Health Bill (Ninth sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 30th June 2026 Public Bill Committees

[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 It removes outdated references in section 65Z5 linked to NHS England and updates the wording so that arrangements can be made with a wider range of persons and not just bodies.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.

Health Bill (Eighth sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 30th June 2026 Public Bill Committees

[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.

[Gregory Stafford]

I am not convinced that clause 24 delivers the transformation that the Minister claims. At its core, it appears to be little more than a rebranding exercise. It replaces joint local health and wellbeing strategies with neighbourhood health plans, but does remarkably little to strengthen the underlying duties on local authorities or integrated care boards. Merely changing the name of a document does not improve patient outcomes, reduce waiting lists or deliver more integrated care.

The duty created by the clause is also remarkably weak. Local authorities and ICBs need only prepare a plan and then “have regard” to it when exercising their functions. That is one of the least demanding obligations available in legislation. It requires consideration, not compliance. An ICB could acknowledge the plan, but decide to depart from it and still satisfy the legal test. If neighbourhood plans are genuinely intended to drive local health policy, the Bill should do a lot more to require decision makers to act in accordance with them, or at the very least to explain publicly why they have chosen not to.

I am also concerned that the clause creates additional bureaucracy without any clear accountability. It requires the production of another planning document, another consultation exercise and another set of reporting expectations, but provides for no—for want of a better phrase—enforcement mechanism or measurable outcomes against which success can be judged. There is a risk that local systems will spend their time drafting plans rather than delivering services. Public involvement is of course essential, and indeed welcome, as we have heard, but the clause offers no detail about what meaningful involvement looks like and contains nothing to prevent a token consultation from satisfying the statutory requirement. If the objective is genuine neighbourhood-led healthcare, the legislation needs to be drafted much more tightly.

Moving on to new clause 70, I do my absolute best not to be flippant when it comes to Lib Dem amendments and new clauses, but once again we have an idea that is fine in principle—in fact, I think we would all support it in principle—yet the hon. Member for Winchester could hardly articulate how the new clause would work and whom it would involve.

--- Later in debate ---

[Gregory Stafford]

I thank the hon. Lady for that clarification. It is helpful to understand that the Liberal Democrats will not press the new clause to a vote, but if we are to use probing amendments effectively, they need to be drawn much more tightly, so that a Minister does not have the opportunity—I am sure that today’s Minister would not do this—to wriggle out of it because it is so poorly drafted.

[Dr Chambers]

What we are desperately trying to do is ensure that we are drawing on the expertise of primary care providers. The hon. Member seems not to understand that talking about 40 new hospitals the whole time with no plan to deliver them is looking at the wrong end of the health service. We need to try to keep people healthy and in the community. The new clause is an attempt to refocus thoughts on keeping people healthy in the community, rather than talking about hospitals that never existed.

[Gregory Stafford]

We can go back to the record in Hansard, but I do not remember mentioning anything to do with hospitals in what I just said; I may have had some sort of amnesia at that point. If the hon. Member is referring to the plan of the last Government, which was fully costed, for 40 new hospitals, then I am afraid I did not mention that. On his wider point, Conservative Members want to understand how local authorities and deliverers of primary care—dental services and so on—will be included and can have influence over the plans and strategies that ICBs draw up. I fully support that ambition; I just feel that, if we are to have that ambition, we need to table amendments and new clauses that the Minister might actually accept, so that we can go forward.

Health Bill (Seventh sitting)

Danny Chambers Excerpts

Committee stage
Thursday 25th June 2026 Public Bill Committees

Others will have a lot to say, so I shall take no more time, other than to commend amendments 45 and 46 to the Committee. They would ensure that we have good representation on the ICB, particularly of social care, and that we get a co-ordinated, joined-up and well delivered commissioning process.

[Dr Danny Chambers (Winchester) (LD)]

We have a few concerns about the clause in general, especially about the removal of local authority and primary care representation on the ICB. Some ICBs are already stepping back from joint commissioning arrangements with social care and the health and wellbeing boards, and it is vital that social care has a seat at the table. We have talked about this extensively in many Committees and in the Chamber, but the Liberal Democrats have been emphatic that we cannot solve any of the problems in the NHS without solving social care. At any given point, our hospital in Winchester certainly has 160 people in it who are well enough or would be better cared for in the community with a social care package; instead, they are stuck in a hospital, obviously affecting flow through the whole hospital and even affecting A&E waiting times.

Combined with the changes to the pooled budgets that will affect the better care fund, we are seriously concerned that the Bill is increasingly separating the NHS and social care just at a time when the service and experts are screaming out for greater integration and collaborative working. We discussed GPs this morning. They have long-standing concerns about getting their voice heard, given their unique place in the health system. They are the front gate to the NHS and they have the most patient contact of any NHS service. Removing the duty seems to be a step in the wrong direction in that regard.

Finally, the change will leave in limbo areas such as Hampshire that do not yet have a fully functional mayoral authority—our elections will be in the next couple of years. There has not yet been sufficient clarity about what the interim arrangements will be.

[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.

--- Later in debate ---

[Edward Argar]

I agree entirely with my hon. Friend the Member for Farnham and Bordon. At risk to my political career, such as it is, I also agree entirely with the hon. Member for Winchester, who made a very good point in drawing the Committee’s attention to something that should not need to be said, which is that the provision of healthcare and social care go hand in hand, and if either part of that equation does not function, the other part will not. He highlighted a good example, and I visited Winchester hospital when I was a Minister.

If we do not have a functioning social care system, or a social care system that is closely integrated in and working closely with the NHS, we see the knock-on effects pretty swiftly in terms of the large numbers of people medically fit for discharge who are unable to be discharged, which then impacts on the flow through an acute hospital setting. That is one of the big factors we see in A&E backing up, because people cannot be discharged, people cannot get into beds because the beds are full and then the ambulances are queuing up outside. The hon. Gentleman illustrated that point extremely well.

[Dr Chambers]

On the economics, it costs around £850 a night to keep someone in a hospital bed and a fraction of that for a social care package. This is an absolute false economy, even if we ignore patient experience and patient recovery.

[Edward Argar]

The hon. Gentleman is absolutely right from the financial perspective. As he mentioned, there is, of course, the human perspective and the impact on someone’s recovery and their health, as well as their psychological health, if they are in hospital when they simply want to get home, because they have no medical need to be in hospital.

My worry about clause 21 is that it essentially seeks to undermine the whole concept that ICBs rest upon. ICBs were conceived to bring together all the NHS services in a particular area, but also, as my hon. Friend the Member for Farnham and Bordon highlighted, to make sure that the NHS footprint mapped on to the geographical footprint of the upper-tier local authority delivering social care, so that the ICB is looking at the same geographical area for the two key parts of the system and they neatly map on to one another.

With changes, mergers and acquisitions—as well as a whole range of other changes—that link is already breaking and weakening, as ICBs start covering larger areas and look in different directions. As my hon. Friend the Member for Farnham and Bordon set out, and as I think the hon. Member for Winchester highlighted in an earlier sitting, because we do not know what local government reorganisation will look like in the years to come, we increasingly run the risk of creating something that again will not map on to a geographical footprint and may have to change.

In a number of areas—take my area, Leicestershire—we do not have a mayoral authority. At present, there is no plan or proposal before us for one. Yet the ICB is merged with Northamptonshire, which does not have one either. We will see a real gap in representation.

We are moving away from what we sought to do with ICBs. During the passage of the 2022 legislation, I always used the phrase—the Minister probably heard it until she wished to hear it no more—that we were seeking to be permissive, not prescriptive, where we could be. However, this was one area where it was not just us in the then Government who were trying to put a bit of a guardrail around the membership of ICBs. We were pushed by the now Government, then Opposition MPs, to go further in what we prescribed for the membership of an ICB.

Health Bill (Sixth sitting)

Danny Chambers Excerpts

Committee stage
Thursday 25th June 2026 Public Bill Committees

[Helen Morgan]

Well, I will just move on a little bit. The important question is: can this be achieved this overnight? Clearly not; we need additional clinicians in the service. The Liberal Democrat view is that the extra—I think 1,000 or 1,500—GPs that the Government have recruited so far is a welcome step forward, but that does not go far enough over the course of a Parliament.

As I was saying earlier, when patients cannot access their GP surgery, they end up, more often than not, in accident and emergency departments. That is no good for anybody. It overburdens the A&E department, leaves people who genuinely need urgent care getting a substandard level of care, and costs the NHS far more. We think it is really important that we put the resource in the right place.

[Dr Danny Chambers (Winchester) (LD)]

Just to reiterate what my hon. Friend is saying, in Winchester we are now putting an urgent treatment centre in front of the A&E, staffed by GPs to do the triage, because so many people who turn up are only there because they cannot get a GP appointment. So we now have hospital trusts paying for GPs to provide same-day GP appointments, and that is coming out of the secondary care budget instead of the primary care budget. That is obviously the most expensive place to treat patients for routine things.

[Helen Morgan]

That is exactly what new clause 2 seeks to drive at.

--- Later in debate ---

[Edward Argar]

I am grateful for that clarification. I am conscious that we have to finish at 1 pm, so I will bring my remarks to a conclusion.

We can all see the intent behind new clause 2; we can all feel that intent in correspondence we get from constituents. Having taken legislation through the House, my concern is that often the challenge is in the drafting of such clauses: while the objective may be honourable, the opacity of them, or the lack of some detail, can risk creating an expectation while not actually setting out how that can realistically be met. My worry here is about the practicalities, in an era where expectations are being set and dashed and that is causing challenges for our democracy.

[Dr Chambers]

Even when the right hon. Gentleman criticises, he does so in a charming way.

None of this is moving the discussion to how we keep people healthy and treat them early. He may criticise our funding models and challenge the detail for achieving this measure, but if we flip that round, the previous Government promised 40 new hospitals, which were not hospitals and did not materialise. The entire focus of healthcare has been on treating people once they are sick, while people cannot get GP appointments.

I hope that the right hon. Gentleman would agree that the thrust of the argument is to try to keep people healthy and treat them early, before they end up needing hospital treatment, and that that is what we should all be focusing on. If he wants to help with the details in order to get 8,000 GPs by the end of this Parliament, he can submit his suggestions to the Liberal Democrat website.

[Edward Argar]

The hon. Gentleman makes his point in a typically reasonable way. Of course, he is right to talk about the need to shift, where we can, from acute settings to either community settings or, ideally, a preventive setting or focus. The Minister may well disagree with me, but I think that is a desire or thread that, however well implemented or otherwise, runs consistently through Governments. It ran through the Blair-Brown Government, the previous Liberal Democrat and Conservative coalition, the Conservative Government and into what the previous Secretary of State announced and what the Minister today is seeking to achieve. I do not think that anyone would disagree with that. We will always need those acute settings for particular treatments and cases, as well as for those very specialist pieces of work or for people with significant illnesses.

There has always been a desire to push the care into the local community. GPS are a central part of that, as are—to address the points raised by my hon. Friends earlier—our community pharmacists and other pharmacists. Pharmacies remain an improving but underused resource as part of that preventive picture. I do not disagree with the hon. Member for Winchester in that, but one can agree with the objective, but nonetheless gently push a little on the detail. As we know, the devil is in the detail, and people will want to see a deliverable plan.

That is one of the challenges that I have had in Melton Mowbray, where the ICB says it will do one thing and then says, “Actually, no, we can’t do that anymore.” Expectations go up and down and people are understandably frustrated. When we put such proposals forward we need to be robust in how we are going to achieve them and in their practicalities. The Minister may wish to make further observations.

Health Bill (Fourth sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 23rd June 2026 Public Bill Committees

[Dr Danny Chambers (Winchester) (LD)]

It is an honour to serve under your chairship, Sir Jeremy.

The hon. Member for Isle of Wight East highlighted extremely well the difficulties of accessing hospital services on an island, but it can be a problem anywhere, including in rural constituencies. Winchester is about 60% rural. Since I was elected, an issue that I have had a great deal of correspondence about—even protests and petitions—has been the cancellation by Hampshire county council of bus services, particularly from rural villages such as Colden Common. People need buses for a variety of reasons—obviously to get to work and school—but the No. 1 issue concerning people is that of mainly elderly people using the bus to access hospital and GP services. They are really worried. It is causing a huge amount of stress that they will not be able to access hospital and GP services and not be able to remain living independently in the village that they have lived in for years.

One of the new hospitals in Hampshire is due to be built in south Basingstoke. Extraordinarily, the consultation on the location of the new hospital did not include consultation with the South Central ambulance service. When moving an A&E department and maternity service to another location, it seems blindingly obvious that the ambulance service should be heavily involved in deciding where a new hospital may be located, given that it is primarily responsible for ensuring that people can get there in a timely manner. Although there is obviously a need for local councils to ensure their constituents can get to a local hospital, it is important that we have some kind of obligation. I assume it would have been an obligation that when setting up the location of new hospital services, the ambulance services must be consulted and engaged with to get their input.

[Sureena Brackenridge (Wolverhampton North East) (Lab)]

On amendment 13, the shadow Minister asked why my hon. Friend the Member for Stoke-on-Trent South felt the need to table amendment 13. One can only assume it is because health inequalities have continued to widen for far too long. In a 20 or 30-minute drive across my Wolverhampton North East constituency, life expectancy drops by seven years. I accept that tackling health inequalities is not just about health; it is about a wider web of societal issues, including educational, employment and housing inequalities. That very long list is beyond the responsibility of the Secretary of State for Health and Social Care.

Amendment 13 will put the tackling of preventable ill health and health inequalities at the centre of national decision making by ensuring that the Secretary of State must consider not just NHS treatment but wider social and economic factors. Will the Minister assure the Committee that future Secretaries of State will not overlook the wider social and economic factors that drive ill health and unequal life expectancy, and that there will be a responsibility to work across Departments to tackle that wider and growing inequality?

Health Bill (Third sitting)

Danny Chambers Excerpts

Committee stage
Thursday 18th June 2026 Public Bill Committees

[Edward Argar (Melton and Syston) (Con)]

I approach this with a sense of déjà vu—standing in a Committee Room in the Palace to debate a Health Bill opposite the Minister for Secondary Care, the only difference being that our sides and places have swapped over in the interim. It is a pleasure to be on this Committee opposite the now Minister.

I will focus my remarks largely on clause 1. My hon. Friend the Member for Sleaford and North Hykeham raised a number of questions about clauses 2 and 3 and their breadth, but I consider them to be necessary and consequential on clause 1, so I will focus on the points made in that clause, which sits behind them. One thing I want to address is the Minister’s question about why, in the Health and Care Act 2022, the Conservatives did not abolish NHS England. I have to say that arguments were made on both the pros and the cons, but the simplest answer is the context of that legislation. At the time, we were just emerging from a pandemic, and I wanted that legislation to retain a clear focus on my vision for the NHS: a linking of ICBs at the local level with the upper-tier local authorities, so that we could deliver social care through a permissive model, rather than a prescriptive one, allowing that local co-operation. I was also conscious that, emerging from the pandemic, there was only so much that the system could realistically bear while it was still grappling with its immediate aftermath, hence the approach we took.

In reality, it cannot be disputed that, inevitably, this is a top-down, centralising reorganisation, and it was not in the manifesto. As Sarah Woolnough said in her evidence on Tuesday:

“These arguments were very well rehearsed by the previous Secretary of State. He undertook personally that he would not follow this course of action, exactly because these things take longer and cost more, and because the benefit realisation case is not always clear.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 10, Q23.]

On that point about centralisation, Jon Restell in his evidence said:

“Obviously, some functions of NHS England moving into the Department, with powers going to the Secretary of State, feels like a centralising measure… On the whole, it is probably more of a centralising measure.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 79, Q122.]

We have to recognise that this is a centralising measure, rather than any sort of devolution that provides local areas with greater autonomy.

For me, there is a worrying lack of clarity at this stage in the process—around 15 months later—on the actual plan and approach. The hon. Member for Lichfield gave a very good speech that not only highlighted the local issues but drew a national read-through from those local examples, and he rightly highlighted that he did not want a protracted reorganisation. However, 15 months on—with the hare having been set running by the Prime Minister’s announcement back in March 2025— we still have protracted uncertainty on what will happen. That is having a very real impact on not only staff but the opportunity cost, through its impact on how services are actually being delivered and what the NHS is focused on.

On that lack of clarity, when asked how this measure will work and whether it can save money, Sarah Woolnough of the King’s Fund said:

“I think, on the basis of the question, we do not know. Our worry has been about the opportunity cost. The Government, when in opposition, said that they would not launch wholescale reorganisation, because they understood the potential opportunity cost on time and other resources. As this has played out, taking longer than anticipated, we have had multiple examples of teams left in limbo about where they will end up in the target operating model.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 10, Q12.]

Jon Restell also highlighted the impact on staff when he said,

“this is becoming psychologically very difficult. You have a change programme that started in March last year with the announcement by the Prime Minister of the abolition of NHS England and the halving of the staff of NHS England and ICBs. For 18 months, that process has dragged on, with lots of design decisions still to be taken about how the organisation will look, what functions it will have, what will be going to the Department and what might be going elsewhere”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 80, Q125.]

[Dr Danny Chambers (Winchester) (LD)]

I too think the hon. Member for Lichfield gave an excellent speech on the need for clarity, but there is another factor to consider. Not only is NHS England being abolished, and ICBs are having their budgets halved, but in Hampshire and other areas we also have local government reorganisation. We are going from having district councils and county councils to unitary authorities, and a mayor will be coming in next year. This is another level of reorganisation in the delivery of healthcare and social care, so there is a huge amount of change. However, there seems to be no clarity, at any level, on how this will affect services on the ground, because there are so many moving parts coming in at once.

[Edward Argar]

The hon. Gentleman makes his point very clearly and he is absolutely right. Not only is there a lack of clarity in the legislation and in the plans for how the NHS will look, but, as was alluded to during evidence, the missing bit from the Bill, which is highly relevant, is social care. It will be deeply concerning if, when the implications of local government reorganisation emerge from the Ministry of Housing, Communities and Local Government in a few weeks’ time, the two are not properly meshed together, because we will risk, yet again, a widening disconnect between the two vital parts of our health and social care system, both of which have to work well in tandem for the whole system to function. The hon. Gentleman makes a pertinent point. He also highlights ICB budgets. I suspect hon. and right hon. Members around the country are already seeing the genuine impact of those changes to the budgets, which are actually pulling through into the frontline services that our constituents receive.

I know that the Minister cares deeply about our health and social care services, and has a wealth of experience from in this place and outside it. Given the comments from our witnesses and the impact assessment, which has page after page listing the risks associated with this approach, I ask her how she will mitigate that loss of focus and that distraction, which is an inevitable human reaction when there is uncertainty. When she comes forward with the plan to merge NHS England into the Department, how will she ensure that she retains the best, most experienced staff? In any organisation where there is a change, it is often the most able and experienced who find it easiest to go to another role, by virtue of their skillset. How will she ensure that there is not a loss or drain of that expertise and knowledge?

I turn to a deeply concerning element that links to the lack of clarity. The impact assessment on the abolition of NHS England is pretty much silent on the monetised costs and benefits and specific figures. The first two pages with the boxes and the summary just say “N/A” in pretty much every box on assessing the costs. If I flick through to the section headed “Monetised and non-monetised costs and benefits of each option”, I see page after page. There are lots of words but virtually no figures, and where there are figures, there is no breakdown of how they were reached, and no explanation of the degree or range of confidence in the few figures that are there.

I ask the Minister whether a detailed spreadsheet of all the statistics, costs and benefits, risks, confidence levels associated with the numbers, and the phasing over years of savings and costs will be published during the Commons passage of the Bill so that Members of the House can consider it. If not in Committee, could it be published at least before Report so that we can have an informed debate? More broadly, once the Bill in whatever form is passed—I expect, given the Government’s majority, that it will be—what mechanisms will the Government put in place to ensure that when a target operating model and all the other details are available, Parliament will have an opportunity to not only debate them, but have a meaningful say, potentially with a vote, be it through delegated legislation or in the House?

Mental Health: Parity of Esteem

Danny Chambers Excerpts

Wednesday 17th June 2026 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

On wraparound care, we have a fantastic initiative in Winchester where Citizens Advice spends time with patients at Melbury Lodge, the in-patient unit, to help them deal with all their life admin, such as debt issues and money issues. It has been shown that those who receive that service have a shorter stay in hospital, are significantly less likely to be readmitted and are more likely to engage with social services once they have been discharged. Is the Minister willing to meet me and the team to discuss that initiative? For every £1 spent on it, £14.08 is saved in cost avoidance for the NHS.

[Preet Kaur Gill]

I thank the hon. Gentleman for mentioning the wraparound care in Winchester citizens advice bureau. We need the local health ecosystem to partner with initiatives in the voluntary or charity sector such as that one, and acknowledge their impact, fund and support them. Some may think that things such as debt are basic, but their impact on mental health cannot be overestimated. I am sure that officials will want to meet the hon. Gentleman and others to look at the landscape across the country, because there are some fantastic initiatives that we need to recognise, partner with and support.

The Government are taking action to elevate the status of mental health. For 2026-27, NHS mental health spending is forecast to increase to a record £16.1 billion, representing a real-terms increase of around £140 million compared with the previous year. Alongside that, the mental health investment standard remains in place. Integrated care boards are required to protect mental health spending in real terms over the next three years, ensuring that mental health continues to receive the investment needed to improve services and outcomes.

Investment alone is not enough. We must transform how care is delivered. That is why the 10-year health plan sets out our vision for a neighbourhood health service, which my hon. Friend the Member for Blaydon and Consett mentioned. That is about bringing care closer to people’s homes, communities creating genuinely patient-centred services, and moving away from a fragmented system that often leaves people navigating multiple services without the support they need. I hope the ICBs are engaging hon. Members in all parts of the House to feed into the design of the neighbourhood health centre model and asking about the unmet needs and service gaps in their constituencies and regions.

Community Pharmacies

Danny Chambers Excerpts

Tuesday 2nd June 2026 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

It is an absolute honour to serve under your chairship, Ms Jardine. I commend my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) for securing this fantastic and timely debate. I also note the expertise of my friend the hon. Member for North Somerset (Sadik Al-Hassan). Not only did he provide some really good insights—I thought his point about the importance of a single patient record all the way from pharmacy to hospital was especially meaningful—but I love how enthusiastically he agrees with everyone else’s points.

[Sadik Al-Hassan]

Only the good ones.

[Dr Chambers]

Yes, the good ones.

There has been a general consensus that pharmacies are often overlooked as a source of care for those in the community. I have visited many pharmacies in my Winchester constituency: there is Eric, who runs Springvale pharmacy up in Kings Worthy; there is Colden Common pharmacy in Colden Common; and there is the Wellbeing pharmacy on Winchester High Street, which gives me my flu jab every year. The people there actually make having a flu jab a lot of fun; we always have a great laugh. I never thought having a vaccine would be something I would look forward to, but I love going in and seeing them.

We know about the 8 am rush for GP appointments, so the fact that a high street service exists where one can drop in for advice and consultations is absolutely brilliant. Pharmacies allow us to siphon off some of the pressures on GP services, but—as pharmacists have been telling me repeatedly since well before I was elected—pharmacies are currently under immense pressure.

Adding to that pressure is the increase in national insurance contributions, which has saddled pharmacies and GP surgeries with additional costs. As a consequence, many local pharmacies have had to limit opening times and staff numbers. In Alresford in my constituency, the hard-working staff at Wessex Pharmacies have had to close shop on Saturday afternoons. That service will be sorely missed, particularly by those who are in full-time education or work during the week and who relied on being able to pick up their prescriptions at the weekend.

In addition, shorter opening times mean that if a patient sees their GP later in the day, the required prescription is delayed by a day if the paperwork is not registered in time. For a patient with an urgent need for medication, that extra day can be extremely frustrating and worrying.

Although we really do welcome the recent 10% increase in Government funding to community pharmacies, it is worth pointing out that that is giving with one hand and taking with the other. In the wake of rising costs for energy, staff and medicines, this funding increase was the first in 10 years, so it was sorely needed, but unfortunately, it did little to alleviate the extreme pressures heaped on community pharmacies in the Budget.

That point comes into focus when we consider the rise in drug costs: a 20% to 30% rise for things like paracetamol and hay fever medications, and an elevenfold rise in the cost of cancer drugs since February, while the funding provided to community pharmacies has dropped by more than 20% in real terms since 2015. That is why we are calling on the Government to invest in pharmacies in smaller towns, particularly in villages and rural areas such as mine in the Meon valley. In places such as Bishop’s Waltham and Colden Common, people need access to a community pharmacy, and not only for convenience: Conservative-run Hampshire county council has cut vital bus services to the nearest big towns, which means that people without a vehicle, especially older people, absolutely rely on local pharmacies for their medication.

We are also calling for a new, long-term, sustainable model for pharmacies and an expansion of Pharmacy First to give patients more accessible routine services so that we can free up GPs’ time. We want an exemption for pharmacies from the national insurance contributions increase so that funds can be spent on patients and vital medications.

I come to my final, key point. I have spoken to many pharmacists since I was elected and before that, and I have had very long, in-depth conversations with them. I have also attended events in Parliament organised by the Royal College of Pharmacy and the National Pharmacy Association and I have discussed their issues with the NHS pharmacy contract. Given my professional background, I am used to sourcing, dispensing and prescribing drugs. However, the contract is so complicated that, despite my extensive conversations with those organisations, I do not fully understand it. The key message that comes out is that it costs pharmacists to dispense NHS medication in many cases, and that NHS medication is sometimes being subsidised by other sales in shops. I even met two pharmacists who said that their personal finances are subsidising some NHS dispensation. That is clearly not tenable in the long run.

[Lee Pitcher]

Standardisation and consistency in services are really important. A person in my constituency of Doncaster East and the Isle of Axholme is living with poor mental health. His pharmacy has stopped doing nomads, and it is too far for them to travel to the next pharmacy, where those are not paid for. Does the hon. Gentleman agree that consistency in how we support pharmacies is massively important to help people such as my resident?

[Dr Chambers]

I completely agree. All businesses need predictability and stability. It appears that, week to week, pharmacists are trying to work out how to source drugs with changing prices, and there is an NHS contract that is not meeting their needs.

When we talk about community healthcare and provision, it is important to remember that having good, well-run pharmacies means that people are being kept out of GP practices and that they are less likely to turn up at A&E. That is even better value for money for the NHS and, ultimately, for the taxpayer. There is no downside from a Government point of view to investing and heavily supporting community pharmacy, because the savings made upstream will be hugely significant. At the moment, we are treating people with conditions that should be treated in the community with the most expensive part of the NHS, in A&E and hospital, when they could quite possibly have avoided going there in the first place.

[Monica Harding]

Accessibility is paramount. The costs that are pushed on to pharmacists mean that they cannot remain sustainable and that they resist opening pharmacies in smaller places, because it will take away business from them. Therefore, those pressures take away accessibility, which is needed.

[Dr Chambers]

That is another legitimate point, and it was made in my second to last words, so I thank my hon. Friend for contributing. I thank the Minister for listening to our concerns.

Junior Doctors’ Foundation Programme

Danny Chambers Excerpts

Wednesday 22nd April 2026 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

It is an honour to serve under your chairship, Mrs Barker. I congratulate the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for another insightful speech; this time I will avoid comparing the anatomy of human and dog ear canals—we have covered that already.

We always rightly start these speeches by paying tribute to NHS staff, doctors, nurses and everyone involved in patient care, especially given the pressures on them as a result of sheer patient numbers and working in systems that can make the job even more stressful and pressurised than it already is. They are caring for severely injured or very ill people at the toughest moments of their lives. The emotional burden of caring for people who could be dying is difficult in itself, but resident doctors work in a system that adds extra pressures and conditions that can add stress alongside that. We cannot pay enough tribute to them for even surviving in those areas.

One of the best books highlighting the plight of resident doctors that I have read is Adam Kay’s “This is Going to Hurt”. It did a lot to help the public to understand just how difficult it is for a doctor to not know where their training place is going to be. It is where they are going to be forced to live and work for several years—a place where they may not have any friends or family; they might be taken away from family and spouses. They might have dependants and children. It is really difficult to plan a career, especially such a difficult and challenging career, when working with that level of uncertainty. I lived with medical students when I was a student at Liverpool University and have followed their careers since. The challenges that the hon. Member set out have been reflected in their lives and careers.

I support the Government’s ambition to increase medical school placements. That is important. We have a recognised workforce shortage in the NHS, so that is an obvious thing to do, but we must ensure that we do not carry on falling into the same trap. The previous Government, under Boris Johnson, said that they would increase medical school placements—and they did, but without providing the infrastructure for training resident doctors who want to go on to specialised training. That obvious bottleneck was going to filter through. No mechanism was put in place to ensure that the NHS would have the capacity to train those extra medical students when they finished their F1 and F2.

In Winchester I speak to many resident doctors, and even to their parents. Those resident doctors have gone through university, sometimes getting themselves in a fair amount of student loan debt, and are working hard on their F1 and F2. The stress of not knowing whether they will get a training placement is overwhelming, frustrating and for us, as a society, ridiculous because we are short of doctors. How have we ended up in a situation where we are training students and resident doctors, but cannot give them the further training places to continue? I urge the Government to ensure that any training places will filter all the way through for the rest of that person’s career.

We know that the last Government not only thought it sounded good for winning votes to say that they would increase medical school placements, but said that they would build 40 new hospitals, though there was absolutely no funding—putting votes before a genuine long-term plan for the NHS. We then come up against a brick wall of reality. People working in the NHS end up suffering and the people who rely on the NHS—everyone—end up not getting the service that they voted for.

The Liberal Democrats welcome the Minister’s statement about increasing training numbers, especially for people from more disadvantaged backgrounds. It is important that we look at the diversity of the professions. Certainly within the veterinary profession, socioeconomic diversity is not what it should be; it does not reflect society. A profession—whether the medical profession or another—offers a better service to society if it better reflects it. I once heard someone say that talent is everywhere, but opportunity is not. It is the job of all professions to ensure that we get the people with the talent enrolled on courses so that they can have fulfilling careers and offer much back to society.

The statement is a really good first step, but it is a bit vague. The Minister writes about underserved parts of the UK seeing new medical spaces; how many will there be, and how will that be delivered? Will current medical schools increase their capacity? Will new teaching hospitals open to support it? The target is to place

“up to 25% of students at participating medical schools…to local foundation training places”.

How many medical schools have indicated that they want to participate? That will be fundamental to how this policy gets delivered.

To reiterate what the hon. Member for Bury St Edmunds and Stowmarket said, we need to treat medical students and resident doctors like people; they are not just numbers. Working conditions are as important as pay, and to improve working conditions we need to double down on improving social care to avoid delayed discharge and corridor care. The doctors delivering treatment will feel that they are doing a better job, and will not feel under pressure as a result of being unable to deliver the care that they want and that patients deserve.

We also need to ensure that we have a happy, resilient, passionate and excited workforce going forward. The Minister has been asked constructive questions. I ask him not to repeat the previous Government’s mistakes of talking about increasing hospital numbers and medical students, while creating a whole generation of doctors who cannot go on to serve their communities and have a fulfilling career.

Women’s Health Strategy

Danny Chambers Excerpts

Thursday 16th April 2026 Commons Chamber

[Madam Deputy Speaker (Caroline Nokes)]

I call the Liberal Democrat spokesperson.

[Dr Danny Chambers (Winchester) (LD)]

The Liberal Democrats welcome the strategy, and its specific recognition of the socioeconomic and racial disparities in women’s healthcare, which it is important to put front and centre. We also appreciate the specific recognition of endometriosis and similar conditions. My partner, Emma, suffers from endometriosis, and on many occasions I have seen her unable to stand up or barely get off the sofa, having been told for years that her symptoms are completely normal and that there is nothing wrong with her. Given that at least one in 10 women suffer from endometriosis and there are over 500,000 people on gynaecology waiting lists, clearly her experience is not unique.

The picture around maternity safety is deeply troubling. Maternal mortality has increased by over 20% in the past 15 years, and there have recently been some high-profile media discussions about women and babies being let down, sometimes with devastating consequences. That is why the Liberal Democrats have been calling for one-to-one midwifery care and specialist doctors on every unit.

I welcome the Government’s specific commitment on treatments for morning sickness. My hon. Friend the Member for Lewes (James MacCleary) has campaigned on that issue for a long time, and it is right that we end the postcode lottery for these medicines. The condition can be debilitating for some people, and it is not fair that women have different experiences simply because of where they live.

Given that this is not the first women’s health strategy to be brought to this place—the previous Government brought one through in 2022—and the fact that many women we speak to do not feel that there has been any meaningful change, a lot of people are saying that we cannot just keep announcing strategies while women are waiting for basic care. Given the failure of the last Government to deliver meaningful change, can we have reassurances that this will not simply be another strategy announcement and that women will feel a difference in the care that they receive?

[Karin Smyth]

I thank the Liberal Democrat representative for his comments—frankly, that is the way it is done.

Let me turn to some of the issues that the hon. Gentleman raised. May I take the opportunity to mention endometriosis in particular? There have long been campaigns on that issue in this place from many women and men such as him talking not on behalf of their partners, but for them about the suffering. That is all very welcome.

I commend the work of Sir David Amess, a former Member of the House whose plaque is behind us, and of my right hon. Friend the Member for Redcar (Anna Turley) in chairing the all-party parliamentary group on endometriosis. When in opposition in 2017 or 2018, I had a member of staff—I hope she does not mind my saying so—who opened my eyes to this issue. Persistence works. We have got to where we are by supporting women’s voices across the country, and that is front and centre in this strategy.

On the hon. Gentleman’s wider point, I am sure that when he gets all the way through the strategy, he will see that there is a list of 102 actions—if I remember rightly—with dates aligned to them. I am sure that all hon. Members will look at that. I notice that my friend Baroness Merron is in the Gallery; she will be keeping everybody’s feet to the fire, including the Secretary of State’s, to deliver on this work. That list is in the strategy, and we wanted to set it out very clearly. We are waiting for the roll-out of NHS Online during the summer, and seeing how that works will be a litmus test for us, so I very much welcome the hon. Gentleman’s challenging us on that.