Health Bill (Seventh sitting)

Edward Argar Excerpts

Committee stage
Thursday 25th June 2026 Public Bill Committees

[Gregory Stafford (Farnham and Bordon) (Con)]

It is a pleasure to serve under your chairmanship, Dr Huq. I will speak briefly about clause 15 and amendment 28, tabled in the name of the hon. Member for Oxford West and Abingdon, the Chair of the Health and Social Care Committee, of which I am a member.

The amendment is clearly positively intended. We all want the co-production of services, and we have discussed it quite a lot on the Health and Social Care Committee. A number of amendments were tabled in the name of the hon. Member for Oxford West and Abingdon but were agreed on by the Select Committee. I think it is fair to say that there are a number of areas that the Committee could not agree on and that are obviously not in front of it, given its political make-up, but we all agreed on the ones she has tabled.

That being said, cross-party agreement often necessitates fairly non-partisan and perhaps non-specific wording, so while I agree with the intention behind the amendment, and while it is clearly important to have co-production when designing services, I am not entirely comfortable with the way the amendment has been drafted. This goes back to comments I made on the Liberal Democrat new clause 2 about how the requirement would operate in practice or how such an approach would be applied consistently across different commissioning functions. Although I am very keen on the principle, I am concerned about the intention.

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

I will not detain the Committee for long, and I will speak primarily to clause 15. I am broadly supportive of what the Minister seeks to achieve, as I understand it, with the clause. It is absolutely right that service users and communities are engaged by their integrated care boards—those commissioning services—in the design of services as well in individual care.

As I alluded to before we adjourned for lunch, however diligent an ICB may be in doing formal consultations or conducting surveys, it is all too easy for that to appear to the actual users of the service as a box-ticking exercise, with the board none the less determined to follow through with the strategic plan that it conceived and consulted on in the first place. We have seen that challenge on a number of occasions in my Melton and Syston constituency, with the recent closure of St Mary’s birth centre in Melton Mowbray. There was a consultation and engagement with the public, but we always feared that, ultimately, a decision to close was what the ICB wanted and, lo and behold, that is what happened. Similarly, the ICB decided to pull away from accepting the need for a second GP practice or enhanced GP services in Melton Mowbray. There was a consultation and discussion, but ultimately the conclusion that we feared at the outset of the process was indeed what was reached at the end of it.

The clause will not necessarily address all that, but it is a step forward in putting pressure on an ICB, or on those commissioning services, whoever they may be, to engage with local communities in a meaningful way.

[Gregory Stafford]

My right hon. Friend is making an absolutely correct point, which I made when we were talking about the Secretary of State’s ability to remove, by sacking or otherwise, the chief executives of ICBs. There is a tension between us as Members of Parliament trying to lobby the Secretary of State for changes in our constituencies when he currently has no power to actually make those changes. The clause will potentially give him the power to make those changes, but being able to sack a chief executive is probably a step too far. How does my right hon. Friend see the powers in the clause, which are probably correct, balancing with the local decision-making process and clinical expertise? There will clearly be a tension between the two.

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[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?

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[Helen Morgan]

I want to draw the Minister’s attention to some of the difficulties relating to cross-border healthcare in a border area. I represent an area on a border. North Shropshire has a very wiggly, for want of a better word, border with Wales, which means that some English constituents are registered with a GP surgery in Wales but receive their secondary care in England. That causes significant difficulties for them because of the lack of joined-up communication between the two Administrations. I seek assurance from the Minister that as ICBs in England will have to pay regard to people who live near the border in Wales, conversations are going on with the commissioners in Wales to ensure that that process is as smooth as possible.

[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?

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[Karin Smyth]

The clause transfers the requirement to conduct annual assessments of integrated care boards from NHS England to the Secretary of State and focuses the assessment on the statutory functions of the organisations. To do that, it removes a prescriptive list of duties to be assessed that was inserted by the Health and Care Act 2022.

ICBs are essential to delivering our health mission. They are responsible not only for arranging healthcare services, but for planning how those services will focus more on prevention, digital innovation and delivery in the community. It is therefore entirely appropriate that the Secretary of State should hold ICBs to account and undertake a meaningful assessment of their performance.

Currently, NHS England assesses the performance of ICBs annually, reviewing how well they have performed against a list of duties prescribed by the current legislation. The process for those assessments is set out in guidance each year and is driven by both publicly available performance data and local insight. The results are published online and form part of the ongoing performance conversation between NHS England and each ICB.

Although NHS England can choose to assess more than those statutory duties as part of that process, the duties form a static list of requirements that are already expected as part of the ICBs’ statutory functions. Having such a list may inadvertently skew attention away from other priorities in the 10-year health plan and our mission. As we reform the NHS, the ICB performance assessment will need to adapt to the evolving role of ICBs as strategic commissioners and reflect new models of commissioning. The list of duties will therefore become too prescriptive to provide the accountability intended. The clause allows a more nimble and flexible approach, ensuring meaningful assessment of ICB performance.

[Edward Argar]

The Minister has saved me from having to give a speech on this clause, so I will ask her a couple of questions instead. Does the Secretary of State intend to publish the list of criteria against which he will require assessment to take place, so that it is transparent what is being considered? Notwithstanding the Minister’s point about the 2022 legislation, the Secretary of State will define the list, so will he publish those criteria? Within what period following the end of the financial year will the Secretary of State commit that the results will be published?

[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.

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[Gregory Stafford]

My hon. Friend makes an interesting point that I had not considered before, but she is absolutely right. The upper-tier authorities and strategic mayors might be from different parties, and, where the mayor does not have an actual responsibility for health, there essentially could be democratic deficit there that I had not thought about. My hon. Friend makes an interesting point.

That democratic deficit will potentially be exacerbated in the other half of my constituency, which is in Surrey. As I have already alluded to, the Surrey ICB has taken on Frimley but is also now merging with Sussex. As far as I can tell, the Government have absolutely no plans to introduce a mayoral authority in Surrey; however, my quick googling suggests that there will be a mayoral authority in Sussex in 2028, so the mayor of Sussex could be sitting on a board where there is no representation from the Surrey side. That is a complete democratic deficit. There would be the Surrey and Sussex ICB, with representatives for the people of Sussex but not for the people of Surrey. That must be an unfairness. I hope the Minister, if she cannot answer now, will at least go away and think about how that democratic deficit will be avoided. I suggest that she dumps the whole idea and goes back to having the people who actually run health and social care in our country on the board.

That is why I am very supportive of amendments 45 and 46, tabled by my hon. Friend the Member for Sleaford and North Hykeham. Reducing the representation to a single mayoral representative is a problem. Reinstating and consolidating the full range of required members and thereby giving the breadth of representation within ICBs that we have all talked about, is essential. It would strengthen the legislative framework, ensuring decision making remains multidisciplinary and balanced and that it incorporates both the clinical expertise, which we are going to lose, and the local authority political input, rather than having a one-sized, over-politicised mayor in charge.

By maintaining that membership, the amendments would help safeguard overdominance by a single actor, support a much more informed and locally responsive decision-making process and, crucially, reinforce the collaborative foundation between health and social care that I thought was a given among all parties in this House. I urge the Minister to reconsider what she is proposing in this clause. She should, at least, give us some clarity on what will happen in the interim period or, at best, go back to the drawing board and ensure proper representation of the people who are actually delivering health and social care in our constituencies.

[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.

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[Dr Prinsley]

I am listening carefully to what the right hon. Member has to say. I wonder whether he could present us with a concrete example of where precisely elected local government involvement in the commissioning of services in ICBs has been essential, because it seems to me that what an ICB needs is expertise in commissioning. We need people who know how to commission services. Although I understand the importance of representation, I think that what we really need is expertise in commissioning.

[Edward Argar]

I take the hon. Gentleman’s point to a degree, but I would refute a chunk of it. We need within the organisation people who have those technical skills and know how to commission, draw up a specification, put it out to tender, or work out what is needed and ensure that what is delivered reflects what was commissioned and that the performance is what is sought to meet the needs of the local area. At board level, we need representation from local authorities and others, because it sets the strategic direction.

The board members are not the people who are going to sit there and write the commissioning document. They will probably approve it, but they are not the experts who will be drafting it. We are talking about two different functions, and I argue that when a board-level decision is being made, we want those voices in the room to ensure that those different perspectives are reflected and there is that critical challenge to what is proposed by the executive directors. We essentially have non-executive directors who are there to challenge, to question—perhaps to agree, but perhaps to push back on things. That is how many boards operate.

In what is proposed, we lose some powerful voices from round the table. They may not carry the day, but those voices should be heard. Having sat where the Minister is sitting now, I appreciate that she may not be willing or in a position to accept the amendments, but I hope that she will take away and reflect further on the challenges of representation.

[Karin Smyth]

I absolutely recognise that this is an area of huge interest to hon. Members across the piece. I assure colleagues that officials and I have been working with representatives of the Local Government Association and mayors throughout the development of the Bill and the future architecture, and we will continue to do so. We will continue to have discussions and to make sure we get this right, because it is complex and complicated. Given that we are all politicians, we understand. Many of us have been councillors and local representatives, and have spent a lot of our time—sadly, for officials—knocking on doors, going out and persuading individuals to vote for these people. We understand that it is quite personal and we want to get it right.

If I may, I will not take any interventions so that I can address the amendments and our approach to ICB membership. As my hon. Friend the Member for Bury St Edmunds and Stowmarket said, ICBs are commissioners. This is a fundamental shift, which I will come on to, and it is different from the 2022 work. I now want to outline the board membership set out in clause 21, but I think we will be discussing this for some time.

Lord Darzi’s review found inconsistency in the roles being undertaken by ICBs and concluded that the health and care system would work better if each organisation had greater clarity and focus on its particular role. That is our starting point, and we set out to do that in the 10-year health plan. In future, all ICBs will discharge their common statutory duties through best-practice approaches, getting better at allocating their budgets to meet the population’s needs and securing the best outcomes. The new focus for ICBs is strategic commissioning. All ICBs will, in future, operate at a minimum efficient scale, with a population of around 1.5 million people covering multiple partner local authorities.

Effective partnership working is core to strategic commissioning and is aided, rather than diminished, by replacing ambiguity in roles with clarity and focus. That is why we are altering the membership requirements for ICBs. We are adding a requirement for strategic authority mayors, or a nominated representative, to be appointed to ICBs operating within their footprint. Strategic authorities will increasingly become key bodies for growth and prosperity in their localities. Mayors, or their nominated representatives, will highlight opportunities to improve health outcomes through a joined-up approach to their other devolved responsibilities, such as transport, housing and employment.

Although we recognise that the coverage of mayors and strategic authorities varies across the country, we will provide guidance to ensure that no area is disadvantaged, regardless of how advanced its local devolution arrangements are. In all cases, ICBs will have an obligation to ensure that their boards have a suitable membership to discharge those functions properly.

Given the larger geographical footprint of ICBs in the future, we are also removing the requirement for ICBs to have at least one member jointly nominated by local authorities. At present, local authorities collaborate with ICBs by sitting on health and wellbeing boards and local integrated care partnerships. The multitude of plans, committees and measures have resulted in confusion, siloed working and, too often, inaction. I think many of us would recognise that in our own areas.

I emphasise that we want to ensure a strong voice for local government in the work of the NHS. Our preferred approach is for local authorities to work with the NHS through health and wellbeing boards, co-commissioning and local authority health scrutiny. Those are likely to be more fruitful forums in which to resolve issues, agree joint approaches and tackle the needs of a local area.

As ICBs become more focused on effective commissioning, it is right that we remove any potential conflicts of interest. That is why the 10-year health plan and the Bill propose removing the requirement for one member jointly nominated by primary medical care providers and one member jointly nominated by NHS trusts and foundation trusts. The clause will provide ICBs with memberships that are best equipped to fulfil their commissioning responsibilities and role in health planning.

On amendment 45, which was tabled by the hon. Member for Sleaford and North Hykeham, I assure her that the Government fully appreciate the importance of general practice and primary care more broadly, and the role that they play in informing ICB decisions. However, as I have said, health and wellbeing boards should be the key forum for resolving local issues and making planning decisions for their neighbourhoods. GPs are well placed to contribute to those discussions and also vital to them. We expect health and wellbeing boards to ensure that they involve relevant stakeholders, including GP practices and primary healthcare providers, in their work.

There is an opportunity for health and wellbeing boards to play a much more proactive and important role in the local economy. To respond to the point made by the hon. Member for Winchester, we absolutely recognise that place is important in those arrangements. Although I agree that the experience of primary care is important, I hope that I have reassured the Committee that having a member nominated by primary care on the board of an ICB is not necessary.

A similar argument applies to amendment 46, which would require a local government representative on the ICB. I should start by saying that I wholeheartedly recognise the important role that local authorities play in the health and care system. As we have discussed, their work in social care and public health, and their influence on the wider determinants of health such as housing and employment, mean that they have a fundamental role in supporting the delivery of our ambitions to improve the health and wellbeing of the population and implement the three shifts identified in our 10-year health plan.

Rather than one local authority attempting to represent the interests of many on an ICB board, however, we think that it is more effective for local government to use health and wellbeing boards to address local barriers to joint working and support the development of neighbourhood health plans, which will shape the commissioning plans of the ICBs. I assure the Committee that we expect ICBs to work effectively with every one of their partner local authorities in the local authority footprint to deliver the neighbourhood health service and progress the integration of health and care services at that level.

I should stress that our changes are not designed to weaken democratic accountability in the NHS. ICBs are NHS statutory bodies that are governed by a unitary board that is jointly responsible for ensuring that the ICB discharges its legal duties. Given that specific role, the ICB board is not the forum in which democratic leaders hold the NHS to account; rather, that is conducted through the local authority health scrutiny functions and Parliament. Again, this is a good opportunity for those health scrutiny functions to be much more robust and proactive at local authority level.

Amendment 46 also proposes retaining provider representatives on the ICB board. As I said earlier, we think that an ICB should have a core focus on commissioning, so it is right to remove the requirement to have providers on them. That will also support the avoidance of potential conflicts of interest.

We debated these issues many times—the right hon. Member for Melton and Syston referred to it—in this Committee Room, or one very similar to it that was not quite as hot, during the passage of the Bill that became the Health and Care Act 2022. These are difficult and complex issues. I mean no disrespect to him—he had a difficult job to do at the time—but the architecture has not worked. It is confusing, and I do not know any area that particularly thinks it has worked. We think that clarifying the roles will make the system much more effective.

I think we agree that adding requirements for strategic authority mayors to make nominations to their ICB boards is a good thing. It will be an effective tool to harness the benefits of joint planning between an ICB and strategic commissioners and strategic authorities, who will have increasingly significant roles in shaping their areas. I ask hon. Members not to press their amendments, and I commend clause 21 to the Committee.

Question put, That the amendment be made.

Health Bill (Fourth sitting)

Edward Argar Excerpts

Committee stage
Tuesday 23rd June 2026 Public Bill Committees

[The Minister for Secondary Care (Karin Smyth)]

Casting my mind back to before the weekend, we had a wide-ranging debate on clauses 1 to 3 but, I think, substantial agreement about the central proposition to abolish NHS England. I pay tribute to my hon. Friend the Member for Lichfield, who succinctly put his finger on the key issue: it is fundamentally right that people and their elected representatives should be able to hold Ministers to account for the performance of the health service. It is also right that Ministers should have the tools to make the changes that are needed. The abolition is a necessary result of restoring that principle.

The debate raised a number of questions, a substantial number of which we will address during the course of the Committee as we reach the relevant clauses. However, I will pick up a couple now. I reassure the right hon. Member for Melton and Syston that the Government do take the impact of this process on staff seriously. We will treat people with the care, respect and fairness that they are owed through this process, now and in the months ahead. I am also committed to consulting recognised trade unions and I have a joint partnership forum to support ongoing engagement. More broadly, we recognise that change of this type is never easy, but we will need to go through the process quickly, which means, of necessity, proceeding in parallel with the legislation on the detailed internal design work for the new Department. That is in the interests of staff, patients and the public.

The hon. Member for Sleaford and North Hykeham raised the issue of whether the Bill was the cause of delays to the workforce plan. To be clear, it has not been, and we will publish that imminently. She also asked about the opportunity costs for other programmes, and I assure her that the Department, NHS England and Ministers are clear that we are here to deliver the 10-year health plan and other changes that make a difference to patients. We can, should and will do several things at once, and the Bill will help us with that by providing clarity of roles, greater freedom to local organisations and other positive changes.

To take just one example of the real impact, we are already saving on agency costs, and this is the first time in many years that the Department has not had to go back to the Treasury for a further injection of cash mid-year. That is getting a grip on the system. I add that the opportunity costs of not acting are very clear to the public, to staff and to patients in every single staff or patient survey that is issued. Those are the opportunity costs of not doing something; that is why we are acting. Clauses 1 to 3 are a necessary requirement for an NHS that is more effective for patients, delivers better outcomes across the country and achieves the initiatives that are expected of us.

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

This brings back memories of being in probably this same Committee Room a few years ago. I made this point during the previous sitting, but is the Minister able to commit that before the Bill leaves the Commons, a full and detailed statistical breakdown of the costs and benefits will be published, given their absence from the impact assessment?

[Karin Smyth]

I can tell the right hon. Member that we expect that NHS England coming into the Department will deliver up to about £1 billion in annual savings by the end of the Parliament, driven primarily by reductions in headcount, calculated using the average staff costs—about £77,000 per staff member in the Department and £94,000 per staff member in NHS England—including all pension and employer costs, which I think should help contribute to those numbers. As I think he knows, we will publish all accounts in the usual way.

I commend the three clauses to the Committee.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clauses 2 and 3 ordered to stand part of the Bill.

Clause 4

Reducing inequalities

Spinal Muscular Atrophy: Newborn Screening Test

Edward Argar Excerpts

Monday 22nd June 2026 Westminster Hall

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

Thank you very much, Mr Mundell. It is a pleasure to serve under your chairmanship. I will seek to speak relatively briefly.

The hon. Member for Sunderland Central (Lewis Atkinson) set out the case behind this petition eloquently, reasonably and with passion. Every year in the UK, 48 babies are born with SMA, with 60% of those having the most severe form: SMA type 1. I was moved to speak in this debate not only as a former Health Minister, but particularly after hearing from my constituent Charlotte. She told me about her son Harvey, who sadly passed away at just shy of seven months old. She very movingly set out her experience to me, and has kindly allowed me to share it with the Chamber today.

I pay tribute to Charlotte and her family for their courage and willingness to share something so personal not just with me as their Member of Parliament, but with hon. Members and more widely. I hope hon. Members will bear with me; I want to quote Charlotte fully, because what she relates is extremely important:

“On 15th March 2017 I gave birth to my first child. A beautiful blonde haired, blue eyed boy—Harvey. He was perfect. He was also unbeknown to us born with SMA Type 1.

As first time parents, having navigated the difficult journey of IVF, we were like rabbits in the headlights and had no idea anything was wrong—but in hindsight the signs were there quite early on. It was only through the concern of a Health Visitor when Harvey was 10 weeks old did the journey to his diagnosis begin. She had sadly come across another baby with SMA 1 earlier in her 30-year career and recognised the signs.

What Harvey went through to be diagnosed via multiple tests and what we went through as his parents was traumatic. Three weeks later we were then told by a room full of medical professionals that he had SMA Type 1 and at the very best he would live to two years old.

I will never forget that meeting, or the box of tissues that were slipped through the door just in case we needed one. I will never forget the walk out of Leicester Royal Infirmary that day, the day our ‘happy bubble’ burst & our lives changed forever. Nor will I ever forget the subsequent times when we had to go back to LRI when Harvey had stopped breathing and I resuscitated him, or to be trained in how to feed him via a nasal feeding tube.

In 2017, treatments were still at trial stage. We as Harvey’s parents decided not to treat Harvey with drugs that hadn’t been approved by NICE, nor did we want to put him through anymore trauma. An unimaginable decision to make, but we decided to focus on him and his needs as they changed whilst making memories together.

Harvey died on 14th October 2017, he was a day shy of being 7 months old.”

Charlotte told me that she and others in her situation were told that change was coming—that there would be an advancement in treatment, and that gene therapy and better diagnosis were on the way. As the hon. Member for Sunderland Central set out, those treatments do exist. There are three effective treatments for SMA in the UK, but as with so many health conditions, and as I saw during my tenure as a Health Minister, all too often, speed of diagnosis is everything.

The disease needs to be caught early, hence the benefits of newborn screening. I pay tribute to the former Health Secretary for bringing forward the ISE to October of this year, and I am grateful to him for that, but as the hon. Member for Sunderland Central set out, only 72% of babies in England will be included, so a large proportion—160,000—will not be screened. The hon. Member for Strangford (Jim Shannon), who has now left, highlighted the divergence in access across different parts of the United Kingdom of Great Britain and Northern Ireland, as did the hon. Member for Sunderland Central.

Until and unless the National Screening Committee makes recommendations on routine screening, many of those babies will miss out. I have seen how systems within the NHS work, often for good reasons—safety and rigour—but sadly that suggests that routine screening will not happen until 2030 or 2031. That is an awfully long time to wait and an awful lot of newborns who will be left unscreened and therefore potentially vulnerable to SMA.

In conclusion, and in paying tribute to Charlotte and her family, I have a question for the Minister, whom I know and have stood opposite on many occasions, both in government and now in opposition. I know that she cares, takes her brief extremely seriously and is a very diligent and caring Minister. My question to her, in Charlotte and Harvey’s name, is very simple: what steps can the Government take to speed up the process to add SMA to the NHS newborn heel-prick test for all newborns in this country?

Health Bill (Third sitting)

Edward Argar Excerpts

Committee stage
Thursday 18th June 2026 Public Bill Committees

My constituents are eager for change. They want their doctors’ surgery. Thousands of my other constituents do not want to be in a situation where they are failed. We should all support being able to abolish NHS England in the way that we are, which allows it to happen as quickly as possible. I place my support for these clauses on record.

[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?

[Joe Robertson (Isle of Wight East) (Con)]

It is a pleasure to serve on the Committee with you in the Chair, Sir Jeremy.

I echo and endorse all the comments made by the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham, who was comprehensive in setting out our position. I therefore speak from a broad consensus surrounding the Committee that the final days of NHS England as a body are here, and so be it, because there are advantages to be gained from its abolition. The Minister set out some of the leading reasons why she and the Government are abolishing NHS England. She referred to the growing bureaucracy, the unnecessary complexity, and the overlap of roles and responsibilities between the organisation and DHSC. She also spoke about being able to better focus on delivering care rather than navigating bureaucratic hurdles.

Health Bill (Second sitting)

Edward Argar Excerpts

Committee stage
Tuesday 16th June 2026 Public Bill Committees

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

Q I would like clarity on a few views that we have heard, not just in this session but in previous ones. There is one mindset that says that by bringing patient voice into ICBs, they are going to be marking their own homework. Equally, I think about places like Wolverhampton, where we have such baked-in inequalities and we simply have not shifted the dial for far too long, as can be seen in the differences in life expectancy. I have also heard that if you want to bring real change, it is best to bring that change from within the system. I will open that up to you, Sarah.

Sarah Tilsed: I disagree with that. It is fine for ICBs to be involved, but it is all about local partnership working—bringing in the voluntary sector and really going into the community, and doing it in partnership. That is the only way of doing it. If you are bringing it into the ICB, consider how much funding there was when Healthwatch was doing it and—I do not want to repeat this point, but I will—the fact that it will be marking its own homework. For me, it is about partnership working going from the community—not within the system and not within the NHS, but going out to the community and feeding inwards.

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

Q I know that in this conversation some have highlighted that patients have stated that their experience has worsened or not improved, but I would argue that is not a Healthwatch failure; it is actually down to the NHS or ICBs not acting on Healthwatch recommendations. It seems to me perverse to give that voice to the organisations that are actually part of the problem through not acting.

As a Minister, I was on the receiving end of some quite sharp recommendations from Healthwatch, but they were always constructive. Whether right or wrong, my fear is that this measure risks a perception among patients that it will be down to NHS managers and ICBs essentially to make recommendations that reflect their priorities, rather than the priorities and voices of patients. Professor, even if the principles that you have enunciated that might mitigate that risk were applied to the new model, are you really confident that they could mitigate the risk to patients’ confidence that their voice is genuinely and independently heard, loud and clear, however unhelpful it is perceived to be by bits of the NHS?

Professor Croisdale-Appleby: I cannot be confident of that, because we are in the foothills, not up the slope, and the details have not been given. ICBs have received something approaching a 50% cut in their running costs. I will not comment on the appropriateness or otherwise of that, but one has to be realistic and think about how high a really informed patient voice—particularly one that seeks out the views of both communities and individuals where the health inequalities are the greatest—will be on the priority list. I would question that, but I will leave it there.

[Liz Twist]

Q You all represent patient organisations in different ways. I would like to put this in the context of the 10-year plan and the shift to involve patients and communities in shaping services. From your patient perspective, how can we best support ICBs, local authorities and other people to drive that change for patients?

James Cooper: It is key that ICBs are given that support. In the conversations that Together for Short Lives and the services we represent have with ICBs, we certainly get the sense that they want support. They want to know how much they should be funding certain services, and they want to know how to plan. A lot of guidance is already out there, particularly in children’s palliative care, where we have service specifications and NICE guidance and quality standards—there is even a legal duty to ensure that ICBs commission palliative care for children and adults. That accountability and support from the centre, and making sure that resource is there, is key.

--- Later in debate ---

[Helen Morgan]

Q Do you think that the health and wellbeing boards, as envisaged by the Bill, will be the right structure to deliver those relationships, and how do you ensure that they have the right skills?

Councillor Wright: I chair a health and wellbeing board, and everyone comes to those; there are really good conversations and really good reviews of what is happening. I think they are in a really good position. What I worry about is how much influence they will have over NHS wider strategy.

I was at a King’s Fund day, and someone said something that I thought was so true: the Health Bill and the NHS 10-year plan is the NHS 10-year plan. The NHS will be judged on how it achieves what it is meant to achieve. Although, as local authorities, we want to help with prevention and those wider determinants of health, ultimately the responsibility sits with the NHS.

It is about trying to work out how we have better conversations with the NHS, to say, “We have done neighbourhood health for years; this is what we do as local authorities. We look at all these things and we use public health and our adult social care system to create healthy environments. We need you to be on board with us.” I therefore think there is something about the power dynamics regarding health and wellbeing boards and how we address them. But overall, I feel that they are the best way of ensuring community health.

The other thing is about geographies. Health and wellbeing boards might not match neighbourhood health geographies, so there are also some challenges in working out how that will work.

[Edward Argar]

Q Having been both a local councillor and a Health Minister, I am very conscious that the real test of any joint working arrangements between different bodies comes when budgets start getting a little tighter. We see that tension growing a little bit with the cuts made to ICBs’ budgets.

I was the Minister who created ICBs, and I sat on that Bill Committee with the current Minister for Secondary Care. I am getting a sense of déjà vu—we are on different sides of the Chamber now, but we sat through the Committee stage of the Health and Care Act 2022 together. I deliberately created ICBs to match the geography of upper-tier authorities because health and social care is essentially one system. If one bit does not work, the other bit does not work.

Since then, we have seen significant mergers and larger areas, further removing them from that direct relationship and read-across. Although the good ones do, I fear that a lot of NHS ICBs do not fully reflect the intention behind their creation, which was to see them as a genuinely collaborative exercise with equal voices in the room.

My question is: if we see ever-larger areas or fragmented areas, whether through neighbourhood health plans or mergers and acquisitions among ICBs, how do we maintain genuine local accountability and the relationships that underpin any structure written in law, on a piece of paper or in guidelines?

Notwithstanding what is being done about the health and wellbeing boards’ increasing involvement, do they actually have the teeth they need? In my experience, however good the collaboration, it is within the ICB boardroom that the decisions are actually made. However well things have been discussed beforehand, the ICBs will make their own decisions based on their own priorities. Does the removal of that voice from the ICB strengthen or weaken the ability to see this as one local system and to deliver a genuinely holistic local solution?

Councillor Wright: It will probably weaken it, unless we are given more say in our local health and wellbeing board. Our Thames Valley ICB has one director of public health. Thames Valley ICB I think has nine local authorities, and one chief executive and one director of public health sit on the board, so already the voice on it is quite small. If we lose that voice, where would we have those conversations? That brings me back to the whole thing about health and wellbeing boards needing to be stronger, definitely.

Sally Burlington: We would agree with that. If you take away the voice that is able to speak on behalf of social care, public health and wider public services, it will be harder and an additional job to bring in that consideration. It will be even harder to expect there to be notional teeth in that relationship, so we have concerns about that.

Maria Higson: It is also worth recognising that the delivery of any strategy or plan will require partnership working with local authorities, so whether or not they are in the room, they will be needed for delivery, and the proof is always in the pudding. For me, the partnership is somewhat non-negotiable in order to achieve delivery.

[Sureena Brackenridge]

Q Constituents have raised issues with me about when elderly patients or patients with dementia, in particular, come to discharge and the transfer of care, because of the lack of effective data and information sharing. To what extent do the provisions in the Bill on the single patient record allow data to be shared with social care providers? I will ask Councillor Wright to start off.

Councillor Wright: At the LGA, we are arguing for a single person record, so that we have a single patient record that brings in social care providers, or at least the local authorities’ social care statutory provision, too. Someone discharged into the community would therefore still have access to records and know what was going on, while others would know what has happened to that person and what they need. Yes, we agree: we hope that a single patient record would make things as smooth as possible from hospital discharge to home and would help when someone comes into hospital, so that the clinicians have a better idea of what the patient’s quality of life was like, what treatments they were on, and so on. We are definitely in support of the single patient record for that, and we would like it to become a single person record.

Sally Burlington: We are supportive as well. The Bill itself is unlikely to solve all the problems in this space. A huge number of practical cultural system problems exist in data sharing, so the regulations that follow the Bill will be important to enable that to work for social care providers and commissioners. It is worth noting that there are thousands of social care providers, so the implementation of the Bill and subsequent regulations will be important. We are keen to ensure that any approaches are co-produced with the social care sector, as well as the NHS. It will be a lot of thinking, a lot of planning and a lot of hard work to get it right, and social care providers will need lots of notice to upgrade their systems in the right, consistent way to enable them to speak to each other, if we are to see the vision of the single person record delivered. I guess it would also be helpful to think about the role of carers as we move into that space, because we know from covid that data sharing among carers was one of the issues that came up.

Health Bill (First sitting)

Edward Argar Excerpts

Tuesday 16th June 2026 Public Bill Committees

[Sureena Brackenridge]

Q I feel that my question may have just been answered, but you may wish to add something, Dr Benneyworth. Will patient safety accountability be improved when a patient’s care spans different organisations within an ICB?

Dr Benneyworth: One of the things that we see regularly in our investigations is that people fall down the gaps between organisations. We have the ability to look right across the system and understand a person’s journey. As a recent example, we looked at medication errors on discharge from hospital. There are a lot of medication errors, and we looked at the process of how information was being shared and what was happening. Those are the type of things where we see a lot of concerns about patient safety. There needs to be much more clarity about accountability for patient safety.

No one is accountable for the discharge of a patient. There is not one person—no single individual—who is accountable when someone is discharged from hospital to social care. You go through multiple layers of accountability. We are keen to learn from other industries that have effective safety management systems. Part of those safety management systems is having much more clarity about accountability, which is lacking across the NHS. I very much hope that, with the changes to ICBs, they really do think about accountability for patient safety.

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

Q In her evidence earlier, Dr Dash said that one of the reasons for her recommendations in her second review of changes to the regulatory and investigatory landscape is that it is a problem for the provider landscape that there are so many different organisations making so many recommendations. You have just said that HSSIB makes very few recommendations. Will the merging or folding—however you wish to characterise it—of HSSIB into the CQC lead to any meaningful reduction in the number of recommendations that organisations have to cope with?

Dr Benneyworth: No, we do not make recommendations to provider organisations at all. All our recommendations go to national organisations. I completely agree with Dr Dash that there are too many recommendations. In fact, HSSIB raised that concern through our work two years ago and flagged it to Dr Dash. We wrote a report called “Recommendations but no action”. We are very concerned about the plethora of recommendations going to providers, which create a huge amount of noise but, distressingly for the families involved, do not lead to the changes needed.

I completely agree that there are far too many recommendations. I am leading some work to address that—we are setting up a recommendations hub with the Department of Health and Social Care—but we are not that problem. We have made 39 recommendations since investigations launched and HSSIB started three years ago, and they are all to national bodies. We might reduce the burden on national bodies by taking that away, but it will not have any impact on providers.

[Janet Daby (Lewisham East) (Lab)]

Q Dr Benneyworth, you mentioned protected disclosures, and you said that individuals or organisations may have a fear of reprisals. Would you like to say anything more on that? What would you like to see from the CQC or in the Bill?

Dr Benneyworth: Yes, absolutely—we have seen that in so many of our investigations. It can often be exacerbated by different parts of the system working together.

To give you an example, we looked at mental health in-patient settings. There is national guidance that says that people should not use risk assessment tools around self-harm, but when we looked we found that, on the ground, everyone was using these tools. We asked why that was, and we were given two reasons. One was that the IT systems were set up such that you could not move past the front screen without ticking one of the risk assessment boxes, and the other reason was that people were fearful about being in front of a coroner and asked about risk assessment tools, so we took action on both those fronts.

Another thing that we see is about speaking up. There are definite inequalities at play when people are speaking up. We have seen significant racial discrimination. We wrote a report about temporary workers. We find that people working as locums or agency staff often feel a lot less able to speak up if there are patient concerns. If you are black or from other global majority groups, to be able to speak up is even harder. On the back of that, we made a recommendation to the National Guardian’s Office, and it has done a lot of work with temporary workers, looking at how we can improve their ability to speak up. We still have a huge way to go on culture generally, but particularly on discrimination and the inequalities that we see in every one of our investigations.

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 14th April 2026 Commons Chamber

[Wes Streeting]

The Chair of the Health Committee raises a very important point, and—not least given the timeliness of the issue—I would be very happy to meet her very soon.

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

Among the things that can help reduce waiting lists and waiting times is increased use of existing community hospital facilities, such as Melton Mowbray hospital in my constituency. Will the Secretary of State join me in calling on the local ICB and University Hospitals of Leicester NHS trust to invest in moving more services out of inner-city acute settings and into Melton hospital, so that more of my constituents can get the treatments they need nearer to home?

[Wes Streeting]

The right hon. Gentleman is absolutely right that we need to see more services moving out of hospital and into the community. That is why I am proud that we are announcing a new wave of community diagnostic centres and expanding lots of existing provision, as well as improving same-day emergency care and urgent treatment centres in hospitals. He has raised the issue of the Melton Mowbray site; I am sure the local commissioners responsible for that will want to look at it, but I also know that I owe him a meeting, so I will follow up with him directly.

Meningitis Outbreak

Edward Argar Excerpts

Tuesday 17th March 2026 Commons Chamber

[Wes Streeting]

Like my hon. Friend, I am a member of the NUS mafia in this place, and I well understand the enormous value that students’ unions bring to promoting student welfare and raising awareness. I think he is absolutely right about the risks of meningitis and other infectious diseases on university campuses, and to suggest that we should work with the meningitis charities, the NUS, student unions and others to see what more we can do not just in response to this outbreak in Kent, but more generally to raise awareness among groups of students, who, because of the nature of their studying and living conditions, can be more prone to the spread of infectious diseases.

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

I associate myself with the Secretary of State’s remarks: the thoughts of all of us in this House are with the families of those, tragically, who have died and all those who have been affected.

While there are understandably questions about vaccination and antibiotic eligibility, it is important that decisions continue to be guided by clinical experts, and in this country we have some of the best in the world. I welcome the Secretary of State asking the JCVI to review the eligibility criteria, but will he please be unequivocal—I think he has alluded to this—in saying that he will continue to be guided by its expert clinical advice in any decisions he subsequently makes?

[Wes Streeting]

I am extremely grateful to the right hon. Gentleman for raising that question and making that point. It sometimes feels that barely a month, if not a week, goes by in this job when I am not regularly exhorted to make a political decision overriding clinical advice. I think that is the wrong thing to do and it sets a dangerous precedent, particularly when others in this House might be minded to make ideological judgments about science and medicine that are neither good science nor good medicine. There is an important principle to defend here, which is that where we are making clinical decisions, they should be based on good, high-quality clinical advice on the basis of robust evidence and data. I give him the assurance that I will continue to follow clinical advice, and he is absolutely right to raise this particular point of principle.

GP Services: Melton and Syston

Edward Argar Excerpts

Thursday 30th October 2025 Commons Chamber

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

Thank you for calling me, Madam Deputy Speaker, and through you I thank Mr Speaker for granting this important Adjournment debate. I congratulate the Under-Secretary of State for Health and Social Care, the hon. Member for Glasgow South West (Dr Ahmed), on his well-deserved promotion to ministerial office—it was in very short order, but it is very well deserved. I thank him for being present to respond to this debate tonight, because he has, as I have just indicated, a rather longer journey home to his constituency than I do back to Leicestershire. At the outset of this debate, I should put on the record that I am, of course, registered as a patient at one of the NHS GP practices in my constituency, which I may refer to in the course of this debate.

As every Member of this House will recognise, general practice is in many ways the gateway to the NHS for our constituents. It has the potential to do a huge amount more. Sadly, on some occasions the gateway to NHS services for our constituents is simply to go to A&E, rather than seeking to go to their general practitioner, or indeed rather than using—to the extent that it has the potential to be used—pharmacy as a first port of call, as people can see a pharmacist for some advice in the first instance. For the vast majority of people, though, it is the GP practice that is the route into the NHS and where people go when they are concerned about their health.

I am sure that all Members of the House would recognise the challenges and pressures faced by general practice irrespective of Government in recent years. There are a number of factors behind that. We should not forget the impact of the pandemic, with the changing patterns of attendance that followed it and the increased demand that came immediately after it. We are also seeing the consequences of an ageing population in our country, with people living longer with more chronic conditions.

We also see the increased pressure in many of our communities, irrespective of where they are in the country, that arises from increases in housing development that are not met with increases in the provision of key local infrastructure. This has been especially true in recent years in my constituency, where we have seen huge increased local development without that infrastructure. There is also the prospect of significantly more development.

I am going to talk primarily today about the particular issues in Melton Mowbray and the surrounding villages, as I have indicated to the Minister, as I am keen that he is able to give a pragmatic and helpful response for my constituents. I will also touch on some broader themes and on the provision of general practice in the village of Sileby in my constituency, which also faces pressure and challenges.

[Jim Shannon (Strangford) (DUP)]

I find in my constituency, and I think the right hon. Gentleman will find the same, that the extra responsibility of filling in forms, such as for personal independence payments, universal credit, employment and support allowance and disability living allowance, falls on the GP. Has he found that providing the evidence for those benefits adds even more to the already large workloads of GPs?

--- Later in debate ---

Motion made, and Question proposed, That this House do now adjourn.—(Gregor Poynton.)

[Edward Argar]

The hon. Gentleman is right. Although I spent two and a half years as a Minister in the Department of Health and Social Care, I was never the Minister for Primary Care, but I am very much aware, as I suspect Members across the House are, that that is an additional pressure on time for general practitioners. We in government sought to do what we could to reduce that, and to be fair to the new Government, I know the Secretary of State is actively looking at what can be done to further streamline administrative processes to allow general practitioners and their teams to spend more time with patients.

Although my focus is on GP services in Melton Mowbray and Sileby, it is true that all GP surgeries in my area—whether that is the County practice and Jubilee medical practice in Syston, or practices in Thurmaston, Bottesford, Long Clawson and other nearby villages—continue to face huge pressures. It is important to say that these practices really do their best. Their staff—not just the GPs, but the whole teams—work incredibly hard, and I know they care deeply about the service they provide to their patients. In Melton Mowbray especially, they see acute pressure, particularly on appointments: we have just one GP practice for a growing town. Latham House medical practice has over 36,000 patients on its books, making it one of the largest in the country. Timely access to GP appointments is one of the largest regular issues to appear in my constituency inbox, with waits—according to the correspondence I receive—of at least six weeks, and it can be eight or 10 weeks before an appointment is available. Clearly, that is not right.

It is important to say, to be fair to Latham House medical practice, that when my constituents get to see either a nurse, an allied health professional or a GP, they regularly cite in their emails the quality of the care and the kindness shown by the staff. Indeed, we recently saw a Cavell star award given to Debra Gilbert, one of the nurses at the practice, so the team there work hard and are passionate about what they do. In 2024, they saw an average of 6,900 appointments per 1,000 of the population on their list. That is higher than the national average, but I would urge a little caution because that is a crude statistic that does not necessarily comparatively reflect the different demographics of different areas, such as whether an older population or deprivation in an area lead to a higher need. It is important to put on the record that they are doing what they can to try to improve access, but clearly, an increase in provision is needed locally.

Back in 2021, the then clinical commissioning group agreed that it recognised the need for increased provision of GP services in Melton Mowbray. In 2023, the integrated care board continued with that and agreed to explore a second GP practice, recognising the need for it. I believe that was a sensible decision by the ICB, but regrettably, just a few weeks ago in early October, it announced that it was pausing its work to develop such a plan until 2027. I have been around the Department of Health and Social Care and worked with the NHS long enough to know what a pause, sadly, all too often means. In Melton Mowbray, we have seen a pause of six months at the St Mary’s birth centre—a midwifery-led unit—to allow for staffing shortages to be addressed. Four months into that pause, we have yet to see any suggestion of how it might be brought to an end. When I hear the word “pause”, I fear that will run on into something more permanent.

This issue, which is hugely important to my constituents, has been covered extensively and powerfully in the local media—in particular by the excellent local paper, the Melton Times. It is important to say that I am conscious that neither I, as a Member of Parliament, nor Melton borough council—which is equally keen for increased provision and with which I have spoken—or indeed the Minister himself have the power to simply overrule a decision taken by an integrated care board in a local matter such as this. I took through the 2022 Act, so I have a vague recollection of how that works.

That remains a deeply disappointing decision, and, I believe, the wrong one. The value of access to general practice, and the impact that a lack of access has, is writ large. Earlier today, I had one of my regular catch-ups with Councillor Ronan Browne, the leader of the opposition on Melton borough council, who did a lot to get us to the point where we were hopeful of seeing a second GP practice. He set out his deep disappointment about this decision. There is a clear remaining need.

The ICB, in its announcement on reaching its decision, stated that the section 106 payments on which it was aiming to base the provision of capital for the new building were now insufficient. It also stated that slow growth in new registrations, and slower population growth than had been anticipated, were relevant to its decision making. However, that does not help my constituents. I am conscious of the challenges of funding buildings. As the Minister and I have discussed, in a sense—ironic though it may sound—finding money for a building is sometimes easier than the second part of the equation, which is securing the staff, and managing the oncosts to fund that.

I should say that I am grateful to the ICB for its engagement and to Toby Sanders, its chief executive, for his open engagement with me. As I say, he has emphasised that he believes that section 106 payments are not enough, and the ICB has said that it has no funds to backfill that or pay for anything from its own funds. It is important to remember that, as the Minister will be aware, general practitioners and general practices are, in many ways, private businesses contracted to provide services to the NHS, but they are not direct employees of the NHS, so they cannot be directly instructed by the Minister, by ICBs or by NHS England—it is important to put that context on the record.

In respect of the argument by the ICB that there were insufficient increases in new registrations and new patients to justify a second GP practice at this time—noting the pause—I am afraid that that fails to reflect the importance of choice for patients in switching to a different service in their locality if they so wish, and, in so doing, potentially easing pressure on the existing practice’s list. Pausing without a clear alternative long-term plan is simply not good enough.

Latham House surgery has recently announced that it has taken steps to help to address this in the short term. On 15 October, it announced that it was recruiting an extra five GPs and additional nursing staff, that its Asfordby satellite surgery would be opening full-time in the future, and that it was looking to create new provision in a small premises on Sherrard Street in the town. Those are welcome steps for which I am grateful, and I look forward to hearing more about those proposals from the practice, but they do not alter my view on the long-term needs of Melton Mowbray and the surrounding villages. The ICB needs to act and be supported in doing so by the Department of Health and Social Care. It is true to say as well that ICBs face real challenges, including the Government requiring them to force cuts in staff and to restructure, but without seemingly providing them with additional ringfenced funding for the costs of that restructuring, be they redundancies or otherwise. That means that regardless of whether the end is a good one—that is, a leaner ICB—ICBs will potentially have to cut from the frontline in the short to medium term to fund that restructuring.

As I have alluded to, there are also the challenges of oncosts and funding GPs to staff a surgery. GPs have a choice as to where they choose to work, and I suspect the old Carr-Hill formula, which the Minister and I have spoken about in the past, does not aid that. It is a challenge that Governments of all complexions have faced and I hope that he, if he is willing, will take on the challenge of looking at the Carr-Hill formula. He will have my constructive support in doing so. Latham House practice has cited the challenges in securing and retaining staff so I recognise that, but again, those are challenges for the Government and the ICB to assist and support with and not ones that should be borne, as a consequence, by my constituents.

I will briefly mention Sileby, another village in my constituency. It has two good GP practices, but it is a rapidly growing village, and larger premises are needed. Again, the ICB has indicated that it will not have funds to fund or support that and once again, section 106 moneys are likely to be insufficient. It is a real challenge faced by GP practices up and down the country as to how they take that step, often having to accept more patients as houses are built. Even when there is a section 106 payment, it is only triggered later in the process once they have already had to absorb an increase in patients. I hope that the Minister might look at that.

Although I recognise and welcome Latham House’s actions and hard work and I hope that delivers results, I fear it simply is not enough to tackle the long-term needs. The Secretary of State’s new neighbourhood health centre programme may well help us in the longer term. For example, one of those could be allocated to Melton Mowbray, which already has Melton Mowbray hospital—in my view an underused and therefore perfect site, and the Minister can take that as a potential early bid for such a centre. That may help in the long term, but we still need action now for my constituents to improve access and to build for the long term.

I am sure the Minister will know that Melton Mowbray and the surrounding villages and towns are fantastic places with a real sense of community, a proud history, a great present and huge future potential, just like the other parts of my constituency. Melton Mowbray’s residents are good, decent people who need, and frankly deserve, improved access to GP appointments and an increased focus on tackling this for their communities.

Will the Minister set out what steps the Government are taking in partnership with ICBs to help address increased need for access to GP appointments, both nationally and locally? Is he willing to take on the challenge of looking at the Carr-Hill formula and how GPs are funded per patient for their activity? Will he reassure ICBs that all restructuring costs, over and above their current budgets, will be centrally funded to avoid them cutting frontline services? Will he work for better links between section 106 moneys and the needs of healthcare provision locally? Will he meet me, ideally in Melton Mowbray—he is very welcome—to discuss what can be done locally to improve GP provision?

I genuinely hope that he shares my view that Melton Mowbray and the nearby villages not only need further enhancement to existing services, which Latham House is trying to put in place, but genuinely need that second GP practice to meet their future needs. I will continue to campaign on behalf of my constituents for that, but I will also, as I hope he has seen in the brief time we have known each other, be willing to work with the NHS and with any political party that helps facilitate that locally and nationally. Finally, will he agree to work with me and my constituents to deliver the improved premises and services needed to meet the current and future primary care needs of my fantastic constituents in Melton Mowbray and the surrounding villages?

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

I thank the right hon. Member for Melton and Syston (Edward Argar) for raising the crucial issue of GP provision. As a relatively junior Member of this place, I have always looked around at the Benches on both sides of the House for elder statesmen and women who are exemplars of how to conduct oneself in this Chamber. He is certainly one of those Members. We miss him on the Front Bench, and we are grateful for all his contributions.

[Edward Argar]

I am grateful to the Minister for that. The only point I would make is that when, at the age of 47, one is described as an elder statesman, one can see retirement looming. I want to reassure him that I have no intention of retiring or stepping back from my duties in this House.

[Dr Ahmed]

As a medical practitioner, I can assure the right hon. Member that he is ageing well, and I am sure he has many more years of service to give.

I will now take on some of the challenges that the right hon. Member said faced GP services in Melton Mowbray and Syston. He is knowledgeable—possibly more knowledgeable than me—about the Carr-Hill formula. I can assure him that my hon. Friend the Minister for Care, whose portfolio this comes under, is very engaged in reforming the Carr-Hill formula. I am sure he would be pleased to give an update on how he is getting on with that. The right hon. Member wishes for a meeting with the Minister of State, and I would be delighted to arrange that for him—I am afraid I cannot confirm the location, but I can certainly arrange the meeting.

When asked about their top priority for the NHS, the public overwhelmingly call for us to fix general practice and access to it. That is at the heart of what people care about in this country, and it is what they need first and foremost from their health service. General practice remains the front door to our NHS, delivering vital care to millions across this country, yet we all know the challenges faced by both patients and GPs—the right hon. Member alluded to many of them in his excellent speech: access to appointments, capacity and workforce pressures, to name but a few. The Government are absolutely committed to tackling these issues, to ensure that everyone receives the care they deserve.

Baby Loss

Edward Argar Excerpts

Monday 13th October 2025 Commons Chamber

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

I pay tribute to the hon. Members for Sherwood Forest (Michelle Welsh) and for Rossendale and Darwen (Andy MacNae) and to my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) both for bringing this debate during Baby Loss Awareness Week and the incredibly thoughtful and moving contributions they have already made to the House. I suspect we will see this House at its best this evening, debating in a measured but passionate way something of huge importance to so many of our constituents.

I welcome to the Public Gallery those family members who have stayed until this late hour because this matters so much to them. I pay tribute to Bliss, Sands and other charities that do so much in this space. It has been a privilege for me to meet, and read correspondence from, constituents of mine who have been affected by baby loss. I have to say, they have carried themselves with the most incredible dignity given what they have been through. I am very conscious that it is something that they will never get over.

I will not use surnames as I have not sought permission, but some families have given me the name of the baby they lost, and I want to place those names on the record, because it matters: baby Wynter, baby Harry and baby Ciara-Mae. I know that they will always be their parents’ baby. It is important that we remember that. I hope to do them justice.

The hon. Member for Sherwood Forest spoke with incredible eloquence when she said that it is about not just mourning the past but fighting for the future. She sums up what this debate must be about if it is about anything. We have seen progress, but it is sadly not enough. As my right hon. Friend the Member for Godalming and Ash mentioned, that progress has apparently plateaued since the pandemic. We still see terrible inequality of outcomes across different groups in our society.

Sadly, giving birth is not risk-free, but by no means are all those baby losses inevitable—many are avoidable. We need to ensure that we do all we can to reduce that risk. When something goes wrong, as sadly it has on too many occasions, families deserve transparency, openness and a fight for improvement. They need to be believed and listened to. We have seen problems in Morecambe Bay, Telford, East Kent, Nottingham—I could go on. Let me focus briefly on Nottingham—as a Leicestershire MP, many of my constituents will have been affected. Donna Ockenden’s work is very welcome; she has built extraordinary trust with the families and those who have been failed. I also welcome the national review that the Secretary of State has put in place, and the work being done by the noble Baroness Amos. I know that the Secretary of State knows this, but I gently say to him that there are different views among the families, and I encourage him and the review team to continue taking the families with them, to work with them at each stage, and to listen to them.

Improvements are needed. My right hon. Friend the Member for Godalming and Ash mentioned the CQC and he was absolutely right to do so. We need to see continued transparent engagement by that review with the families. We need to see whether more can be done to consider the role of the independent regulators. It is important that we look at the support available for both parents when the worst happens and they are bereaved. We need to raise more awareness. I know that the Secretary of State knows that. The families I have spoken to speak well of him. I know him well; he is a decent man and cares deeply about this. I know that he is listening. The fact that a Secretary of State is on the Treasury Bench at this hour and will conclude the debate at around midnight is testament to his commitment—I wish him well in his work.

It behoves us all to continue to strive and do more to reduce the number of avoidable baby deaths and the pain the avoidable baby loss causes. Equally—I echo the words of my right hon. Friend the Member for Godalming and Ash—we must also focus on hope and progress, and on safety, accountability and what more we can do to ensure that a child coming into this world is not a moment of sadness and grief but a moment of joy. I wish the Secretary of State well in his work on that.