s abolition. Consistent national standards will help us to identify the best and the weakest-performing areas, to identify what improvements need to be made and to tackle the longest waits.
Amendment 52 was tabled by the hon. Member for Sleaford and North Hykeham. We are committed to ensuring that all patients receive the NHS care they need in a timely manner, and I recognise the importance that Committee members have placed on that matter. The NHS constitution sets out that patients should start consultant-led treatment within 18 weeks of referral, and it is imperative that the system continues to work towards returning to and then upholding that standard.
I listened with great care to the comments from Members on the Opposition Benches, but I was here—as were you, Dr Huq—during the last couple of Parliaments; I was here as waiting lists rose and rose after 2012, under the previous Government’s stewardship, until they reached 4 million people, all waiting an inordinate amount of time. That Government had no kind of approach to reducing the numbers; they were quite content to have 4 million people on waiting lists, and to never bring forward measures to change that. They were quite content not to challenge NHS England or trust boards about why people across the country in all our constituencies were languishing on those lists. We are determined to resolve that situation.
Karin Smyth
I will move on. It is absolutely right that integrated care boards, as local commissioners, retain the ability to manage their services and waiting lists effectively, given the shocking numbers that they have inherited. This is complicated, difficult work: commissioners have to balance demand, capacity and clinical need, and a prohibition such as the one set out in the amendment would threaten to remove legitimate flexibilities that are required at the local level to ensure that services are delivered safely and efficiently.
We are clear that systems should not be setting minimum wait times that exceed the 18-week constitutional standard, but hon. Members will appreciate that not all elements of waiting are inappropriate. In many cases, they reflect clinical pathways, sequencing of care or the need to prioritise the most urgent patients. It is imperative that clinical judgment and urgency remain the key drivers of prioritisation, which is something the amendment threatens to remove.
Turning to amendment 52, I recognise that Members across the House are committed to ensuring that all patients receive the NHS care they need in a timely manner. Validation is a routine and long-standing part of waiting list management by providers. It ensures that patient records are accurate, that patients are on the best pathway to meet their needs and that they still need their appointments. Routinely validated waiting lists will support a return to the 18-week NHS constitutional standard.
Reasons for removal as a result of validation include a patient no longer needing their appointment or there being a duplicate appointment. The previous Government left behind some systems and trusts in such a poor condition that they give out duplicate appointments, and we need to resolve that as part of our work. Other reasons for removal include a patient’s record not being properly updated following treatment or a clinical decision—another sign of the inefficiency that the previous Government left behind.
Karin Smyth
Once again, my hon. Friend is absolutely right. He is expert on this issue and has outlined to us some excellent clinical examples. I look forward to debating the single patient record further in Committee.
Importantly, any patient removed from a waiting list should be notified alongside their GP. Data on the total number of removals from waiting lists is published by NHS England. That data includes, but cannot separately identify, patient pathways removed as a result of validation. The Department remains committed to the transparent publication of official waiting list statistics following the abolition of NHS England, although there are no plans to publish more detailed breakdowns. NHS staff are delivering record levels of elective activity, which has enabled us to meet our interim target of 65% of patients being seen within 18 weeks.
Dr Johnson
If a person has been waiting more than 18 weeks, the trust calls them and asks them to see a consultant to check whether they still need the appointment or whether they need a different treatment. If, after having that appointment, they are told that they still need the treatment, that same day they go back on the waiting list as if it were day one. Therefore, they have not waited less than 18 weeks, even though the Minister’s statistics might suggest they have. Does she accept that?
Edward Argar
The hon. Member for North Shropshire makes the point very well. Back when I was a Minister, and subsequently shadow Secretary of State, she raised that point with me. The clause is sensible. The Minister articulated concisely and reasonably why it is necessary. It is the nature of any devolution arrangements that a little bit of cross-border co-operation is required along the border to make sure that services work effectively for people. This may have changed, but in my experience the majority of those crossing the border were people from Wales coming for secondary care services in a hospital on the English side of the border, so I think the clause is entirely reasonable.
I echo the hon. Lady’s request: I would be grateful if the Minister updated the Committee on what conversations she has had, particularly with the Welsh Government, but also with the Scottish Government, to ensure that there is reciprocity and that they will put an equivalent provision into their laws to ensure that patients in England are taken into consideration in their healthcare planning.
Dr Johnson
The clause imposes a duty on ICBs to have regard to the likely impact of their commissioning decisions on areas of Wales and Scotland close to the border. In some respects, this is like other parts of the Bill—a statement of the obvious regarding a person’s job. Are we suggesting that the Secretary of State, and in particular ICBs, would not consider the effect of their decisions? I hope that they would, but, given that the clause is there, what teeth does it have? What if they do not? Is there any consequence in the Bill if they do not? As others have said, will the Minister confirm whether there is a reciprocal agreement with Wales and Scotland? If there is not, what negotiations has she entered into and what progress are they making?
Karin Smyth
As an MP in Bristol, which is not quite on the border, but is pretty close, I absolutely understand. We have relationships with our Welsh colleagues and I have been involved in debates on this matter. The clause ensures that, with the abolition of NHS England, regard is had to to arrangements with our colleagues across the border. We all understand that devolution means that different arrangements will be made in the constituent parts of the United Kingdom. It is not for the UK Government to determine what those are, because they are devolved. However, I assure members of the Committee that across the piece in the Department, and indeed across the Government, regular meetings and conversations on these and other matters with regard to the devolved functions are a regular part of the work that we do.
Question put and agreed to.
Clause 17 accordingly ordered to stand part of the Bill.
Clause 18
Transfer schemes in connection with integrated care boards
Question proposed, That the clause stand part of the Bill.
Karin Smyth
The clause gives the Secretary of State the powers to make transfer schemes where an ICB is being abolished or established, or where the area covered by an ICB is being amended. A transfer scheme ensures that all the staff, property rights, responsibilities and liabilities, other than criminal liabilities, of the ICB being abolished are transferred to another ICB. That ensures that the ICB taking over has the appropriate information and resources to continue to arrange healthcare services for their population. In the past, that has been used to support the restructuring of ICBs to achieve geographical boundary alignment with strategic authorities, as set out in the 10-year health plan. The power also allows transfers to the Secretary of State and, when a new ICB is established, allows the transfer of staff from an NHS trust or foundation trust or from a special health authority.
Following the abolition of NHS England, we expect that Ministers will continue to need to be able to make transfers between ICBs. The clause allows that as needed. I therefore commend the clause to the Committee.
Dr Johnson
I have one question for the Minister. Which ICBs does she envisage being abolished, or is this just a precaution for the future?
Karin Smyth
It is precautionary to give the power in the event—future-proofing the Bill.
Question put and agreed to.
Clause 18 accordingly ordered to stand part of the Bill.
Clause 19
Integrated care boards: power to provide assistance
Question proposed, That the clause stand part of the Bill.
Karin Smyth
The clause relates to the power for integrated care boards to provide assistance and support in relation to the health service. It replaces section 14Z48 and, in part, section 12ZA of the National Health Service Act 2006 with a clearer and more flexible power. At present, the various ICB assistance powers are narrower and more confusing. Section 12ZA provides for certain forms of practical assistance in connection with ICBs’ commissioning functions, while section 14Z48 provides a more limited power to make grants or loans. Other specific assistance powers sit elsewhere in the legislation, including in sections 96, 112, 124 and 147, which allow assistance and support for primary medical services, dental, ophthalmic and pharmaceutical services.
Clause 19 replaces all those separate powers with a general power for ICBs to provide assistance or support. The clause will make it clearer when an ICB may support providers, prospective providers or other activity connected with the health service. It will allow an ICB to provide assistance or support to a person who is providing or proposing to provide services as part of the health service. It will also enable an ICB to support a person who is carrying out or proposing to carry out activities that the ICB considers to be conducive to the health service. The assistance may include financial assistance, making available the services of ICB staff, or making available any other ICB resources. The clause also allows assistance to be provided on agreed terms, including terms about payments by or to the integrated care board.
The clause supports ICBs in their role as strategic commissioners. ICBs need to be able to support the development, improvement and resilience of services for their populations. They need to be able to cultivate their provider sector to meet the needs of the people they are responsible for, and they need to be able to do so in innovative and flexible ways. The clause gives them a clearer statutory basis for doing so. This is only an enabling power; it does not require an integrated care board to provide assistance and it does not create any entitlement for a person to receive assistance, nor does it disapply the ordinary legal and financial controls that apply to integrated care boards, or any other element of the usual way in which NHS bodies are overseen and regulated.
The clause should be read alongside clause 9, which creates a broadly analogous assistance power for the Secretary of State. In combination, the clauses support the move to a simpler, more flexible statutory framework that enables everybody, from the centre to ICBs, to discharge their responsibilities in ways that can be adapted to the complexity and multiplicity of circumstances they will inevitably encounter. I commend clause 19 to the Committee.
Dr Johnson
The Government’s explanatory notes state that the clause is intended to give ICBs the ability to provide a broad range of support to those involved in providing or administering the health service. The flexibility there aligns with the Government’s stated vision for more autonomy across the system. I have a couple of questions. If the ICB were to provide support in a way that was out of line with good practice or what is expected by the Department, what would be the recourse? Where will it be possible for right hon. and hon. Members to see the financial expenditure that ICBs make in any such circumstance?
Karin Smyth
I thank the shadow Minister for her questions. ICBs are part of the accountability outcomes framework, so they will be monitored in the usual way, and any expenditure by the ICB—and, indeed, by the Department—is recorded in the departmental accounts.
Question put and agreed to.
Clause 19 accordingly ordered to stand part of the Bill.
Clause 20
Performance assessments of integrated care boards
Question proposed, That the clause stand part of the Bill.
Karin Smyth
I recognise the right hon. Gentleman’s expertise as a former Minister in this role. I do not want to mislead him, so I will come back to him in writing on both those points, if that is acceptable. He tempts me to be more prescriptive than I think we intend to be at this point, but I will ensure that he gets a proper answer to both questions. I commend the clause to the Committee.
Dr Johnson
As has been said, the clause replaces the part of the NHS Act that requires NHS England to carry out performance assessments of the ICBs and rewrites it so that the Secretary of State has to carry out those assessments. That makes some sense, but, as the Minister said, it takes out the criteria against which the ICBs will be assessed.
I accept what the Minister says—she wants those criteria to be set out more flexibly than can be done in primary legislation—but it is not reasonable or fair to assess people against criteria that they do not know in advance. It will be important, will it not, that ICBs know in advance what those criteria will be? Given what she said to my right hon. Friend the Member for Melton and Syston about writing to him, will she commit to writing to us to say not only what the criteria will be at the moment, but how far in advance ICBs can expect to receive them before they are expected to work to them and then be assessed against them?
Will variation be a factor in whether an ICB is deemed to have been performing well or not? We know that there is a tension in the Bill between the Secretary of State’s need to equalise provision and the ICBs’ desire and intention to vary it and innovate. Given that the Secretary of State is a political individual, how will the assessment process be conducted in a way that gives ICBs and their leaders confidence that there will not be political interference in it?
Karin Smyth
Of course ICBs will know how they are going to be assessed; that will be in guidance in the usual way. In the last two years, in planning terms, we have brought forward all that work for the system—including on the finances—in order that the system works more efficiently, and we will continue to seek to do that.
The hon. Member, as she has several times in the Committee, returned to the question of variation. When there is devolution and local systems are different, there will be a degree of variation, as I have said. In performance management terms, where there is unwarranted variation, we will seek justification and understanding of that. Sometimes, there is variation for geographical reasons. There may also be historical structural reasons in a local system, or temporary reasons why performance is variable. We would look at that as part of that general work.
Question put and agreed to.
Clause 20 accordingly ordered to stand part of the Bill.
Clause 21
Membership of integrated care boards
Dr Johnson
I beg to move amendment 46, in clause 21, page 15, leave out from line 33 to line 6 on page 16 and insert—
“(2) The constitution must provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include—
(a) at least one person nominated by one or more NHS trusts or NHS foundation trusts which provide services under arrangements made by the integrated care board, in accordance with regulations made under sub-paragraph (2A);
(b) at least one person nominated by a body representative of providers of primary medical services whose area falls wholly or mainly within the area of the integrated care board, in accordance with regulations made under sub-paragraph (2A);
(c) at least one person appointed by a local authority whose area falls wholly or partly within the area of the integrated care board; and
(d) at least one member nominated by the mayor of each mayoral strategic authority whose area coincides with, or includes the whole or any part of, the integrated care board's area (if any).
(2A) The Secretary of State may by regulations make provision about the nomination of ordinary members under sub-paragraph (2)(a) and (b), including provision about which NHS trusts, NHS foundation trusts or representative bodies are entitled to make nominations.
(3) The constitution must set out the process for making nominations under sub-paragraph (2).
(4) A person making a nomination under sub-paragraph (2) must have regard to any guidance published by the Secretary of State as to the selection of candidates.”
This amendment modifies Clause 21 so that, rather than replacing the existing mandatory membership requirements in Schedule 1B to the National Health Service Act 2006 with a requirement for mayoral representation alone, the new sub-paragraph (2) reinstates and consolidates the full range of required ordinary members.
The Chair
With this it will be convenient to discuss the following:
Amendment 25 in clause 21, page 15, line 38, at end insert—
“(2A) The constitution must also provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include at least one member nominated jointly by the local authorities whose areas coincide with, or include the whole or any part of, the integrated care board's area.”
This amendment would require integrated care boards to have a member jointly nominated by local authorities from within the board's area, as is currently the case but would otherwise be removed by clause 21.
Amendment 45, in clause 21, page 15, line 38, at end insert—
“(2A) The constitution must provide for the ordinary members as mentioned in sub-paragraph (1)(b) to include at least one member nominated by local primary care providers.”
This amendment would ensure that ICBs have to have representation from primary care providers.
Amendment 26, in clause 21, page 16, line 3, leave out from “mayor” to “sub-paragraph (2)” on line 4 and insert
“or local authority nominating an ordinary member as mentioned in sub-paragraphs (2) and (2A).”.
This amendment is consequential on amendment 25 and would require a local authority involved in nominating a member of an integrated care board to have regard to guidance published by the Secretary of State.
Amendment 27, in clause 21, page 16, line 9, at end insert—
“‘local authority’ has the meaning given by section 2B(5);”.
This amendment is consequential on amendments 25 and 26 and defines the term “local authority”.
Clause stand part.
Dr Johnson
At present, integrated care boards will have a chair, a chief executive and at least three further ordinary members. Those three ordinary members will include a representative of the NHS trusts and NHS foundation trusts in the area, someone from the primary medical services in the area and someone nominated by the local authority areas within the ICB area. Under the clause, the requirement for those individuals is replaced with a requirement to have someone from each of the mayoral authorities.
Because of the order in which the Government have done this—removing half the budget from the ICBs, which has caused them to merge in a way that is not coherent with the Government’s not-yet-complete local government reorganisation—we have a situation where representation is not even. For example, in my ICB area the Mayor of Greater Lincolnshire and the Mayor of the East Midlands will each be able to choose someone to represent them on the board, but the proportions of the population are not even. Lincolnshire will be over-represented, which is not an issue for my constituents, but it may be for those from Nottinghamshire and Derbyshire. Likewise, the northern part of Greater Lincolnshire, which is in a different region, has a small population relative to its ICB. Some mayors will therefore have representation that is not proportionate to their population size.
There is surely a risk that the next step will be for the Government to say they want to make things more even, with ICBs working in relation to mayoral authority areas. Yesterday, the Minister for Care suggested at his appearance before the Health and Social Care Committee that the ICBs should be aligned with strategic authorities, but the only way in which that can happen once the Government have decided where the strategic authorities will be is if things are changed once again.
That brings ongoing costs—financial costs, opportunity cost for service development, and cost to the people delivering these services. The people working hard to try to deliver the Government’s plan find themselves and their jobs threatened and chopped and changed all the time. We heard evidence that the concentration on reorganisation rather than service delivery, provision and development is causing distress to those people.
We also heard about the effect on social care, which, certainly in Lincolnshire and in other places, is delivered by the upper-tier local authority, but not all mayors have any responsibility for health—our mayor does not. We will therefore have someone who is not responsible for health on the ICB while someone responsible for delivering social care will have their seat on the ICB removed. I am afraid that I simply do not understand that. I watched through several times the Minister for Care’s Select Committee appearance, and I still do not understand the rationale. I will be grateful if the Minister for Secondary Care could explain that.
Gregory Stafford
The clause will replace the constitutional requirements contained in paragraph 8(2) to (4) of schedule 1B to the 2006 Act so that “ordinary members” must now include at least one member nominated by the mayor of each mayoral strategic authority whose area coincides with or includes the whole or any part of the ICB’s area. The ICB’s constitution must set out a process for making such a nomination, and a mayor nominating an ordinary member must have regard to any guidance published by the Secretary of State, following the abolition of NHS England, as to the selection of candidates.
The definition of a local authority in paragraph 8(7) of schedule 1B to the 2006 Act will be replaced with the definition of a mayoral strategic authority. Sub-paragraph (1), outlining the process to determine the appointment of an ordinary member, and sub-paragraph (6), specifying that one ordinary member must have knowledge and experience in mental health services, are both retained. The clause therefore represents a clear shift in the structure of integrated care boards and, in my view, an unwelcome one, by removing the requirement for representation of GPs, local authorities and NHS trusts, while introducing a requirement for representation from mayoral authorities.
Those are not minor features of the system. The inclusion of local authorities in particular was designed to ensure that decision making reflected local needs and supported genuine integration between health and social care.
For as long as I can remember, Governments of all colours have talked about bringing health and social care together. Some have been more successful at that than others, but there should be agreement across the House that much more needs to be done. With this clause, the Government seem to be taking at least one step back—I would say numerous steps—from trying to bring health and social care together. Like my hon. Friend the Member for Sleaford and North Hykeham, I watched the Health and Social Care Committee’s discussions with the Minister for Care yesterday, and I too cannot fathom why the Government are doing it. I hope that it is an oversight and that, once the Minister goes away and reflects on it, she will look to table some amendments further down the line—I am sure that she will vote against ours today—so that we can bring these matters back.
I am especially concerned about the removal of local authority representation. We are effectively asking local authorities to continue to deliver vital services while removing their voice in the room where strategic decisions about health and social care are made. That raises a fundamental question about how the integration is intended to work in practice. There is also a broader concern about the direction of travel. We are moving away from place-based representation towards a model that places greater emphasis on these mayoral structures, yet the legislation is not prescriptive about who the mayors appoint, and colleagues within and without this Committee have already raised concerns that there is a gap in the understanding at the centre about how local authorities operate in practice.
That brings me to the point raised by my hon. Friend the Member for Sleaford and North Hykeham and the hon. Member for Winchester. I apologise; the Minister said that she did not want a geographic tour of our constituencies, but I am afraid that she will get one now. Part of my constituency sits in Hampshire in the Hampshire and Isle of Wight ICB, and as the hon. Member for Winchester said, we may or may not have mayoral elections in a year’s time. Hampshire county council has launched a judicial review against the proposed local government reorganisation; if that is successful, or even if it delays the process, this Bill will come into effect without our having a mayor, and there will be no representation for anybody on this board. We need clarity from the Minister on who will represent the people on the board if there is no mayoral authority. I would say that local authorities—Hampshire county council in this case—should remain on that board, at least until there is a mayoral authority.
Dr Johnson
Where a mayor is from one political party and local authorities are run by different political parties, the mayor, as part of the ICB, will be able to make decisions about spending done by authorities that are run by different parties. That will surely create a political conflict, or at least the potential for one.
Health Bill (Sixth sitting)
Caroline Johnson ExcerptsThursday 25th June 2026
(2 months, 3 weeks ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 25 June 2026 - (25 Jun 2026)
The Chair
Before we begin, I remind Members to switch all electronic devices to silent. Tea and coffee are not allowed during sittings. As Members will have noticed, I have taken my jacket off, so please feel free to take yours off—it is hot in here.
Clause 12
Commissioning functions: responsibility
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I beg to move amendment 57, in clause 12, page 10, line 10, at end insert—
“(4A) Before making regulations under subsection (1)(b) that would alter the range of services or facilities which the Secretary of State is required to commission nationally, the Secretary of State must—
(a) prepare and publish a commissioning transition plan in accordance with subsection (4B),
(b) consult in accordance with subsection (4C), and
(c) lay the commissioning transition plan before Parliament.
(4B) The commissioning transition plan must set out—
(a) a description of each service or facility that the Secretary of State proposes to add to, or remove from, national commissioning responsibility under section 3B(1)(b), and the reasons for each proposed change;
(b) a description of the body or bodies to which commissioning responsibility for each such service or facility would transfer and the basis on which that body is considered capable of commissioning that service or facility effectively;
(c) an assessment of the impact of each proposed change on patients who rely on the affected services or facilities, including—
(i) patients with rare diseases or conditions,
(ii) patients whose needs cannot be met by a single integrated care board area, and
(iii) patients who may face differential impacts on account of a protected characteristic within the meaning of the Equality Act 2010;
(d) the transitional arrangements to be put in place to ensure continuity of service for patients during any transfer of commissioning responsibility;
(e) the workforce and capacity implications for the bodies to which commissioning responsibility would transfer;
(f) the financial arrangements for the transfer of commissioning responsibility, including the funding to be allocated to receiving bodies; and
(g) the proposed timetable for implementation of each change.
(4C) Consultation under this subsection must include—
(a) integrated care boards that would assume commissioning responsibility under the proposed changes;
(b) NHS trusts and NHS foundation trusts providing the services or facilities affected by the proposed changes;
(c) patient groups and representative organisations for patients likely to be affected by the proposed changes;
(d) clinicians with expertise in the services or facilities affected; and
(e) such other persons as the Secretary of State considers appropriate.
(4D) Consultation under subsection (4C) must—
(a) run for a period of not less than twelve weeks, and
(b) begin no earlier than the date on which the specialised commissioning transition plan is published under subsection (4A)(a).
(4E) Following the consultation period, the Secretary of State must publish a response to the consultation that—
(a) summarises the representations received,
(b) sets out the Secretary of State's response to the key issues raised, and
(c) describes any amendments made to the specialised commissioning transition plan in light of consultation responses.
(4F) No regulations under section 3B(1)(b) that alter the range of nationally commissioned services or facilities may be made until at least 60 days have elapsed after the consultation response required by subsection (4E) has been published.”
This amendment requires the Secretary of State to publish and consult on a commissioning transition plan before making any regulations under the new section 3B of the National Health Service Act 2006 (inserted by Clause 12) that would alter which services are commissioned nationally.
The Chair
With this it will be convenient to discuss the following:
Clause stand part.
Clause 13 stand part.
Dr Johnson
In essence, the clause confers the commissioning duties of NHS England on to the Secretary of State, because NHS England is being abolished. In that respect, it is quite straightforward. In the existing National Health Service Act 2006, which is to be amended, section 3 sets out the duties of integrated care boards as to commissioning health services, and section 3A similarly. Section 4 is about NHS England’s responsibility for the provision of high-security psychiatric services. In essence, clause 12 replaces the references to “NHS England” in sections 3 and 3A with “the Secretary of State”. The ICBs now must act consistently with the discharge by the Secretary of State of the section 1 duty to promote a comprehensive health service. That is consistent with the aims of the Bill. I have concerns, which I have expressed previously, about how the Government ensure that the Secretary of State can make those decisions fairly, on the basis of clinical need, rather than because of pressure from a lobby group, a celebrity campaign or such like, but again, that seems consistent.
The clause also replaces entirely section 3B of the 2006 Act. Under the previous section 3B, the Secretary of State could direct NHS England to commission the service nationally; the proposed new section 3B confers a regulation-making power to require the Secretary of State to arrange nationally services for members of the armed forces and their families specifically, as well as such services or facilities as may be prescribed. Perhaps the Minister will comment on what sort of services or facilities might be prescribed under that proposed new section.
In doing that, the Secretary of State must have regard to the number of people needing the service, the cost and the number of possible providers. That reflects a balance. Some services, such as hip replacements, are very common. They occur in all areas of the country, perhaps at different rates, but they are broadly a common service. Accident and emergency is another common service. Some people, however, have the misfortune to have a condition that is rare and requires specialist care, in small numbers. That needs to be commissioned on a more national basis, because of the need for specific expertise among commissioners and health professionals.
In subsection (4), proposed new section 3B(5) modifies section 4 of the 2006 Act so that the duty to arrange high-security psychiatric services transfers from NHS England to the Secretary of State, and the Secretary of State gains a new power to direct the providers of those bodies—but only non-public bodies—if he is satisfied that the provider is already licensed under the Health and Social Care Act 2012 and would be required by its licence to obey the direction.
In one respect, as I said, it is necessary to transfer powers to Secretary of State, now that NHS England is to be abolished, but I have a couple of questions. NHS England published a direct commissioning update on 2 March, which describes a new commissioning structure. At the moment, NHS England commissions regional NHS England bodies and the ICBs at a more local level. The update suggests that we will have the ICBs commissioning services, and the Secretary of State instead of NHS England, but that each of the seven regions will have an office for pan-ICB commissioning, known as an OPIC, to support ICB commissioning services—both standard commissioning and at-scale commissioning in some instances.
How is that more efficient than the old structure? Are we just going to see the people working in the regions of NHS England get made redundant, at a huge cost to the state, only to be re-employed by the OPIC? What is the estimated cost of that? Is that the intention? We are going to either lose the expertise of the regional advisers in NHS England or end up re-employing them having paid them redundancy. Can the Minister explain which she thinks it is?
There is a hugely long list of specialist nationally commissioned services. Can the Minister guarantee that those services will not be moved locally? The ICBs only have so much capacity. It will be a challenge for an ICB to deal with conditions that may affect only one or two people in its area in a given year, particularly given the 50% budget cut; obviously, it will prioritise things that affect more of its population. People who have the rare conditions that are currently commissioned nationally may be worried that they will not get the same level of service that they are getting at the moment.
The direct commissioning update talks about prisoners and the justice system. At the moment, NHS England works directly with the Ministry of Justice to commission healthcare for those in the justice system. That includes adults in the custodial system, children in secure children’s homes, non-custodial care, sexual assault and abuse centres, and abuse referral centres.
There are eight high-security category A prisons in England. Instead of being specially commissioned as one batch, they are going to be commissioned specially by their local ICBs. Where are the ICBs going to get the advice and expertise to do that? Dealing with category A prisoners is about not only managing the prisoner and providing them with healthcare, but keeping the people providing that healthcare safe while they are working. This is a specialist area. I am interested to understand why the Minister thinks it will be managed best locally. If, under her new system, it is to be managed locally and the prisoner’s home address ICB is different from the prison address ICB, where will the funding move from and to? Will the prison’s ICB be reimbursed by the prisoner’s home ICB or will it bear the brunt locally?
What will happen to the sexual abuse referral centres? It is perfectly possible, particularly in some areas of the country, that an individual is sexually assaulted in one ICB area, lives in another and reports a crime in a third. Will local commissioning have an impact on where the individual needs to go for their pretty intimate examination and assessment? Has the Minister considered that? What is her view?
What happens to healthcare for migrants? That is another area that is dealt with partly by the justice system at the moment. Can the Minister update us on that? There are over 100,000 people in asylum accommodation, including 30,000 in hotels, and many members of her party are keen to welcome even more. Who will be responsible for commissioning their care?
The Government are also delegating the child health information services, which are the record of whether children have been vaccinated and such like. Given that they are planning to have a single patient record and the electronic red book, why do they want the services to be commissioned locally rather than nationally? Do they expect commissioning for a uniform service, such as a screening service, to lead to differential outcomes—and if it does not, what is the rationale for it?
A particular example is blood spot screening. The Minister will be aware that there was a Westminster Hall debate earlier in the week on spinal muscular atrophy, in which blood spot screening was mentioned. Metachromatic leukodystrophy is another condition for which people want blood spot screening. If blood spot screening is to be commissioned on a local ICB level, will ICBs be required to do it in line with Government guidelines, or will they be able to vary the service they provide to those patients?
By delegating more to ICBs, Ministers are creating variation. On one hand, they want local differentiation and variation; on the other hand, they have put in a clause that requires the Secretary of State to limit local variation. Again, there is a tension there. Will the Minister talk about that?
Moving to some technical points, I noticed that “hospital premises” is defined in section 4 of the 2006 Act, but I cannot find it defined in the Bill. Under the original section 3B of that Act, the Secretary of State had to obtain appropriate advice before making regulations about commissioning services; when services were commissioned locally or nationally, the Secretary of State had to take expert advice. That seems like a sensible thing that we want the Secretary of State to do. One would hope that if the Secretary of State were doing his job properly, he would do that, but it seems a little odd that that requirement has been taken out, as though there is an intention for the Secretary of State not to do that. I would appreciate the Minister’s comments on that.
Proposed new section 3B provides that a direction can be given to a person other than a public authority regarding high-security psychiatric services. The Minister knows that high-security psychiatric services are currently provided at Broadmoor, Ashworth and Rampton, which are still stand-alone units run by NHS providers. Does she plan to ask a private provider—someone other than a public authority—to run those facilities? If not, what is the purpose of the clause? There is a secure children’s unit in Sleaford in my constituency. What will happen to those children if it is commissioned locally, and where will the money flow from?
We asked in a previous sitting whether the Minister thought that the new Prime Minister will want to continue with this Bill. When it comes to the OPICs, in essence the Government will be firing staff from one job, paying them redundancy, and rehiring them, potentially on different terms and conditions, to do a similar job in the OPICs. Is the Minister aware that the right hon. Member for Makerfield (Andy Burnham) used to speak out against firing and rehiring staff, and abolishing and recreating organisations? That is essentially what is happening, so will she have to abandon these changes?
Dave Robertson (Lichfield) (Lab)
We have heard a few times about Conservative fears about redundancy payments and so on. Why did they not add NHS England to the list of organisations covered by the modification order when they had the opportunity to do so? Is the hon. Lady aware of a reason why that did not happen when the Conservatives were in government?
Dr Johnson
I am afraid I do not know the answer to that question. The key point is that it is not logical to abolish a three-tier structure and recreate it with taxpayers’ money to do exactly the same thing. If NHS England is replaced by the Secretary of State, the regional NHS England is replaced by the OPICs and the ICBs are at the bottom—the more local tier—what has changed? The middle tier will be doing the same thing.
Dave Robertson
The modification order is a piece of legislation that is often used in the public sector. It means that when people from a lot of public sector organisations are made redundant and find alternative employment at another state-funded organisation, they are not entitled to a redundancy payment. During their 14 years in power, it would have been entirely possible for the Conservatives to add NHS England to the list of organisations covered by the modification order. That would have prevented the costs that the hon. Lady has mentioned several times. It just seems like they did not take the opportunity to do that, and now they are saying that they should have done that when they were in government.
Dr Johnson
But we were not planning to abolish NHS England, so we had no reason to worry about redundancy. We were not planning a large-scale abolition—the largest that has ever happened in this country.
Amendment 57 would require the Secretary of State to publish and consult on commissioning transition plans before making regulations under proposed new section 3B that alter which services are commissioned nationally. It is a very reasonable amendment that would just mean that people get answers. It would mean that vulnerable people with unusually rare or highly complex conditions requiring regional or even national treatment could understand any changes the Government planned to make. We know that some services are delivered in only three or four centres in the UK. If a patient lives far from a centre, and suddenly that centre is closed, that can have huge travel and service implications, which can create huge distress and worry and make care worse.
Helen Morgan (North Shropshire) (LD)
It is a pleasure to serve with you in the Chair, Ms Lewell. In general, the Liberal Democrats support clauses 12 and 13. We think that local decision making and community empowerment in the NHS, including on commissioning decisions, is the right thing to be doing.
However, I echo some of the concerns of the shadow Minister, the hon. Member for Sleaford and North Hykeham, particularly on specialist commissioning. I declare an interest as vice-chair of the spinal cord injury all-party parliamentary group. We are concerned that expertise in low-volume, very specialist concerns will be lost if the commissioning is pushed out to multiple ICBs. My understanding is that specialist commissioning sat with NHS England in the first place because of concern that multiple commissioning groups would struggle to deal with low-volume, complex issues.
The president of the Royal College of Psychiatrists warned earlier this month that the new commissioning structure lacks mental health experts, with only one senior mental health lead across the seven new regional commissioning hubs taking specialised services from NHS England. Equally, the chief executive of the Derby and Derbyshire, Lincolnshire, and Nottingham and Nottinghamshire ICB cluster has said that it does not look like there will be a requirement for senior mental health expertise in reorganising ICBs. Will the Minister reassure us that when the Department designs which specialist services will be pushed back down to ICBs and which will be retained centrally, it will be minded to listen to representations from experts in the sector?
There are excellent services located geographically by accident—for example, the orthopaedic hospital in my constituency and the veterans service that goes with it. Both are highly valued, but they need specialist commissioning at national level to be utilised properly and to provide the best outcomes for patients. I would be grateful for the Minister’s reassurance on those points.
Dr Johnson
I agree with much of what the hon. Lady has said. Does she therefore support amendment 57, which would ensure that such a consultation takes place?
Helen Morgan
Yes, we would support the amendment, which is a reasonable way to get there, but an assurance from the Minister that the Department will consider specialist commissioning and really think that through properly before the powers are delegated to ICBs would be sufficient.
The Minister for Secondary Care (Karin Smyth)
Clause 12 inserts new section 3B into the National Health Service Act 2006, re-establishing the responsibility of the Secretary of State to commission services. Although we intend ICBs to commission the vast majority of services, as we discussed this morning, we will use this regulation-making power to set out the small number of specialised services that the Secretary of State will be responsible for. That may include, for example, proton beam therapy, alongside a small number of other specialist services not currently suitable for ICB commissioning, such as gender dysphoria services and clinical genomics. By their nature, those are services to which national commissioning is appropriate because, for example, they have fewer patients or providers, greater or changeable costs, or they require specialist clinical expertise and input. Having a regulation-making power allows us to future-proof the system and update the regulations when new services or treatments emerge, or when services become cheaper or mainstream and therefore sit better with ICBs.
I now turn to amendment 57, which was tabled in the name of the hon. Member for Sleaford and North Hykeham. I recognise that any change to the way these services are commissioned matters enormously to the patients who depend on them. The hon. Lady used the word “worried”, and I understand that. Any change must be made with the greatest of care. However, the amendment would require the Secretary of State, before any regulations are made that alter the range of nationally commissioned services and regardless of the scale of the change, to publish a transition plan covering seven prescribed matters, to consult five prescribed categories of persons for a minimum of 12 weeks, to publish a response to that consultation and then to wait a minimum of 60 days before the regulations can be made.
As I have said, I understand and share the concern about continuity of care and the careful allocation of responsibility that lies behind it, but the proposals in amendment 57 are not the right way to address that concern. It proposes a fixed sequence of steps with minimum time periods that would apply to every change without exception. Taken together, the prescribed steps would add the better part of half a year to any change, including changes that are minor or technical, or that, for reasons of clinical safety, need to be expedited. That would create delays for patients and uncertainty for the wider system over where commissioning responsibility sits.
I would like to offer assurance on some of the concerns raised today. I commend my hon. Friend the Member for Blaydon and Consett, who has spoken to me regularly about her concerns, for the work that she does in this area. I also commend the Lib Dem spokesperson, the hon. Member for North Shropshire, for her work on spinal cord injuries. I have met the chair of the APPG on spinal cord injury to discuss this topic. I would like to thank Bristol Councillor Kelvin Blake, who has a spinal cord injury and who for many years has impressed on me the difficulties faced by people with spinal cord injuries who are wheelchair dependent. I commend the work of people with these conditions who, as the hon. Member for Sleaford and North Hykeham said, struggle through a system that they should not have to struggle through. We want to make sure that these changes are assured, and I commit to working with hon. Members to do that as the Bill goes through.
I can assure the Committee that any significant change to nationally commissioned services will be accompanied by proportionate and appropriate engagement with patients, clinicians and the bodies affected. Change will always proceed according to appropriate transition arrangements. Each service, as hon. Members know, has very different patient needs and commissioning requirements, and demands different skills to commission effectively. The framework the Government are proposing will enable the Department to manage these processes flexibly and proportionately.
The hon. Member for Sleaford and North Hykeham asked about arrangements for new organisations. In a changing organisation where people are coming forward for redundancy and in a new organisation that is taking shape, it is important that the executive looks at all redundancy requests and changing needs with regard for critical business infrastructure and the retention of skills. That is what we are currently doing.
The hon. Lady also asked about funding. The Bill allows the Secretary of State to set out which ICB pays for whom, and there are clear rules for people in prisons and those not registered with a GP currently under the guidance of court, which is called “Who Pays?” There are also long-standing processes for ICBs to pay each other as needed. The hon. Lady also asked about high security mental health services; I can assure her that we have no plans to ask the private sector to provide services. The power to direct has been updated to ensure that directions would bite on non-NHS providers if that changes in future.
Clause 13, which is part of this group, is a technical clause that permits the Secretary of State or an integrated care board to confer on a person discretion in relation to anything that is to be provided under the commissioning arrangement. In practice, this means that they could undertake some activities traditionally carried out by a commissioner, such as reviewing how services are provided for a population and designing the way that those services will be delivered within the parameters set by the commissioner. These activities would be clearly set out and measured under the contract, and the commissioner would retain overall responsibility for the delivery of their functions. Currently, integrated care boards are already permitted to do this, and with the transfer of NHS England’s commissioning powers to the Secretary of State, we propose a similar approach for services that are commissioned nationally.
I hope that I have been able to reassure the hon. Member for Sleaford and North Hykeham, and that she will withdraw her amendment. I commend clauses 12 and 13 to the Committee.
Dr Johnson
Unfortunately, the Minister’s reassurances have not convinced me. In relation to change, “significant” means various things to different people. As for “proportionate”, what is “proportionate” to one person is not necessarily “proportionate” to another.
Amendment 57 makes reasonable provision for a situation in which there is a change from national to local commissioning, or from local to—mostly, it is from national to local commissioning. Therefore, I would like to push it to a vote.
Question put, That the amendment be made.
Dr Johnson
Clause 14 is very straightforward: it states that schedule 1
“confers functions on integrated care boards in relation to commissioning primary care services…transfers related functions from NHS England to the Secretary of State, and”—
perhaps most interestingly—
“contains other amendments relating to primary care services.”
Schedule 1 essentially makes the following changes to the NHS Act 2006: it makes ICBs responsible for commissioning pharmacy services instead of NHS England; it amends section 99 to make ICBs responsible for commissioning dental services instead of NHS England; it amends section 83 to make ICBs responsible for commissioning primary medical services such as general practice instead of NHS England; and it amends section 115 to make ICBs responsible for commissioning ophthalmic services.
Largely, this change is formalising existing delegation and the risk of disruption is therefore relatively low. Local commissioners can tailor decisions to local need, and it is better if decisions are taken closer to users. However, there are a few other things in there as well. Paragraph 12(2) amends section 97 of the 2006 Act containing local medical committees, which are statutory committees. The way it is phrased,
“the whole or part of the ICB’s area”,
does not allow for overlap. Is that the Government’s intention? The Government, in a broader sense, talk about the strategic authorities and having the mayoral authority level involved in the ICB. But in Lincolnshire, for example, an area that I represent part of, the local medical committee could not work in conjunction with the mayoral authority under this legislation, as far as I read it, because it essentially covers two ICB areas and two regions.
The mayoral authority is the Greater Lincolnshire mayoral authority. That includes Lincolnshire’s upper-tier area, the Lincolnshire county council area. It also includes the areas around Scunthorpe, Grimsby and Immingham, which fall into the Yorkshire region as opposed to the midlands region, and therefore not a whole or part of any given ICB area. I wonder whether the Minister has any comment on whether that was the intention, because it is also the case with paragraph 24(2) of schedule 1, which amends section 113 of the 2006 Act on local dental committees. Again, although the ambition stated and discussed in the Health and Social Care Committee yesterday by the Minister for Care, who is responsible for primary care, was that ICBs were to be covered at strategic level, that would not be possible for local medical committees or local dental committees under my reading of paragraph 12(2).
Gregory Stafford
Does my hon. Friend agree that this Bill would have been the perfect time to align health commissioning services with local government structures and that the fact that these structures are being created totally without the new local government structures is not just an oversight, but a potential problem with the whole Bill? Does she also agree—I think that she was outlining this already, but I want to ensure that the Minister is clear on it—that the Government still have a chance to amend the Bill to ensure that the commissioning structures and commissioning areas outlined in the Bill neatly map out to the new local government areas? In relation to, for example, the current Hampshire and Isle of Wight ICB, Hampshire is potentially being split up into a number of local government areas. I am against the way it is being split up, but if the Government are pressing ahead with it, this would have been the perfect opportunity to align commissioning with those areas. The problem is that we will now have a situation in which they do not match up, and the problems that my hon. Friend has outlined in her speech thus far will come to the fore.
Dr Johnson
Of course, my hon. Friend is right. One challenge with the Bill is that although not all the measures are a problem individually, the way they are being brought in is a problem. The planning and organisation that has gone into it has not been coherent. A 50% cut has been made to the budgets of ICBs, which has required many of them to merge, but that has been done before the local government reorganisation has been finished, which means that ICBs have been melded together in a way that is not the same as the local government reorganisation.
Let me again give the example of Lincolnshire. Lincolnshire had an excellent ICB, run by chief executive John Turner. That has now merged with Nottinghamshire and Derbyshire. Nottinghamshire and Derbyshire form the East Midlands mayoralty, but Lincolnshire ICB, as was, forms part but not all of the Lincolnshire mayoralty—which, as I said, also includes part of what was the Yorkshire region. Because the cuts were done before the local authority reorganisation, and the left hand does not know what the right hand is doing, we have ended up with an incoherent pattern, which does not help, particularly for social care services that are delivered by local authorities. We will come back to that when we talk about who is on the ICB. The risk is that we end up spending money doing this twice—being forced to do it at short notice, because of the 50% cuts brought in overnight by Government, and then doing it again to try to sort out the mess and bring things back into line with the new local authorities as and when it is decided what they will be.
Going on to the pharmaceutical arrangements—I should probably declare at this point that my brother is a rural dispensing GP—I share the concerns raised by the hon. Member for Bury St Edmunds and Stowmarket in relation to rural dispensing GPs. Let me give the Minister an example from my constituency. The Cliff Villages medical practice was an excellent medical practice. However, there was a doctor retirement and the illness of a doctor, and as a result the service reduced in quality quite substantially.
The ICB was working alongside the surgery and the one remaining practice doctor—not swiftly enough, it must be said. What happened in the end was that the Care Quality Commission came in, found that the service was really not good enough and closed the surgery down overnight, in the middle of the week. It was closed with immediate effect and there were no appointments for any patients in my constituency. Then, because the surgery had been closed, the ICB worked very hard to get a new practice in straightaway, and it got that opened on the Monday, which was pretty quick in the circumstances; but people lost their dispensing GP.
Living in a rural area—I have a dispensing GP myself, living in a rural area—people can go to the doctor’s, see the doctor and, if the doctor perhaps says, “You need some antibiotics,” they can go back to the waiting room and sit there for 10 minutes, be given the antibiotics and then leave. That is significantly more helpful to a rural constituent than having to drive eight or nine miles into the centre of town, park the car, find somewhere to get the prescription and then go all the way home again, which would take much longer. People really value that service—I saw how much when I held a public meeting with the ICB and the new provider to talk about what had happened at the surgery, and 250 people turned up to an evening event in the village hall at short notice. It is hugely important to people.
Will the changes allow the Secretary of State to step in in such circumstances, where the medical contract has been lost due to that cut-off by the CQC? Will that sudden loss of service be able to be replaced with a new dispensing service? Could Ministers have therefore given dispensing rights to the new provider? At the moment, those rights are not transferable, and it means that the only way that my constituents who live in that area and attend that practice can maintain dispensing rights is either to move house—perhaps to next door and back again, but they have to move house—or to change practice immediately, that same day, to another dispensing practice. To be honest, that seems ridiculous. Could the Minister make any comment on how the provisions in the Bill will help that situation and what her views are?
I am confused by new clause 23 and new schedule 1; the Minister has introduced them later than the rest of the Bill, but they seem quite significant. They would move pharmacy appeals from the first-tier tribunal to an NHS body specified by regulations made by the Secretary of State. I presume the regulations are not yet written, so we do not know what form that would take, but the first-tier tribunal is part of an independent judicial system and the appeals will now be under political control, within the Department.
Could the Minister explain why they think that is fair? Why do the Government want to do that? Is it just about saving money? How will the judgments made by that new authority be properly enforceable and give people confidence, given the change from the first-tier tribunal in the judicial system to something more politically controlled?
I move on to new clause 2, which would require the Secretary of State to establish within six months a scheme to give patients the right to a GP appointment within seven days of seeking one, or 24 hours if urgent. I would be interested to hear the Minister’s comments on that and how she thinks it could be achieved.
Modelling by the Health Foundation suggests that 6,500 full-time equivalent GPs—37,800 in total—will be needed by 2030-31 to meet greater clinical need. We have already talked about the doubling of medical school places; I presume the Minister has sought correction since we last spoke on whether the Government have a plan to double those places or not, but the Government are not on track to have that number of GPs. Is it simply that they do not have the resources to deliver it? I would be interested to hear the Minister’s comments.
Helen Morgan
With permission, I will explain to the shadow Minister our votes on amendment 57, which she pressed to a vote. I was reassured by the commitment the Minister made to consult widely on those commissioning changes, so the Liberal Democrats switched our vote from support to abstain.
I move on to new clause 2, our amendment in this group, which the shadow Minister was just discussing. It would require the Secretary of State to introduce a scheme to ensure patients have the right to see a GP or another appropriate clinician within their GP practice within seven days.
The NHS constitution currently confers rights on patients when they are considered really important. There are, for example, rights within the NHS constitution around receiving cancer diagnoses and treatment. We felt that there was a gap on access to GPs. Given the Government’s stated aim of transferring more care into the community, which we fully support, and given the observation in the Darzi report that more and more money is being spent on secondary rather than primary care, we think it is really important to confer the right on patients to be able to access primary care when they need to.
As the hon. Member for Sleaford and North Hykeham pointed out, this measure would require a large number of additional GPs and would therefore not be achievable overnight, but over the course of a Parliament. The Liberal Democrat plan includes recruiting and retaining an extra 8,000 GPs, relieving pressure on the rest of the health service and enabling that shift into the community. When patients—
Dr Johnson
We Conservatives share the hon. Lady’s desire to ensure that patients get their appointments as soon as they need them to be had, but she is talking about a difference between urgent appointments, within 24 hours, and non-urgent appointments, within a week. Who is going to make the decision about whether the appointment is urgent? Will it be the clinician? Will it be the patient themselves? Has she thought about where that responsibility lies?
Helen Morgan
Yes, I have thought about where that responsibility lies. It clearly lies with the triaging process within the GP surgery. I do not think any of us envisage somebody phoning up about a child with a cold and saying, “I consider this to be urgent,” and getting an appointment within 24 hours, but I would imagine somebody from the surgery saying, “Please describe the symptoms to me,” and then, if they detected something more serious, saying, “That is urgent and you do need to come in within 24 hours.” The point of new clause 2 is to clarify in the NHS constitution that some services require parity with others. We have already established legal rights under the NHS constitution for certain types of treatment, and this puts GP access on the same level. We think that that is important.
I am conscious of time, so I will move on to new clause 52, which is about dental deserts. Everyone is horrified by dental deserts and by “DIY dentistry”, a phrase that means—let us face it—people using pliers to extract their teeth and super glue to reattach crowns, and cavities filled with household adhesives. More than 5 million children did not see a dentist at all in 2025. That is a stark failure. Dental care is as important as care for other parts of the body, in particular when most of what goes wrong in dentistry is preventable. We should absolutely focus on prevention, and that is in line with the Government’s aims to move from sickness to prevention.
New clause 52 is about our £750 million dental rescue plan to guarantee access to an NHS dentist for anyone needing an urgent or emergency appointment, which I hope would end that awful DIY dentistry. The plan needs to be achieved through bringing dentists back from the private sector, fixing the contract, using flexible commissioning wherever necessary and introducing an emergency scheme. For example, the emergency dental scheme in Shropshire, operated by the community dental practice, enables people who have urgent need and cannot register with an NHS dentist to get the care that they need when they need it. I urge the Minister to take our new clauses on board and to ensure that people get the care they need when they need it.
Dr Johnson
One thing that my hon. Friend mentions is the Government’s stated intention to bring things closer to home, as opposed to the reality of the Bill as drafted. Does he agree with me that the document that explains what will happen to the commissioning of specialist services, and that talks about seven regions and how ICBs could collaborate within those regions, might imply that the Government are looking forward to having seven areas in which most commissioning takes place? These are even larger areas than have been described in the mergers so far.
Gregory Stafford
It is for the Minister to clarify that point, but I share my hon. Friend’s concern. It is ironic that we seem to be heading back towards the strategic health authorities of an earlier age. Things in the NHS are neither created nor destroyed; they just go round and round and round. I think we may end up being back where we were 15 or 20 years ago, in an ever decreasing cycle of spending money on changes that are perhaps not wanted or needed.
I have touched on dental services, so I will not go any further on that. On pharmaceutical services, I agree entirely with what my hon. Friend said about dispensing GPs. That is a big issue. And I have touched on the Liberal Democrat new clauses. In conclusion, although Conservative Members support a number of the ambitions in relation to the group that we are debating, the questions that my colleagues and I have raised require more clarification from the Minister.