Underperforming NHS Trusts: Government Oversight

Graham Stuart Excerpts

Wednesday 14th October 2026 Westminster Hall

[Mr Richard Holden (Basildon and Billericay) (Con)]

The hon. Lady makes some important points. We share a hospital trust. Many of my constituents in Basildon and Billericay go to Broomfield hospital. Some of them go down to Basildon hospital in the constituency of the hon. Member for South Basildon and East Thurrock (James McMurdock), as well as the Southend hospital in another neighbouring constituency.

I want to pick up on that point around contingency planning, because Basildon hospital, which is part of the trust, is particularly bad for corridor care. It is very clear to me that it is a major issue that is really hammering people. I want to make a very brief point about that care.

[Graham Stuart (in the Chair)]

Very brief.

[Mr Holden]

Thank you for your indulgence, Mr Stuart.

A constituent came to me who was handed a second-hand book on grief, with somebody else’s notes in it, after he had just lost his wife. It really struck me that, whether it is corridor care or that almost thoughtlessness, care is actually missing in parts of the Mid and South Essex NHS foundation trust.

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[Several hon. Members rose—]

[Graham Stuart (in the Chair)]

Order. I need to introduce a time limit of three minutes.

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[Jim Shannon (Strangford) (DUP)]

It is a real pleasure to serve under your chairship, Mr Stuart. I thank the hon. Member for Chelmsford (Marie Goldman) for raising this issue and giving us a chance to participate in this debate.

The new intensive recovery programme has identified several NHS trusts in England that are underperforming as a result of waiting lists, persistent financial difficulties and leadership instability. The trusts identified include North Cumbria, Mid and South Essex, Hull, North Lincolnshire and Goole, and East Kent. Performance across those trusts and beyond has raised serious questions about whether patients in England are receiving consistent access to cancer treatment.

I want to focus on cancer treatment in particular. The NHS has a long-standing target that 85% of patients should get treatment within 62 days of an urgent referral for suspected cancer. However, the performance at many trusts is substantially beneath that, and it is having serious consequences on patient outcomes. For example, in 2023, the death of a patient admitted to Mid and South Essex was linked to the trust’s failure to meet any of NHS England’s cancer waiting time targets. At that trust, only 47.7% of patients began treatment within 62 days, and by 2025 the number had further declined—in other words, it was getting worse.

At the County Durham and Darlington trust, which the hon. Member for Darlington (Lola McEvoy) referred to, the situation is similar. Significant failings were identified in breast cancer care, as she illustrated very well. A review of the care received by women between 2023 and 2025 found that 32 women had undergone unnecessary surgery, 20 had experienced a late diagnosis and a further 78 patients were found to have suffered moderate or severe harm. A review has been committed to, demonstrating that the true scale of the issue is likely much bigger than we know.

Analysis of NHS cancer waiting time performance found that nearly every English NHS trust missed cancer targets. In Northern Ireland, we have also experienced serious concerns regarding cancer care. For example, recently there has been a call for a public inquiry into urology services at the Southern Health and Social Care trust, where it was identified that cervical screening services had reported some results incorrectly. Patients were told their scan was clear, and then shortly afterwards told it was not. That is an absolute scandal, and it caused patients and families considerable distress. Northern Ireland’s waiting time statistics further illustrate the pressure on cancer services. Some 30% of patients began treatment within 62 days, and that percentage has been on a downward decline.

I know the Minister has no responsibility for Northern Ireland, but she has responsibility for the trusts here. I look to her to ensure the promotion of effective oversight and accountability in all our trusts. Underperformance is widespread and must be addressed. These failures are undermining public confidence in the health service. A suspected cancer diagnosis is already a distressing experience, and patient outcomes are not being helped by lack of clarity and reassurance.

[Graham Stuart (in the Chair)]

Last but not least from the Back Benches, I call Adam Dance.

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[James McMurdock (South Basildon and East Thurrock) (Ind)]

I appreciate your allowing me to speak at the last moment, Mr Stuart, and it is an honour to speak under your chairmanship. I thank the hon. Member for Chelmsford (Marie Goldman) for bringing this very important and timely debate to Westminster Hall.

I want it to be clear that although the list of figures that I am about to bring forward is concerning, I do not place any of the burden of blame on the shoulders of frontline staff—indeed, the more concerning the figures, the more gratitude and appreciation I show the staff for enduring these challenging circumstances and the challenging work environments they turn up to each day to give the highest quality of care—so much so that whistleblowers have brought to my attention, at great personal risk to their careers, concerns and details about the state of care and operational functionality at Basildon hospital.

I can give a quick example: a surgeon reached out to me, stating how senior management had come in and put in place the organisation and throughput practice that they thought best, while the surgeon was sat there with his own experience, seeing that surgical spaces were very often left empty because of the way processes were being put forward and forced upon the staff. Some changes have been put in place, but—although I have not personally been able to verify this—a consultant said to me that actually more management staff than consultants have been hired in the last couple of years.

I want to share some figures. I have almost a dozen bullet points here, and every single one is rather concerning, but suffice to say that Mid and South Essex trust—of which Basildon hospital, in my South Basildon and East Thurrock constituency, is part—ranks 131st out of 134. The Care Quality Commission ranked Basildon hospital as inadequate, and it was so concerned with the state of affairs there that it performed multiple repeat visits to try to improve things.

Complaining alone is not enough, but the hon. Member for Chelmsford raised two points that are really striking. The first is that problems should not be obvious. I should not turn up to a medical practice as a layman and be able to spot clear errors. I remember visiting the mental health ward at Basildon hospital; there was a foyer with overgrown grass, weeds up to your chest, garbage and concrete strewn everywhere. I was walking around with the CEO, and I said, “What’s happened here?” He turned around in complete shock, as if he had never seen it before, and said, “Oh, I’m not sure. Sometimes you just go nose-blind”—staggering. The problems do not just start there, but that is the standard of things.

While many of my constituents will be concerned to hear that Basildon hospital was ranked poorly, I want to stick up for the staff there and say that I will personally continue to use that hospital, because I recognise how important it is. I will make one last point, as I am being encouraged to conclude—

[Graham Stuart (in the Chair)]

Order. I call the Liberal Democrat spokesman.

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[Helen Morgan]

I fully agree, and that is why HSSIB has a role to play, because it provides a safe space for people to raise concerns without fearing for their jobs. The National Guardian’s Office, which is also being removed by the Health Bill, enables and encourages safe whistleblowing across the NHS, and it is important that we retain it.

The Thirlwall inquiry highlighted constant reorganisation as a problem as well. I received a notification in my inbox this week that Shropshire, Telford and Wrekin ICB had clustered with Staffordshire and Stoke-on-Trent ICB to get ready for a merger, but that it is all on hold now because it does not line up with local government reorganisation. It is really problematic for local health services when their management teams do not know whether they are coming or going from one month to the next. I urge the Minister to deal with that problem as well.

It is clear that urgent action is needed to turn around underperforming trusts for the safety of their patients, the welfare of their staff and the value delivered for the taxpayer. I hope the Government will look at the measures we have outlined and accept some of them in the Health Bill as it passes through the House of Lords, so that we can really affect people’s lives and put back their confidence that the NHS will be there for them when they need it most.

[Graham Stuart (in the Chair)]

I call the spokesman for His Majesty’s Opposition, Dr Caroline Johnson.

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[Dr Johnson]

Before the interruption, we were talking about the importance of workforce to the health service and to any improvements that we wish to make to services. The previous Conservative Government developed a long-term workforce plan. This Government decided to develop their own, which is fair enough, but it is very delayed. Can the Minister tell us, without using the words “in due course”, “imminently” or “soon”, when it will be published, preferably giving a date?

Returning to other plans, the Government say that maternity and neonatal care is their priority, which is good, but when they came into government, they said that they had a plan to improve it. They spent the first 12 months writing their 10-year plan, which said that they would produce a maternity and neonatal plan. They did a review, which took six months longer than it was supposed to. They were then two years into a parliamentary term. That plan says that they will have a commissioner, who they have yet to appoint, and another plan for a modern service framework, which is apparently due by Christmas. Can the Minister guarantee that, two and a half years into the Parliament, they will have a delivery plan for maternity improvements?

The bottom line is that I am concerned that the Government are too busy reorganising the NHS to deliver on their promises. NHS performance is declining in many areas. There is huge variability between trusts and departments. The Government picked five for intensive treatment. What about the others? Can the Minister clarify that it works? The Government are internalising patient experience, which means that it may suddenly look much better, but how will anyone have confidence in the figures if they are produced by the Government marking their own homework? The abolition of NHS England has been badly planned. ICB cuts, mergers and paused mergers are simply a distraction. The removal of the need for governors removes another layer of accountability and scrutiny.

The Government say they are working at pace, but it is a very slow pace. The workforce plan and the maternity plan have been delayed, but so have things like the Hughes report. People suffering from valproate and mesh have been waiting and waiting. It is getting towards three years since that report was published. They have waited long enough. I urge the Minister to say when the Government intend to respond to that report.

The Government need to get a grip of who is holding the trusts to account, so that when the Health Bill comes out the other side of the Lords, there is a clear chain of command. Perhaps it will lead up to the Secretary of State, but it is clear that they will not be able to micromanage every detail. There needs to be a clear path so that people know who is accountable, who will drive improvement, who to congratulate when improvements are made and who to hold accountable when it goes wrong.

[Graham Stuart (in the Chair)]

Thanks to the discipline of the speakers so far, there are some extra minutes for the Minister to take interventions if she so chooses.

[The Minister for Secondary Care (Karin Smyth)]

That is very kind of you to encourage me, Mr Stuart. What are the timings now?

[Graham Stuart (in the Chair)]

We will finish at 4.15 pm, so ideally we will allow the wind-up at 4.13 pm.

[Karin Smyth]

Thank you. It is a pleasure to serve under your chairmanship, Mr Stuart.

I want to try to get back to most colleagues. I thank the hon. Member for Chelmsford (Marie Goldman) for securing this debate, and all Members who have spoken about the experiences of patients, because this is absolutely about the experiences of patients, families and the NHS staff in all our constituencies.

When an NHS trust underperforms, however we define it, the effects are very real. Patients wait longer, staff work without the stability and support they need, and public money is not used as effectively as it should be. Since becoming a Minister, I have made it clear that I think Members of Parliament should be part of conversations with local trusts. I commend my hon. Friend the Member for Ipswich (Jack Abbott) for hosting his trust in the way he has and seeing an improvement in his constituency, as he outlined, with mental health being considered as well as acute services. The Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), spoke about her work in supporting her local trust and seeing those improvements. It can and does happen.

Many of the trusts that have been discussed today have faced problems built up over many years. In fact, I remember some of them from being a manager in the health service over the past 20 years or so. There is rarely one cause or a quick fix. There are varying problems, whether they be workforce shortages, poor estates, weak leadership, organisational change or rising demand, and some of those can reinforce one another. Let us be clear for patients and members of the public who are paying attention and for all our constituents: this Government will not accept poor performance, and we are determined to accelerate the recovery, particularly in the most challenged trusts.

I will just clarify some of the rules. Everyone knows that NHS England is an arm’s length body. That was a decision taken a number of years ago by my good friends the Liberal Democrats and the Conservatives when we were in opposition. The Health Bill, which is progressing through the House of Lords, changes that arrangement to put the NHS together with the Department of Health and Social Care. The Bill was not opposed in principle by any political party, because we all know that the arrangement has not worked.

As we bring the two bodies together, it is important to maintain the distinction between running large trusts and running the system as a whole, with operational performance oversight. It is a skilled job. It is hard to run a big trust. It requires good clinical and operational managers, and good leadership and knowledge. The complete separation of the Department and Ministers from NHS England meant that the oversight and what we could see in our constituencies as Members of Parliament was not linked up under the previous Government. That is one thing that will improve. As the hon. Member for Sleaford and North Hykeham (Dr Johnson) just said, of course Ministers will not be micromanaging. It is a skilled job. The complete separation that removed oversight from local trusts has been a dysfunction of the system over the last decade.

To be clear, I regularly meet teams and Members of Parliament in my role. I want to share how some of that operational oversight works. I will highlight two major areas. One is the oversight framework, which provides a clear and consistent assessment of every NHS organisation. In her expertise, the hon. Member for Sleaford and North Hykeham recognised that there are many ways to judge performance, but the new framework looks at what matters most to patients and taxpayers: waiting times, quality of care, use of staff and money, and leadership capability in order to have good-quality patient care. They cannot be separated in my view. I have made sure that it is transparent for the public and Members of Parliament. That is quite controversial; some people do not like what they call league tables, but I think it is important that people can see that.