Health and Social Care

Karin Smyth Excerpts

Tuesday 20th October 2026 Written Corrections

The following extract is from the Westminster Hall debate on Underperforming NHS Trusts: Government Oversight on 14 October 2026.

[Karin Smyth]

The clinical strategy will make greater use of neighbourhood and community care in line with our 10-year plan and focus on maternity and planned care treatment. This is backed by £80 million for Southend hospital’s long-standing structural estate problems and support for a neighbourhood health centre in Maldon.

[Official Report, 14 October 2026; Vol. 791, c. 184WH.]

Written correction submitted by the Minister for Secondary Care, the hon. Member for Bristol South (Karin Smyth):

[Karin Smyth]

The clinical strategy will make greater use of neighbourhood and community care in line with our 10-year plan and focus on maternity and planned care treatment. This is backed by support to develop an estimated £80 million scheme to address Southend hospital’s long-standing structural estate problems and support for a neighbourhood health centre in Maldon.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 20th October 2026 Commons Chamber

[Mrs Elsie Blundell (Heywood and Middleton North) (Lab)]

1. What recent discussions she has had with the interim leadership of the Northern Care Alliance NHS foundation trust.

[The Minister for Secondary Care (Karin Smyth)]

I absolutely endorse your comments about our colleague, Mr Speaker.

I know that my hon. Friend and many other colleagues are deeply concerned about the issues at Northern Care Alliance. As of June this year, the trust has been placed under the highest level of regional oversight and support from NHS England. It is imperative that rapid movements are made, governance systems are strengthened and that every patient receives the standard of care that they deserve.

[Mrs Blundell]

My constituents are very concerned about Northern Care Alliance hospitals. Across the trust, there were 10 serious incidents between 2025 and 2026 that were found to be wholly preventable, lengthy delays causing severe harm to patients and industrial action, culminating in a sustained decline in performance and national rankings on patient safety. What options are therefore on the table if the trust does not show urgent signs of improvement?

[Karin Smyth]

My hon. Friend rightly highlights on behalf of her constituents the number of issues that have led to this significant regulatory intervention and support. If necessary, further action is available to NHS England and the Care Quality Commission. We want to ensure that the focus now is on supporting and challenging the trust to make the rapid and sustained improvements necessary in those key areas. I know that my hon. Friend and our other colleagues will work closely with the trust on this; I always encourage MPs to work closely with their trust to ensure that that happens. If necessary, other measures will also be available.

[Rachael Maskell (York Central) (Lab/Co-op)]

2. What steps she is taking with Cabinet colleagues to regulate funeral services.

--- Later in debate ---

[Dr Sam Rushworth (Bishop Auckland) (Lab)]

7. What steps her Department is taking to increase the use of community hospitals and beds for step-down intermediate care.

[The Minister for Secondary Care (Karin Smyth)]

My hon. Friend makes an excellent point about the importance of intermediate care, which is a key component of supporting patients into discharge to recover outside of hospitals. Community beds play an important role, but we are clear that home-based intermediate care also needs support, particularly for frail people, through neighbourhood health. That should be the default pathway, and we will continue to work with the system to make that happen.

[Dr Rushworth]

Ward 7 at Bishop Auckland hospital is an example of the NHS working—physios, nurses, healthcare workers and some excellent facilities—so we were shocked to hear that our local NHS trust plans to close the ward, move it to Darlington and break up that team. Will the Minister meet me so I can represent my constituents and the workers at that hospital, and raise those concerns with her face to face?

[Karin Smyth]

I am, of course, happy to meet my hon. Friend to discuss that issue further. I am clear that all changes to services should be based on clear evidence that they deliver better outcomes for his constituents and people across the country. He is absolutely right that we want to extend care closer to home. As I said, the default is to get more care into people’s homes, and I am happy to discuss that further with him.

[Alex Brewer (North East Hampshire) (LD)]

Our community hospital in Fleet is doing a brilliant job, but it could be a much more established resource for local people, especially given the delays in rebuilding our local hospitals. Will the Minister meet me to discuss how we can make the best use of community hospitals in North East Hampshire while we wait another two decades for the rebuild of Basingstoke hospital?

[Karin Smyth]

The hon. Lady is right that we absolutely want to get more care closer to people’s homes and into people’s homes. We want to support frail people in their homes before they even get into hospital. I am working with the integrated care board to make sure that all that happens. I am happy to discuss that further with her.

[Mr Speaker]

I call the shadow Minister.

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

Step-down beds in community hospitals, such as the Chase community hospital and Haslemere hospital in my constituency, are vital. Unfortunately, neither of those two hospitals is being used for that purpose at the moment. At the same time, delayed discharges have hit an all-time high under this Government. More than 14,000 patients a day are stuck in hospital for two weeks or more after being declared fit to leave—that is up 12% since July last year. Behind every one of those numbers is someone who wants to be at home and an acute bed that another patient desperately needs. Why are the Government failing so abysmally at getting people out of hospital and into care at home?

[Karin Smyth]

As the hon. Gentleman knows, the situation deteriorated massively under the 14 years of Conservative government. He is well aware of the fragmentation of all our services. He knows how the system was fragmented and what happened under those reforms. He knows that is why we are trying to change it. He is absolutely right, though, that people being in beds in hospitals or in parts of the system where they should not be is not good for their health or their outcomes. That is why it is part of our three shifts, and that is fundamentally why the Prime Minister is very clear that we will raise social care up the agenda and ensure that people are treated more in their homes and in community services where they live. I welcome his support for our shift to neighbourhood care and to better care closer to home.

--- Later in debate ---

[Jonathan Davies (Mid Derbyshire) (Lab)]

T2. My constituent Audrina Hatton-Wright is a 12-year-old cancer survivor. She has spent a huge amount of her childhood in hospital, where she has found that the food is sometimes not of a nutritional quality to support people’s recovery. She is running a high-profile campaign on this issue, which has taken her on to the BBC and ITV’s “This Morning”. Will Ministers meet me and Audrina to see where we can work on this issue together?

[The Minister for Secondary Care (Karin Smyth)]

I thank Audrina for the great work that she is doing, supported by the campaign. Food in hospitals is really important, and we would be very happy to meet Audrina. Well done to her.

[Mr Speaker]

I call the shadow Secretary of State.

--- Later in debate ---

[Jack Abbott (Ipswich) (Lab/Co-op)]

T4. East Suffolk and North Essex NHS foundation trust has made a £98 million application to the estates safety fund for a new maternity building. Our local services support the delivery of around 3,000 babies every year, but the existing building has not been fit for purpose for many years. Will the Secretary of State support our bid for a new maternity wing at Ipswich hospital, to make sure babies and families get the state-of-the-art services that they so desperately need?

[Karin Smyth]

My hon. Friend raises an excellent point about the state that these buildings were left in by the Conservative party, as Lord Darzi’s report made clear. We are investing unprecedented amounts in capital and giving greater certainty, and I would be happy to meet my hon. Friend to discuss the proposal from Ipswich. It is up to local systems to come forward with plans, but I would be happy to discuss that further with my hon. Friend.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

--- Later in debate ---

[Mr Speaker]

Order. Can Members please help other colleagues to get in by shortening their questions?

[Karin Smyth]

My hon. Friend is absolutely right that it is the responsibility of the commissioners to look holistically at the provision of services. We want more services closer to home, using technology, care in people’s homes and so on, but she is quite right to highlight this issue. I know that she will continue campaigning on it, and I hope everyone has listened to her, so that people can come together to help her constituents.

[Mr Gregory Campbell (East Londonderry) (DUP)]

T5. Bowel cancer rates are increasing among the under-50s. What targeted interventions are taking place to try to reduce such incidences?

--- Later in debate ---

[Ben Obese-Jecty (Huntingdon) (Con)]

I thank the Minister for her recent confirmation that the renal dialysis service would remain at Hinchingbrooke hospital in my constituency during the build under the new hospital programme, but I am conscious that it is not in the scope of the actual new hospital and may not be there in the longer term. Can she offer me some assurances that this vital service for constituents will remain at Hinchingbrooke? If not, is any provision being made to ensure that this local resource stays available?

[Karin Smyth]

I am glad the hon. Gentleman found that correspondence helpful. As he knows, I am keen to discuss the new hospital programme and its progress with all Members. I am sure that discussions about the renal service at Hinchingbrooke continue to take place locally, and that those involved will continue to work together. I know that the hon. Gentleman will keep in touch about the progress of the discussions on behalf of his constituents, and I am happy to talk to him about the issue.

[Lorraine Beavers (Blackpool North and Fleetwood) (Lab)]

Blackpool Victoria hospital desperately needs more money, because the ICB’s funding for hospital trusts does not account for the 20 million tourists or the complexity of care required. Will the Secretary of State ensure that the hospital receives its fair share of extra funding from the ICB?

[Karin Smyth]

I appreciate my hon. Friend’s concern on behalf of her constituents. We are moving the system governing hospitals such as Blackpool away from deficit funding so that it becomes well governed and managed, in line with fair shares allocation, and I shall be happy to discuss that further with my hon. Friend.

[Caroline Voaden (South Devon) (LD)]

Torbay hospital, which serves my constituency, is one of the oldest parts of the NHS estate, and the Devon and Cornwall fire services recently ruled that its tower block would now be unsafe in the event of a fire. A quarter of the beds in the hospital are in that tower block, so patients are now being moved. Staff are extremely worried about what will come next, and this is making the hospital much less viable. Will the Minister meet me, and other Devon Members, to discuss its future funding, and the need to make it safe and secure and ensure that it continues to operate?

[Karin Smyth]

I have met the hon. Member for Torbay (Steve Darling) to discuss this matter. Obviously, money has been allocated. We are well aware of the hospital’s position, and it is also part of the programme. I shall be happy to provide further information if the hon. Lady is not clear about the allocations that have been made.

[Tracy Gilbert (Edinburgh North and Leith) (Lab)]

Demand for surrogacy from the UK is leading to the exploitation of women in countries across the globe, including Ukraine, Nigeria and Mexico. Can my right hon. Friend give a commitment on when legislation will come to the Floor of the House, so that we can play our part in ending that exploitation as soon as possible?

[Mr Gagan Mohindra (South West Hertfordshire) (Con)]

Under the last Conservative Government, upwards of £300 million, which would have been lifesaving as well as life-changing for many of my constituents, was earmarked for the new Watford general hospital. The lack of those funds, combined with the closure of the urgent care centre at Mount Vernon hospital, means that many of my constituents are not now receiving the first-class healthcare that they would reasonably expect. What assurances can the Minister give local residents?

[Karin Smyth]

I pay tribute to my hon. Friend the Member for Watford (Matt Turmaine) and others for their campaigning in that part of north-west London and elsewhere. The movement of services is now firmly part of the programme, and the people of Watford will have the services that they deserve. Discussions are continuing, and I shall be happy to update the House on the final decision as soon as possible.

[Jayne Kirkham (Truro and Falmouth) (Lab/Co-op)]

Percy, a five-year-old constituent of mine, wrote to me ask whether gluten-free products would ever be provided on prescription for people with coeliac disease. What steps is the Minister taking to address postcode variations in the provision of gluten-free food by integrated care boards?

--- Later in debate ---

[Steve Darling (Torbay) (LD)]

The fire service and the Care Quality Commission have now served legal notice against the tower block at Torbay hospital, and more than 100 beds are under threat. With that new information, this is now a crisis at Torbay hospital. Will the Minister please meet me and other Devon MPs to help navigate this crisis?

[Karin Smyth]

I recently met the hon. Member, and as he knows, we are absolutely committed to working with the local system to do that. I absolutely commit to updating him as soon as possible if he is not aware of where we are on that. I will get something back to him very quickly.

[Markus Campbell-Savours (Penrith and Solway) (Lab)]

For those considering suicide, the message must be that there is always another way, but with new Office for National Statistics data showing that the rate of suicide in Cumberland has increased yet again, would Ministers meet me and Cumbrian Members to ensure that our health system is providing support to all when they need it?

--- Later in debate ---

[Luke Myer (Middlesbrough South and East Cleveland) (Lab)]

Will Ministers meet me to discuss the future of East Cleveland hospital and what other services we can get closer to our community?

[Karin Smyth]

Yes.

[Shockat Adam (Leicester South) (Ind)]

I welcome the Government’s commitment to regulating funeral services, but for Jewish and Muslim families, burying a loved one quickly is a religious duty, not a preference. Will the Minister ensure that faith communities and burial societies, such as the Muslim Burial Council of Leicestershire in my constituency of Leicester South, are consulted directly, and that the new legislation does nothing to delay burials?

[Lloyd Hatton (South Dorset) (Lab)]

This month, we heard that Wareham’s chemotherapy clinic will reopen early next year, following two years of campaigning, meaning that patients across Purbeck will no longer have to travel long distances to access cancer care. Building on that success, will the Minister work with me to finally restore the rheumatology clinic at Swanage community hospital, so that many more patients can access care much closer to where they live?

[Karin Smyth]

I am always keen to discuss and visit places in Dorset with my hon. Friend. I am happy to look, with him, at the integrated care board’s overall plan for the provision of all those services.

[Saqib Bhatti (Meriden and Solihull East) (Con)]

I recently met pharmacists in my constituency, who expressed concern about the resilience of the supply chain, and specifically about wholesale suppliers spreading rumours, with the result that medicines are stockpiled, forcing up prices. In this case, it was Ramipril, but this is an issue across the board. It is the British taxpayer—our constituents—who suffer. Is the Secretary of State aware of this issue, and has she considered getting the Competition and Markets Authority involved?

--- Later in debate ---

[James Wild (North West Norfolk) (Con)]

On Saturday, I joined hundreds of people in King’s Lynn in protesting against leaked plans for Norfolk and Waveney University Hospitals Group to downgrade accident and emergency and maternity services, and the intensive care unit, at the Queen Elizabeth hospital. Does the Health Secretary agree that services should be as local to people as possible, and will she reject any plans to remove services from the QEH?

[Karin Smyth]

I am aware of the issues around the hon. Gentleman’s local hospital; I have worked with him closely as part of the new hospital programme as well. It is up to local systems to decide on the clinical pathways across the whole patch. Those decisions must be clinically led, and there must be consultation with local people. I am very happy to keep an eye on that, and to talk with him in the future.

Health and Social Care

Karin Smyth Excerpts

Friday 16th October 2026 Written Corrections

The following extract is from the fifteenth sitting of the Health Public Bill Committee on 9 July 2026.

[Karin Smyth]

We are also looking to support general practice in better identifying and recording which of their patients are unpaid carers, to help ensure that those carers can get the support they need in the community. NHS England recently published guidance to support that, and work is ongoing to ensure more consistent coding of unpaid carers by general practitioners.

––[Official Report, Health Public Bill Committee, 9 July 2026; c. 608.]

Written correction submitted by the Minister for Secondary Care, the hon. Member for Bristol South (Karin Smyth):

[Karin Smyth]

We are also looking to support general practice in better identifying and recording which of their patients are unpaid carers, to help ensure that those carers can get the support they need in the community. NHS England published guidance on supporting carers in general practice in 2019. A refreshed version has been developed with sector partners and will be published in due course. Work is ongoing to ensure more consistent coding of unpaid carers by general practitioners.

Integrated Care Board Boundary Changes

Karin Smyth Excerpts

Wednesday 14th October 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

On 22 September, the NHS England executive formally decided three changes to integrated care board boundaries. These have been approved by Ministers and will take place on 1 April 2027:

An area of Buckinghamshire, covering Newton Longville, will transfer from Central East ICB to Thames Valley ICB which covers the rest of Buckinghamshire country council;

An area of North Yorkshire adjacent to Lancashire, including Ingleton and Bentham, will transfer from Lancashire and South Cumbria ICB to Humber and North Yorkshire ICB;

The Craven area of North Yorkshire will transfer from West Yorkshire ICB to Humber and North Yorkshire ICB.

These changes will deliver alignment between those ICBs and local and strategic authorities, and progress delivery of our intention to align ICBs with strategic authorities by the end of the Parliament.

Further decisions on ICB boundary changes and mergers will be taken alongside other decisions regarding public service boundaries and strategic authorities, with any further changes expected on 1 April 2028. The Government and NHS England will continue working with local partners to ensure that all changes achieve the best outcomes for patients and citizens.

[HCWS379]

Underperforming NHS Trusts: Government Oversight

Karin Smyth Excerpts

Wednesday 14th October 2026 Westminster Hall

[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.

[Dr Caroline Johnson]

Will the Minister give way?

[Karin Smyth]

I will move through some of these points for the moment. For providers with the most entrenched financial, operational, leadership and structural challenges that impact patient care—that is what these trusts are about—we are taking a more holistic approach to that enhanced support because, as the shadow Minister asked, how do we choose? They are the most challenged long-term systems.

At a national level, the intensive recovery programme is providing short-term, intensive support for organisations to help strengthen their immediate operational and financial stability while developing an organisation-owned plan for long-term sustainability. We cannot keep going round in this circle; at the end of the day, these organisations need to be well run and well led, and local systems need to own that problem. That is also part of our wider devolution agenda. I think I outlined that in my letter to the hon. Member for Chelmsford in September, but I am very happy to meet again and go through that in more detail if that is helpful.

The first IRP cohort includes Hull, Northern Lincolnshire and Goole, East Kent, North Cumbria and Mid and South Essex. Each faces very different circumstances, so there is not a one-size-fits-all response. I will touch on some of them, for hon. Members have raised their own issues with them.

There is interest in Hull and Northern Lincolnshire and Goole. Following an independent review, the decision has been taken to dissolve the Humber health partnership arrangements. In Hull, the focus is on strengthening core hospital services, making the best use of specialist services, improving productivity and reinforcing clinical leadership and accountability. For Northern Lincolnshire and Goole, the priority is to move more care into neighbourhood and community settings, reflecting the demands in those areas. There are good signs of progress.

The hon. Member for Chelmsford and others who intervened highlighted Mid and South Essex. The 2020 merger of those three trusts has not delivered the planned benefits for 1.2 million people. Staff culture and morale remain a serious concern, with little improvement, as was highlighted in those terrible survey results over the past five years. We have heard those. The trust has long-standing performance problems linked to how demand is managed across the wider health system in that part of Essex. Work is under way to improve the long waits, improve patient flow, strengthen governance and make better use of the estate. I shared the analysis in productivity packs with everybody earlier in the year, and I am sure that everybody looked at them in detail, but I am very happy to go through them again. It identified more than £122 million of productivity opportunities. It is not simply about saving money.

Better organisation across sites and stronger clinical integration should improve patient experience, reduce delays and raise quality for patients. The clinical strategy will make greater use of neighbourhood and community care in line with our 10-year plan and focus on maternity and planned care treatment. This is backed by £80 million for Southend hospital’s long-standing structural estate problems and support for a neighbourhood health centre in Maldon.

I will touch on North Cumbria because, for the hon. Members for Westmorland and Lonsdale (Tim Farron), for Honiton and Sidmouth (Richard Foord) and for Yeovil (Adam Dance), the work going on there really highlights what can and needs to be done in rural healthcare. I remind hon. Members that hospitals in some of those areas are additionally funded to cope with some of those rurality issues. We highlighted that in our 10-year health plan. We absolutely understand that across the country, there are different issues with regard to rurality. I will not talk about Kent, because it has not been raised, but again, it has very different issues. That is why those areas have been chosen. They have long-standing and deeply entrenched problems.

My hon. Friend the Member for Stoke-on-Trent South (Dr Gardner) raised ambulance handover delays. I did not know she was going to raise that today, but to assure her, the continued problem with the ambulances was raised with me in my oversight meeting with the team yesterday. Those issues are flagged by NHS England and its operational management across the country. They are long-standing issues, as she knows, but I gently disagree with her. She is absolutely right in her assessments of history, but this issue is not a failure of oversight and accountability. Good co-operation, collaboration and management are the responsibility of the services locally. The oversight has worked. We know that this is a problem. We and her constituents can see that. We very much want the services to work together to resolve that flow so that the ambulance handover works much better.

My hon. Friend the Member for Salford (Rebecca Long Bailey) highlights, sadly, her constituency’s downward improvement trajectory. She asked to meet me, and I am very happy to do that. My hon. Friend the Member for Darlington (Lola McEvoy) did the incredibly difficult job of raising the terrible distress for women in her constituency. She highlighted a terrible case, and I will make sure that she has a meeting with the Minister to go through how that can be supported on behalf of her constituents. I know that she will work closely to make sure that they are served better.

We are seeing early improvements through the IRP, but we need to demonstrate progress through safer care, better operation and financial performance. We have clear milestones and credible plans for stronger organisations. Support nationally is time-limited but proportionate, because trusts ultimately have to stand on their feet. Intensive oversight is not about naming and shaming. Staff in challenged trusts are working in exceptionally difficult circumstances. As we need to encourage people to work there, we must show them that it can be better. The purpose is to remove barriers to improvement, provide the right expertise and hold boards and NHS leaders to account for results.

The Government will continue to work with NHS England. I am committed to keeping Parliament informed of significant developments. We will judge our approach by its effect on patients and staff, not by the creation of more processes. The oversight framework and the intensive recovery programme provide a clear route from identifying the risk to taking targeted action. There is much more to do. It can only be done in local circumstances with co-operation and transparency, including working with Members of Parliament. Where we hear examples of trust chief executives not doing that, I am prepared to call it out. It is not acceptable.

There is more to do, but we want practical, safer and more timely care, and stronger organisations. I am pleased to have had the opportunity to debate this issue today. It is important for MPs to be part of the discussion. We want to improve all trusts, but we are focusing on those with long-term issues, sometimes having been affected for decades. The people in those areas deserve better, and we are determined to make sure they get it.

Health and Care Reviews, Improvement and Regulation

Karin Smyth Excerpts

Monday 12th October 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

I would like to inform the House of several updates from the Department of Health and Social Care, following developments and announcements over the conference recess.

Adult Social Care

The Government are delivering a package of reforms to fulfil the Prime Minister’s commitment to improve the strength and capability of those providing care. This includes plans to appoint the first unpaid carers champion to drive support for the millions of people who provide unpaid care for older or disabled people, and a new social care workforce action plan, to be published later this year, bringing together the steps the Government will take to support that workforce.

As part of the action plan, the Government will work with the care sector to expand sector-based work academy programmes, in order to help more young people and jobseekers access training, work experience and routes into care jobs; and to develop a national collective pension scheme, in order to improve care workers’ retirement outcomes. Alongside the first fair pay agreement, these measures will support recruitment, retention and career development, while laying the foundations for a national care service.

Healthy Babies Programme Expansion

The Healthy Babies programme will be rolled out nationally to every Best Start family hub, extending support based on Sure Start principles during pregnancy and the first two years of life to families in every part of England. Building on delivery in 75 local authorities, Healthy Babies will help parents and carers access joined-up support with infant feeding, parental mental health and forming strong attachments with their baby. The expansion will help all families give their baby the best start in life and lay the foundations for the healthiest generation of children ever.

Violence against Women and Girls

As part of the Government’s overall strategy to tackle violence against women and girls, the Department of Health and Social Care will adopt a public health approach to tackling VAWG, addressing the root causes, emphasising early intervention, and making sure no woman is turned away from the support she needs. A targeted consultation with stakeholders on the development of a national framework to support this approach will be launched. This will start with an investment of up to £34.4 million over three years to support 12 integrated care boards across England in delivering the first phase of a primary care referral pathway called Steps to Safety, which will make sure that women and girls experiencing violence and abuse can access specialist support through their GP. A further £15 million over three years will be invested in local victim support services through all integrated care boards in England.

A national clinical lead for violence against women and girls will also be appointed, combining clinical and public health expertise. They will cover prevention, early identification, partnership working and the health system’s response to victims, survivors and people at risk of harm, including NHS staff.

Independent Review into Mental Health Conditions, Autism and ADHD

The independent review into mental health conditions, autism and attention deficit hyperactivity disorder published its final report on 9 October. It can be viewed online at the link below, and copies will be placed in both Libraries: https://www.gov.uk/government/publications/independent-review-into-mental-health-conditions-adhd-and-autism-final-report

Chaired by Professors Peter Fonagy, Sir Simon Wessely and Gillian Baird, the review found that there has been a substantial rise in mental distress, particularly among children and young people, driven by a range of factors, such as financial pressures, social media and poorer sleep. For ADHD and autism, the review found diagnoses, referrals and waiting lists have risen dramatically. The report concludes that the balance of evidence suggests that underlying population prevalence has remained broadly stable, but it points to the need for more up-to-date population prevalence surveys. The review finds that the current system is overly focused on diagnosis as the gateway to support. The review recommends strengthening prevention, early help, wellbeing support and practical interventions for individuals facing mental distress, without waiting for a diagnosis, as well as improving access to high-quality specialist treatment and care for people with the most severe, complex and enduring needs.

The upcoming cross-Government mental health strategy will respond to the review’s longer-term recommendations, including increasing early intervention and shifting from a diagnosis-led system towards a needs-led system. We will require stronger partnerships with the voluntary and community sector, redesign commissioning arrangements, improve integrated mental health and neurodevelopmental support, and work across Government to address areas where diagnosis is currently the only gateway to support.

In the immediate term, the Government have also announced a comprehensive package of reforms to improve ADHD and autism assessments. We will work to bring all diagnostic assessments under Care Quality Commission regulation, helping to ensure that people receive high-quality, clinically robust assessments regardless of how they access care, and we are also acting on concerns about the advertising of ADHD and autism assessment services. In future, we will ensure that NHS funding is only used for assessments delivered by CQC-registered providers, and will require integrated care boards to improve oversight of commissioned services.

Independent Review into Maternity and Neonatal Services at Leeds Teaching Hospitals NHS Trust

Terms of reference for the independent review into maternity and neonatal services at the Leeds teaching hospitals NHS trust were published on 29 September. The Government worked closely with the review’s Chair, Donna Ockenden, and affected families to finalise the terms of reference, ensuring that families’ experiences and priorities shaped the scope of the review.

The review is due to be published in 2029, and will therefore consider maternity and neonatal care from 1 January 2011 up to and including 31 March 2028, where mothers and babies have suffered severe harm or death while under the care of the trust. Affected families will receive further information about the commencement of case reviews in due course.

Public Inquiry into Mental Health Care at Tees, Esk and Wear Valleys NHS Foundation Trust

His Honour Judge John Potter was appointed chair of the statutory public inquiry into Tees, Esk and Wear Valleys NHS foundation trust on 17 September. The inquiry formally commenced on 21 September 2026. This inquiry has been established to investigate the circumstances and issues surrounding patient deaths associated with Tees, Esk and Wear Valleys NHS foundation trust, and to ensure that lessons are learned to help protect patient safety.

The inquiry’s work will now be a matter for the judge. It is important that the voices of bereaved families, patients and carers are heard throughout the inquiry process, and that they are treated with compassion, dignity and respect.

Over the coming months, the chair will begin establishing the inquiry’s operating arrangements and consulting on its terms of reference. The terms of reference will be announced in due course.

National Cancer Board

Anita Charlesworth has been appointed the National Cancer Board’s independent co-chair, and Dr Robert Metcalf has been appointed national clinical lead for rare cancers. Ashley Ball-Gamble has also been announced as the representative for children and young people’s cancers on the board and Dr Dianne Addei as the representative for inequalities.

The National Cancer Board held its first meeting on 21 September. This meeting brought together senior leaders from the Department of Health and Social Care and NHS England, as well as external stakeholders and patient representatives, to discuss the progress that had been made on the commitments set out in the national cancer plan.

Government Response to the National Commission into the Regulation of Artificial Intelligence in Healthcare

Finally, the Government have issued their formal response to the recommendations made by the national commission into the regulation of AI in healthcare. Through its response, the Government welcome the national commission’s 44 recommendations, accept them in full, and will work with partners to implement them. This reflects the Government’s commitment to ensuring that the UK plays a leading role in using AI effectively and safely to improve health care systems and health research, ensuring that innovation also maintains public confidence.

The response has been prepared as an initial action plan setting out how the Government will take forward the national commission’s recommendations, and will provide stakeholders with certainty regarding direction of travel.

This publication is not the end of the process. It marks the next stage in an ongoing conversation that will support the work of the Medicines and Healthcare products Regulatory Agency and the wider Government, who will publish a more detailed implementation plan next spring.

[HCWS364]

UK Medical Specialty Training Programmes: Prioritisation of Doctors

Karin Smyth Excerpts

Tuesday 15th September 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

We have now laid before Parliament the Medical Training (Prioritisation for Specialty Training Programmes) Regulations 2026. These regulations specify categories of person who will be prioritised for interviews and offers for UK medical specialty training programmes from 2027 onwards.

The Medical Training (Prioritisation) Act 2026 introduced a system of prioritisation for the allocation of postgraduate medical training places across the UK. It delivered the commitment in the Government’s “Fit for the future: 10 Year Health Plan for England” to prioritise UK medical graduates for foundation training and to prioritise UK medical graduates and other doctors with significant NHS experience for specialty training places.

The Act is designed to support a sustainable medical workforce that can meet population health needs, reducing the UK’s reliance on the international labour market, and ensuring we make best use of the substantial taxpayer investment in UK-based medical education and training. By creating a clear pathway from medical school to specialty training, we strengthen domestic talent and improve retention.

For specialty training, the Act prioritises graduates of medical schools in the UK or Ireland; international medical graduates who studied in Iceland, Norway, Liechtenstein and Switzerland, to reflect international agreements; and individuals who have completed or are completing the UK foundation programme or the relevant previous stage of a UK specialty training programme.

For specialty training offers made in 2026 only, the Act also prioritises individuals holding the following immigration statuses: British citizens; Irish citizens who do not require leave to enter or remain in the UK; Commonwealth citizens with the right of abode; individuals with indefinite leave to enter or remain in the UK; and those with EU settled and pre-settled status. These provisions were intended to act as a proxy to capture applicants most likely to have significant experience of working as a doctor in the NHS.

For specialty training places starting from 2027, the Act provides a power to specify by regulations groups to be prioritised, by reference to criteria indicating significant experience of working as a doctor in the NHS or health and social care in Northern Ireland, or described by reference to their immigration status, in a way that best delivers our policy intent.

During the Bill’s parliamentary passage, we committed to engaging with stakeholders on future regulations in this area. In spring 2026, NHS England undertook targeted stakeholder engagement on behalf of the four UK Governments. This included, among others, the medical royal colleges, bodies representing international medical graduates, trade unions including the BMA, NHS providers, the General Medical Council, think-tanks and medical schools. Most stakeholders favoured moving away from immigration status as the basis for prioritisation once NHS experience can be measured directly. Views on an appropriate minimum threshold for NHS experience were more mixed and based on limited evidence due to how recently prioritisation had been implemented, and we do not believe that we have a sufficiently robust evidence base to define alternative criteria setting a threshold for NHS experience in regulations at this stage.

The urgency of the Act meant that for 2026 it came into force after applications had closed and only introduced prioritisation for the offer of places. This meant that the evidence available from the 2026 recruitment round is necessarily limited, as prioritisation could have had little effect on applicants’ behaviour.

Having considered the available evidence, we have concluded that the immigration statuses that applied for specialty training offers made in 2026 remain the most appropriate basis for prioritisation at this stage. These statuses capture people with a permanent, unrestricted right to live and work in the UK and remain an effective proxy to capture doctors most likely to have significant experience working with the NHS. While we recognise this is not a direct measure of NHS experience, applicants with these immigration statuses are more likely to have worked in the NHS for a significant period of time or to remain working in the NHS for longer.

Using these immigration statuses from 2027 provides continuity with 2026 prioritisation arrangements while enabling evidence gathering from future recruitment rounds to support a fuller assessment of potential alternative approaches for future years.

These regulations do not amend the other categories of person already prioritised for specialty training places under the Act as set out above. These regulations also do not affect the prioritisation regime for foundation training under the Act.

[HCWS350]

Health Bill

Karin Smyth Excerpts

Report stage & 3rd reading
Tuesday 8th September 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I beg to move, That the clause be read a Second time.

[Madam Deputy Speaker (Judith Cummins)]

With this it will be convenient to discuss the following:

Government new clause 95—Disclosure of information relating to medicines.

Government new clause 98—Disclosure of information relating to medical devices.

Government new clause 99—Further and consequential amendments relating to medical devices.

Government new clause 100—Power to amend meaning of “medical device”.

Government new clause 101—Power to restate medical devices law in Northern Ireland.

New clause 9—Powers for coroners and medical examiners to report suspected health system failings—

“(1) The Secretary of State must, by regulations, establish a standard mechanism for coroners and medical examiners to refer cases where they suspect failings in the provision of health care.

(2) A coroner or a medical examiner has a duty to report (a “duty to whistleblow”) using the mechanism established under subsection (1) if, in the course of their duties, they have reasonable grounds to suspect that a death or incident involved systemic failings in a health care setting.

(3) A referral under this section must be directed to any or all of the following bodies, as the coroner or medical examiner considers appropriate, based on the nature of the suspected failing—

(a) the chief officer of police for the relevant police area,

(b) the Care Quality Commission,

(c) the Department of Health and Social Care, and

(d) the Health Services Safety Investigations Body.

(4) Regulations under subsection (1) must specify—

(a) the information to be included in a referral,

(b) the timeframe within which a referral must be made following the formation of a suspicion, and

(c) guidance on the criteria for determining to which of the bodies listed in subsection (3) the referral must be directed.

(5) A disclosure made in fulfilment of the duty under subsection (2) is a protected disclosure for the purposes of Part 4A of the Employment Rights Act 1996 (protection for whistleblowing).

(6) The duties imposed by this section are in addition to, and do not affect, a senior coroner’s duty to make a report under paragraph 7 of Schedule 5 to the Coroners and Justice Act 2009 (reports on action to prevent other deaths).”

This new clause requires the Secretary of State to create a standardised framework for them to formally refer suspected health system failings (including systemic issues) directly to the police, the CQC, the Department of Health and Social Care, and the HSSIB, with a duty on coroners to participate. It provides legal protection for those making such referrals.

New clause 10—Duty of NHS boards to report medical malpractice—

“(1) A member of the board of directors of an NHS trust or an NHS foundation trust in England must report any evidence or reports they have seen of systemic medical malpractice within the trust to—

(a) the Care Quality Commission,

(b) the Department of Health and Social Care, and

(c) the Health Services Safety Investigations Body.

(2) The board of directors of an NHS trust or NHS foundation trust in England has a collective duty to—

(a) refer the trust to the Care Quality Commission, and

(b) alert the Department of Health and Social Care and the Health Services Safety Investigations Body, if staff employed by, or acting on behalf of, the trust raise concerns of systemic medical malpractice.

(3) In this section, “systemic medical malpractice” means an action or omission in the provision of health care that falls below the expected standard of care and indicates a widespread, patterned, or recurring failure within the systems, processes, or governance of the trust.”

This new clause would introduce a mandatory individual duty for members of NHS and Foundation Trust boards to escalate evidence of systemic medical malpractice to the CQC, the Department of Health and Social Care, and the HSSIB. It also imposes a collective duty on the board to formally refer the trust to regulators if staff raise concerns regarding malpractice.

New clause 13—Medical Disinformation—

“(1) The Secretary of State must, within 6 months beginning on the day on which this Act is passed, publish a strategy on anti-vaccine and medical disinformation (“the Strategy”).

(2) The strategy must consider—

(a) support for medical professionals to build trust and engage with persons who are anti-vaccine,

(b) support for medical professionals and NHS leaders to engage with anti-vaccine councillors or officials in local authorities,

(c) investment in public messaging to combat medical disinformation, including engagement with trusted online influencers,

(d) outreach campaigns focused on communities who are sceptical about vaccinations,

(e) introducing criminal liability for those, including online influencers and politicians, who profit from medical disinformation,

(f) a new verification requirement for any social media account claiming to be a medical professional.

(3) The Secretary of State must lay a copy of this strategy before Parliament upon publication.”

This new clause places a duty on the Secretary of State to publish a strategy to combat anti-vaccine and medical disinformation.

New clause 14—Healthwatch funding—

“(1) The Secretary of State, must within 12 months of the passing of this Act, enact a scheme to fund Healthwatch England and local Healthwatch organisations for the 2027/2028 financial year to the level estimated by the Department for Health and Social Care in 2013/14.

(2) The Secretary of State must consider uprating this funding with inflation for 2026/2027.”

This new clause would ensure that Healthwatch England and local Healthwatch organisations are funded to the level estimated by the Department for Health and Social Care in 2013/14.

New clause 20—Cancer Survival Research—

“(1) Within 12 months beginning on the day on which this Act is passed, the Secretary of State must by regulations establish a Cancer Survival Research Programme.

(2) Regulations under this section must—

(a) require government co-ordination and funding for research into cancers with a five-year survival rate below 20%, and

(b) establish a fellowship programme for foreign academics in cancer research.

(3) Any programme established under paragraph 2(b) must make provision to waive visa fees for entry into the UK for participating academics.

(4) Regulations under this section are subject to the affirmative procedure.”

This new clause would require the Secretary of State to introduce regulations requiring the government to coordinate research into cancers with the lowest survival rate.

New clause 24—Strategy for provision of Minor Injuries Units and Urgent Treatment Centres in rural areas—

“(1) Within six months of the passage of this Act, the Secretary of State must prepare and publish a strategy for expanding the provision of Minor Injuries Units and Urgent Treatment Centres in rural areas.

(2) The strategy under subsection (1) must be laid before both Houses of Parliament.

(3) The Secretary of State must lay a report before both Houses of Parliament on the implementation of the strategy every 12 months after the strategy has been published.”

This new clause would require the Secretary of State to prepare a strategy for expanding the provision of Minor Injuries Units and Urgent Treatment Centres in rural areas and report on the implementation of the strategy annually.

New clause 26—Patient safety recommendations: national oversight—

“(1) The Secretary of State must establish a scheme relating to the oversight of patient safety recommendations (“the scheme”).

(2) The scheme must make provision for the monitoring and delivery of patient safety recommendations arising from—

(a) investigations,

(b) inquiries,

(c) reviews, and

(d) other patient safety bodies,

relating to patient safety.

(3) Within one year beginning on the day on which this Act is passed and every subsequent year, the Secretary of State must lay a report before Parliament on the progress of the scheme.”

New clause 27—Duty of candour and enforcement of standards of ethical conduct in DHSC—

“(1) In discharging its expected standards of ethical conduct, the Department of Health and Social Care (DHSC), must, in particular—

(a) set out the steps DHSC will take to ensure that legal services provided to NHS bodies and other relevant health-related organisations are consistent with the statutory duty of candour and the principles of openness, transparency and learning following patient safety incidents,

(b) set out which oversight body is responsible for ensuring the standards set out in DHSC code of ethical conduct are adhered to and enforced,

(c) set out provisions to allow a relevant oversight body to examine, on its own initiative, suspected serious or systemic breaches of DHSC’s code of ethical conduct,

(d) set out a mechanism for ensuring that any breaches of DHSC’s code of ethical conduct are recorded and that proper data is kept and published that records the extent to which complaints have been made regarding its ethical conduct and their outcome.”

New clause 28—Review of NHS neurodiversity policy—

“(1) Within six months of the passage of this Act, the Secretary of State must publish a review on—

(a) standards of NHS care for neurodiverse people,

(b) the effectiveness of current NHS trust policies regarding care for neurodiverse patients,

(c) the quality of training and guidance for frontline NHS staff in supporting neurodiverse patients, and

(d) health outcomes for neurodiverse patients at NHS trusts.

(2) The review under subsection (1) must be laid before both Houses of Parliament.”

New clause 30—Review into acute stroke support services in rural areas—

“(1) Within six months of the passage of this Act, the Secretary of State must publish a review of acute stroke support services in rural areas.

(2) The review under subsection (1) must include an evaluation of—

(a) decision making processes,

(b) evidence used to justify decisions,

(c) public consultation processes,

(d) health outcomes,

(e) travel times for access to services, and

(f) impact on the NHS workforces.”

New clause 41—Remit of the Human Tissue Authority—

“(1) The Secretary of State must, within six months of the passing of this Act, by order under section 14(4) of the Human Tissue Act 2004, amend the remit of the Human Tissue Authority to include the regulation of funeral directors, private mortuaries, direct cremation services and other organisations which transport or hold the bodies of deceased persons for the purposes of ensuring that the carrying out of their functions is consistent with the protection of public health.

(2) The Authority must establish and maintain a register of the bodies subject to its oversight under subsection (1).

(3) The Secretary of State may by regulations make further provision regarding the establishment and operation of the register under subsection (2).

(4) Regulations made under subsection (3) are subject to the affirmative procedure.”

This new clause would require the Secretary of State to extend the remit of the Human Tissue Authority to include regulation of funeral service providers to ensure their activities are consistent with the protection of public health; and to maintain a register of those bodies subject to its regulation.

New clause 42—Oversight of funeral service provider premises and practices connected to the storage, preparation and movement of human remains—

“(1) The Secretary of State may by regulations establish a body corporate, or confer functions on an existing public authority, ("the Regulator") to provide oversight of the premises and practices connected to the storage, preparation and movement of human remains by funeral service providers in England.

(2) The purpose of the Regulator is to ensure that the activities undertaken under subsection (1) are consistent with the protection of public health.

(3) The Regulator shall be independent in the exercise of its functions and shall not be regarded as a servant or agent of the Crown.

(4) Regulations under this section may, in particular, make provision for—

(a) a scheme for the registration of funeral service providers;

(b) the inspection of premises, vehicles and other facilities used by registered providers for the storage, preparation, care or transportation of deceased persons, or from which funeral services are arranged or conducted;

(c) the publication and enforcement of a code of practice for the funeral services sector; and

(d) the imposition of sanctions, including suspension or removal from the register, for breach of that code.

(5) Before making regulations under this section, the Secretary of State must consult—

(a) providers of funeral services;

(b) such persons representing the interests of bereaved people as the Secretary of State considers appropriate; and

(c) such other persons as the Secretary of State considers appropriate.

(6) Regulations under this section are subject to the affirmative procedure.”

New clause 45—Secretary of State directions relating to early access to medicines—

“(1) The Secretary of State may give directions to any of the bodies mentioned in subsection (2) about the implementation of a scheme providing early access to medicines to people with life-threatening or seriously debilitating conditions.

(2) The bodies are—

(a) integrated care board,

(b) NHS Trusts,

(c) NHS Foundation Trusts,

(d) NHS Advanced Foundation Trusts, and

(e) other health and social care bodies.”

This new clause would give the Secretary of State power to direct integrated care boards, NHS Trusts, NHS Foundation Trusts, and NHS Advanced Foundation Trusts to implement a scheme to provide early access to medicines to people with life-threatening or seriously debilitating conditions.

New clause 47—Review of the Early Access to Medicines Scheme—

“(1) The Secretary of State must, within six months of the passing of this Act, commission a review of the regime for early and accelerated access to medicines in England and Wales.

(2) The review conducted under subsection (1) must consider—

(a) the effectiveness of the Early Access to Medicines Scheme (EAMS),

(b) the effectiveness of early access outside of the Early Access to Medicines Scheme (EAMS), and

(c) equality of access across England and Wales, with the aim of reducing geographical inequalities between different NHS trusts.

(3) The Secretary of State must lay a copy of the report and recommendations of the review before both Houses of Parliament.”

This new clause would require the Secretary of State to commission a review of regime for early and accelerated access to medicines.

New clause 49—National Guardian’s Office—

“(1) Within three months beginning on the day on which this Act is passed, the Secretary of State must re-establish the National Guardian's Office.

(2) The Office established under subsection (1) must—

(a) hold any responsibilities held by the National Guardian's Office as of 29 June 2026; and

(b) be operationally independent.”

This new clause will re-establish the National Guardian’s Office.

New clause 52—Cancer treatment: waiting times—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision for every patient to have access to cancer treatment within 62 days following referral.

(2) Provision under subsection (1) must by regulations amend the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 to place a right in the NHS constitution for England for every patient to have access to cancer treatment within 62 days following referral.

(3) The Secretary of State must establish a scheme to support NHS hospital trusts in meeting the requirement under subsection (1).

(4) As part of the Scheme, the Secretary of State must expand the capacity of the Medicines and Healthcare products Regulatory Agency.

(5) The Secretary of State must make an annual statement to Parliament on progress made in meeting the requirement under subsection (1).

(6) Any statement made under subsection (5) should be made as close as reasonably practicable to 4 February.”

This new clause would give patients a right under the NHS constitution to start cancer treatment within 62 days of referral and requires the Secretary of State to establish a scheme to deliver this. It also requires the Secretary of State to update the House on progress against the target on or around the time of World Cancer Day.

New clause 63—Social Care—

“(1) Within 3 months beginning on the day on which this Act is passed, the Secretary of State must lay before Parliament detailed proposals for reform of the social care sector.

(2) Proposals under subsection (1) must include provision for—

(a) a respite care scheme;

(b) reform of carers allowance;

(c) free personal care; and

(d) a cap on care costs.”

This new clause would require the Secretary of State to lay before Parliament plans to reform the social care sector, including free personal care, a cap on care costs and that delivers for family carers.

New clause 68—Report on dementia care—

“(1) Within 12 months of the passage of this Act and every 12 months thereafter, the Secretary of State must publish and lay before both Houses of Parliament a report on—

(a) the provision of NHS care in relation to dementia.

(b) the provision of social care in relation to dementia.

(2) A report under subsection (1) must have regard to—

(a) any targets or standards set out in a national plan, guidance, or framework relating to dementia services, and

(b) any other information the Secretary of State considers appropriate.

(3) A report under subsection (1) must include—

(a) an assessment of variation in dementia services and outcomes between Integrated Care Board areas,

(b) information on workforce capacity, capability and training standards relevant to dementia care,

(c) information on access to ongoing post-diagnostic support services, including support for unpaid carers of dementia patients,

(d) information on continuity and coordination of care for people living with dementia, including access to a named professional responsible for coordinating support across services,

(e) outcomes and experiences for people living with dementia and unpaid carers, including crisis prevention, carer wellbeing, and experiences of joined-up care,

(f) progress on dementia prevention and risk reduction, and

(g) dementia research activity in the NHS.”

This new clause would require the Secretary of State to publish an annual report on the provision of NHS care and social care in relation to dementia.

New clause 72—Provision of Minor Injuries Units in Rural Areas—

“(1) The Secretary of State must, within 12 months of the passing of this Act, publish and implement a strategy to improve access to minor injuries units in rural communities.

(2) The strategy under subsection (1) must include measures to—

(a) expand, maintain and protect existing minor injuries units serving rural populations;

(b) ensure that integrated care boards assess local demand for urgent treatment services in rural constituencies and make provision accordingly, and

(c) promote the recruitment and retention of healthcare professionals required to staff such facilities.

(3) The Secretary of State must lay before Parliament an annual report on—

(a) the number and geographical distribution of minor injuries units in England;

(b) changes in patient access to urgent care services in rural areas; and

(c) progress made in implementing the strategy required under subsection (1).

(4) In this section, “rural constituency” means a parliamentary constituency designated as predominantly rural by the Office for National Statistics or such successor body as may be prescribed by regulations.”

This new clause would require the Secretary of State to expand and safeguard minor injuries units in rural communities with the aim of improving access to urgent care, reducing pressure on major hospitals, and ensuring equitable healthcare provision regardless of geography.

New clause 81—Family support duty following serious childhood diagnosis—

“(1) Where a child is diagnosed with cancer or another life-threatening condition, the responsible NHS provider must, within 14 days of diagnosis, ensure that the child’s family is offered appropriate information, support and coordination services.

(2) For the purposes of subsection (1), the responsible NHS provider must offer—

(a) access to a named family support coordinator;

(b) information regarding welfare benefits, financial support and relevant public services;

(c) information regarding employment rights and workplace support available to parents and carers;

(d) signposting to appropriate mental health and psychological support services;

(e) information regarding relevant local and national charities, support organisations and peer-support services;

(f) a written family support plan setting out the support available to the family during treatment; and

(g) notification and information sharing in accordance with subsection (3).

(3) The responsible NHS provider must provide the child’s registered general practitioner and where different, the registered general practitioners of the child’s parents or primary carers, with a Family Support Summary.

(4) A Family Support Summary must include—

(a) the child’s diagnosis;

(b) the proposed treatment plan;

(c) the expected duration and intensity of treatment, where known;

(d) information regarding the potential impact of the diagnosis and treatment on parents, carers and siblings; and

(e) any recommendations regarding wellbeing support, monitoring or referral for the family unit.

(5) Following receipt of a Family Support Summary, the relevant general practice shall be encouraged to consider the wellbeing needs of parents, carers and siblings and, where appropriate, provide information, assessment, referral or signposting to suitable support services.

(6) The Secretary of State must publish guidance for NHS providers on the discharge of duties under this section.

(7) In this section—

“child” means a person under the age of 16;

“family” includes parents, guardians, primary carers and siblings; and

“life-threatening condition” means a condition designated as such by the Secretary of State in guidance.”

This new clause places a duty on NHS providers to offer practical information, coordination and support to families within 14 days of a child being diagnosed with cancer or another life-threatening condition.

New clause 82—Parent mental health and bereavement support duty—

“(1) Where a child is diagnosed with a life-threatening condition, the responsible NHS provider must ensure that the psychological wellbeing of parents, guardians, primary carers and siblings is considered as part of the child’s care pathway.

(2) Within 14 days of diagnosis, the responsible NHS provider must offer—

(a) a parental psychological wellbeing assessment;

(b) access to a designated family support practitioner, psychologist, counsellor or other appropriately qualified professional;

(c) information regarding the psychological impact of serious childhood illness, including trauma, anxiety, depression, stress and bereavement;

(d) a written Family Mental Health Support Plan;

(e) notification to the child’s registered general practitioner and, where different, the registered general practitioners of parents or primary carers.

(3) During active treatment, the responsible NHS provider must ensure that parents and primary carers are offered periodic psychological wellbeing reviews.

(4) The responsible NHS provider must offer an additional psychological wellbeing review following any—

(a) significant deterioration in the child’s condition,

(b) relapse,

(c) progression of disease,

(d) transition to palliative care, or

(e) other material change in prognosis.

(5) The responsible NHS provider must ensure that support under this section is offered proactively and must not be dependent upon a parent, guardian, carer or sibling requesting support, identifying their own need, or making a self-referral.

(6) Following the death of a child, the responsible NHS provider must—

(a) offer a bereavement wellbeing assessment to parents or primary carers;

(b) offer access to bereavement counselling, psychological support or equivalent specialist services;

(c) make proactive contact with the family within 14 days of the child’s death;

(d) offer further follow-up support at intervals specified in guidance issued by NHS England; and

(e) ensure that referral pathways are available where significant psychological distress, trauma, anxiety, depression or post-traumatic stress symptoms are identified.

(7) The responsible NHS provider must ensure that information regarding available support services is provided to siblings and that age-appropriate emotional support pathways are available where required.

(8) NHS England must publish guidance regarding—

(a) parental psychological wellbeing assessments;

(b) family mental health support following serious childhood diagnosis;

(c) bereavement support following the death of a child;

(d) support for siblings affected by serious childhood illness;

(e) referral pathways into specialist mental health services; and

(f) minimum standards for proactive family mental health support.

(9) NHS England must publish and lay before Parliament an annual report on compliance with this section.

(10) In this section—

“child” means a person under the age of 16;

“family” includes parents, guardians, primary carers and siblings; and

“life-threatening condition” means a condition designated by the Secretary of State in regulations.

(11) The Secretary of State must, within three years of the commencement of this section, undertake a review of its operation and lay a report before Parliament.”

This new clause would establish a statutory duty on NHS providers to identify and support the psychological wellbeing of parents, carers and siblings following the diagnosis of a life-threatening childhood condition. It would create a proactive, opt-out family mental health pathway from diagnosis through treatment and, where applicable, bereavement.

New clause 83—Review of uncertain imaging findings in high-risk childhood illness—

“(1) Where imaging undertaken in relation to a child with a high-risk cancer or other life-threatening condition identifies findings that are—

(a) inconclusive,

(b) indeterminate, or

(c) suspicious,

the responsible NHS provider must ensure that the findings are reviewed by a consultant clinician responsible for the child's care.

(2) Following such a review, the responsible NHS provider must ensure that the child's parent, guardian or primary carer is informed—

(a) of the nature of the uncertainty identified;

(b) whether disease progression, relapse or recurrence can be confidently excluded;

(c) what further investigations or surveillance are being considered; and

(d) the risks and benefits associated with immediate further imaging, alternative imaging modalities, or continued observation.

(3) Where disease progression or relapse cannot be confidently excluded, the responsible NHS provider must consider whether additional imaging or investigation should be undertaken within 14 days or as soon as clinically practicable, whichever is sooner.

(4) The outcome of any discussion held under subsection (2), including the views expressed by the child's parent, guardian or primary carer, must be recorded in the child's medical records.

(5) NHS England must publish guidance on the operation of this section, including circumstances in which further imaging should be considered following uncertain or indeterminate findings.”

This new clause requires consultant review of uncertain imaging findings in children with designated high-risk conditions. It also aims to ensure that parents are informed of the uncertainty, the available options and the risks and benefits of those options before a decision is made.

New clause 86—Compassionate access to innovative treatments—

“(1) In exercising their functions in relation to the health service, the Secretary of State must by regulations make provision for compassionate access to innovative treatments, involving substances listed in Schedule 1 of the Misuse of Drugs Regulations 2001, for patients with serious or life-threatening conditions in circumstances where conventional treatments have been unsuccessful, unsuitable, or unavailable.

(2) Regulations made under this section must make provision for the authorisation, supply, possession, administration and supervision of such treatments, notwithstanding any restriction imposed by or under the Misuse of Drugs Act 1971 or the Misuse of Drugs Regulations 2001, including provision for—

(a) appropriate clinical and regulatory safeguards;

(b) approval arrangements for participating clinicians, providers and pharmacies; and

(c) case-by-case decision-making having regard to clinical need, patient safety, and available evidence.

(3) For the purposes of this section, a serious or life-threatening condition is defined as a condition involving a substantial risk to life or serious impairment of health or functioning.

(4) Regulations under this section are to be made by statutory instrument subject to the affirmative procedure.”

This new clause would require the Secretary of State to make provision for compassionate access to innovative treatments, involving substances listed in Schedule 1 of the Misuse of Drugs Regulations 2001, for patients with serious or life-threatening conditions in certain circumstances.

New clause 87—Research into innovative treatments involving controlled substances—

“(1) The Secretary of State must by regulations take steps to enable and support the development of research relating to innovative treatments, which use substances listed in Schedule 1 of the Misuse of Drugs Regulations 2001.

(2) Regulations made under this section must make provision, for—

(a) the lawful possession, supply, administration, production and importation of such substances for the purposes of clinical trials or other research activities approved in accordance with regulations made by the Secretary of State, notwithstanding any prohibition or restriction imposed by or under the Misuse of Drugs Act 1971 or the Misuse of Drugs Regulations 2001; and

(b) proportionate and timely arrangements relating to the approval, licensing and oversight of authorised research activities under this section.

(3) Provision under subsection (2) applies to—

(a) approved research bodies,

(b) authorised researchers, and

(c) participating healthcare providers,

and specified substances used for approved research purposes, and does not alter the schedule or classification of a substance.

(4) Regulations under this section are to be made by statutory instrument subject to the affirmative procedure.”

This new clause would require the Secretary of State to take steps to enable and support the development of research relating to innovative treatments, which use substances listed in Schedule 1 of the Misuse of Drugs Regulations 2001.

New clause 88—New Hospital Programme: publication of multi-criteria decision analysis (MCDA) reports—

“(1) Within three months beginning on the date on which this Act is passed, the Secretary of State must publish the MCDA reports used to determine the prioritisation of schemes and their allocation to waves within the New Hospital Programme.

(2) The information published under subsection (1) must include—

(a) the multi-criteria decision support analysis tool used to prioritise schemes;

(b) the input data used in that analysis for each hospital in the New Hospital Programme;

(c) the scoring mechanism used in that analysis;

(d) any assessment of estate condition, including data from the NHS England Estate Return Information Collection;

(e) any assessment of patient safety, service disruption or maintenance backlog;

(f) any assessment of the presence of reinforced autoclaved aerated concrete;

(g) any assessment of the risks associated with delaying individual schemes; and

(h) any review of the appropriateness of the input data or scoring mechanism by NHS England or the Department of Health and Social Care.

(3) The Secretary of State may redact information published under this section where publication would—

(a) prejudice commercial negotiations,

(b) disclose personal data, or

(c) endanger the safety or security of patients, staff or NHS premises.

(4) Where information is redacted under subsection (3), the Secretary of State must publish a statement explaining the reason for the redaction.

(5) The Secretary of State must lay the reports and information published under this section before Parliament.”

This new clause requires the Secretary of State to publish the criteria, input data and scoring mechanism used to determine the prioritisation of schemes and their allocation to waves within the New Hospital Programme. Whilst the input data was obtained from publicly available sources, the MCDA reports are currently not publicly available.

New clause 89—New Hospital Programme: estate failure—

“(1) Within six months beginning on the date on which this Act is passed, the Secretary of State must review whether hospitals experiencing significant estate failure are being appropriately prioritised within the New Hospital Programme.

(2) For the purposes of subsection (1), “significant estate failure” includes the closure, partial closure or restricted use of hospital buildings because of structural, safety or infrastructure failures.

(3) In prioritising schemes within the New Hospital Programme, the Secretary of State must ensure that hospitals experiencing significant estate failure are treated with the same urgency as hospitals affected by reinforced autoclaved aerated concrete.

(4) The Secretary of State must publish the outcome of the review in subsection (1).”

This new clause requires the Secretary of State to review whether hospitals experiencing significant estate failure are being appropriately prioritised within the New Hospital Programme, and to ensure that such hospitals are treated with the same urgency as RAAC-affected hospitals.

New clause 92—Duty to report on the regulation of cosmetic surgery—

“(1) Within three months of the passing of this Act, the Secretary of State must publish a report assessing the effectiveness and safety of current regulation of cosmetic surgery.

(2) The report under subsection (1) must investigate regulatory measures regarding professional checks on the providers of cosmetic surgery, including whether they—

(a) are registered medical practitioners;

(b) have completed recognised specialist surgical training; and

(c) hold Cosmetic Surgery Board Certification, or an equivalent certification, accreditation or qualification.

(3) The report must also consider the safety of current regulations of the premises where cosmetic surgery procedures are undertaken.”

This new clause would require the Secretary of State to prepare a report assessing the regulation of cosmetic surgery.

New clause 102—Report on impact on health of social media addiction—

“(1) The Secretary of State must, within six months of the passage of this Act, commission a report on the impact on health of social media addiction.

(2) The report under subsection (1) must consider and make recommendations concerning—

(a) the mental health effects of social media addiction;

(b) the physical health effects of social media addiction; and

(c) the effects of social media addiction on demand for NHS services.

(3) The Secretary of State must lay a copy of the report with proposed actions to minimise the health harms of social media addiction before both Houses of Parliament.”

This new clause would require the Secretary of State to commission a report considering the impact on health of social media addiction.

New clause 103—Communication with parents of critically ill children—

“(1) The Secretary of State must, within 12 months of the passing of this Act, issue guidance to integrated care boards on communication with parents of critically ill children, with particular reference to major decisions in the child’s treatment and care.

(2) Guidance issued under subsection (1) must—

(a) make provision for ensuring that parents have been fully consulted and are fully informed of decisions concerning the care or treatment of their child and the rationale behind such decisions;

(b) make provision, where potentially life-ending or life-changing decisions are to be made, to facilitate parents in accessing an independent specialist second opinion;

(c) make provision, where there is a disagreement between parents and clinicians on the care or treatment of a child, for the appointment of an independent mediator;

(d) make provision, following the advice of an independent specialist second opinion, for transfer of the child to another hospital, subject to appropriate clinical safeguards;

(e) make provision, prior to the death of a child, for family members to be given access to the child, whether in the hospital, a children’s hospice or the family home.

(3) Guidance issued under subsection (1) must have regard to Article 2 of the European Convention on Human Rights.”

This new clause would require the Secretary of State to issue guidance to integrated care boards concerning their role in communicating with parents of critically ill children, and involving them in decision-making.

New clause 107—Fracture liaison services: implementation framework—

“(1) The Secretary of State must, within six months of the passing of this Act, publish an implementation framework for ensuring universal access to fracture liaison services in England by 2030.

(2) The framework must set out—

(a) the minimum standards expected of fracture liaison services;

(b) the steps to be taken to reduce unwarranted variation in access and quality between integrated care board areas;

(c) the respective responsibilities of integrated care boards and NHS trusts;

(d) the workforce, diagnostic, digital and data requirements necessary to support implementation; and

(e) arrangements for identifying people at risk of further fragility fractures and ensuring that they receive appropriate assessment, treatment and follow-up.

(3) The Secretary of State must make a statement to Parliament each year, until 2030, setting out progress towards universal access to fracture liaison services.”

This new clause would require the Secretary of State to publish an implementation framework for ensuring universal access to fracture liaison services in England by 2030.

New clause 110—Rural access to child and adolescent mental health services—

“(1) Each integrated care board must make arrangements to ensure that children and young people in rural areas have reasonable access to child and adolescent mental health services.

(2) In exercising its functions under subsection (1), an integrated care board must have regard to—

(a) travel distances and travel times;

(b) the availability of public transport;

(c) the availability of locally accessible community facilities; and

(d) the particular needs of children and young people who may face barriers to travelling to a centralised service.

(3) The Secretary of State must provide appropriate support to integrated care boards and local authorities to develop community-based child and adolescent mental health services in rural areas.

(4) An integrated care board and a local authority may make arrangements for the use or repurposing of vacant or underused public buildings for the provision of child and adolescent mental health services.”

This new clause would improve access to CAMHS in rural areas by supporting locally delivered services and enabling vacant or underused public buildings to be repurposed for community mental health provision.

New clause 111—Child and adolescent mental health workforce and service capacity—

“(1) Each integrated care board must assess whether child and adolescent mental health services in its area have sufficient staffing and clinical capacity to meet the needs of children and young people.

(2) Where an assessment under subsection (1) identifies a significant shortfall, the integrated care board must prepare and implement a plan to address that shortfall.

(3) The plan must include measures to support the recruitment and retention of suitably qualified staff and, where clinically appropriate, the provision of specialist services including trauma assessment, dialectical behaviour therapy and art therapy.

(4) In preparing the plan, an integrated care board must have regard to—

(a) the number of children and young people receiving CAMHS services;

(b) waiting times for assessment and treatment;

(c) the number and complexity of cases managed by individual staff members; and

(d) the availability of specialist clinical services.”

This new clause would require integrated care boards to assess and address staffing and service capacity in CAMHS, including access to appropriate specialist services.

New clause 112—Review of child and adolescent mental health services in rural areas—

“(1) The Secretary of State must conduct, or arrange for the conduct of, reviews of the provision of child and adolescent mental health services in rural areas in England.

(2) Any review must consider—

(a) waiting times for assessment and treatment;

(b) access to interim support following referral;

(c) travel distances and access to public transport;

(d) staffing and specialist service capacity;

(e) the availability of community-based provision; and

(f) the use of vacant or underused public buildings for the delivery of services.

(3) A review must identify areas where the provision of child and adolescent mental health services is insufficient to meet local need.

(4) The Secretary of State must publish the findings of any review and an action plan setting out measures to address any significant deficiencies identified.

(5) The first review under this section must be completed within 12 months of the passing of this Act and subsequent reviews must be completed at intervals of not more than five years.”

This new clause would require a national review of CAMHS provision in rural areas, including access, waiting times, workforce capacity and the availability of community-based services.

New clause 113—Radiotherapy services: access and accountability—

(1) The Secretary of State must publish and maintain a national framework for improving access to radiotherapy services in England.

(2) The framework must set out nationally agreed metrics against which integrated care boards must measure and report their delivery of, and investment in, radiotherapy services.

(3) The metrics must include, but are not limited to, metrics relating to—

(a) waiting times for radiotherapy;

(b) access to radiotherapy services, including variation in radiotherapy treatment rates between integrated care board areas;

(c) the age, capability and replacement needs of radiotherapy equipment;

(d) radiotherapy capacity against assessed population need; and

(e) workforce capacity.

(4) Each integrated care board must publish an annual report on its performance against the metrics in the framework.

(5) Before publishing or revising the framework, the Secretary of State must consult persons with clinical, technical, operational and patient expertise in radiotherapy services.

(6) The Secretary of State must lay before Parliament, at least once in each financial year, a report on the implementation of the framework and any steps proposed to address underperformance or unwarranted variation.

(7) In this section, “radiotherapy services” means services involving the use of ionising radiation for the treatment of cancer.”

This new clause would require the Secretary of State to publish a national framework for improving access to radiotherapy services. Integrated Care Boards would be required to report annually against national metrics on waiting times, access, equipment, capacity, workforce, investment and variation.

New clause 114—Radiotherapy services: access and waiting times—

“(1) Within six months of the passing of this Act, the Secretary of State must conduct and publish a review of access to radiotherapy services and waiting times for radiotherapy in England.

(2) The review must include an assessment of—

(a) variation in access to radiotherapy services between integrated care board areas;

(b) waiting times for radiotherapy services, including where radiotherapy is the first, second or subsequent cancer treatment received by a patient; and

(c) the extent to which capacity, equipment, workforce or investment constraints are affecting access to radiotherapy services or waiting times for radiotherapy.

(3) In conducting the review, the Secretary of State must consult persons with clinical, technical, operational and patient expertise in radiotherapy services.

(4) The Secretary of State must lay the review before Parliament and set out any steps proposed to address identified gaps in access to radiotherapy services or waiting times for radiotherapy.

(5) In this section, “radiotherapy services” means services involving the use of ionising radiation for the treatment of cancer.”

This new clause would require the Secretary of State to review access to radiotherapy services and radiotherapy waiting times. The review would examine variation between ICB areas, delays where radiotherapy is a first or subsequent treatment, and the capacity constraints affecting patient access.

New clause 116—Access to medicinal cannabis for children: review and clinical trials—

“(1) The Secretary of State must, within six months beginning on the day on which this Act is passed, publish a review on access to medicinal cannabis for children on the NHS.

(2) The review under subsection (1) must consider—

(a) variation between integrated care boards in the referral and prescribing of medicinal cannabis to children;

(b) the barriers preventing children from accessing medicinal cannabis through the NHS, including the number of patients who access private prescriptions as a result;

(c) the current evidence base for the clinical effectiveness of medicinal cannabis for children; and

(d) options for expanding that evidence base through clinical trials.

(3) The Secretary of State must take reasonable steps to support and facilitate clinical trials into the use of medicinal cannabis for children, with the aim of establishing a clearer evidence base to inform NHS prescribing guidance.

(4) The Secretary of State must lay a copy of the review before both Houses.”

This new clause would require the Secretary of State to review inconsistencies in NHS access to medicinal cannabis for children, including the extent to which patients are forced to rely on private prescriptions, and would place a duty on the Secretary of State to support clinical trials to strengthen the evidence base for prescribing.

New clause 117—Access to speech and language therapy—

“(1) The Secretary of State must, within six months beginning on the day on which this Act is passed, publish a strategy for improving access to NHS speech and language therapy services in England.

(2) The strategy under subsection (1) must include—

(a) an assessment of waiting times for speech and language therapy across integrated care boards;

(b) an assessment of variation in access to speech and language therapy between different areas of England;

(c) an assessment of the speech and language therapy workforce, including current vacancy rates and future workforce need; and

(d) proposals to reduce waiting times and geographical variation in access.

(3) The Secretary of State must lay a copy of the strategy before Parliament.

(4) The Secretary of State must publish a further report reviewing progress against the strategy within eighteen months beginning on the day on which this Act is passed.”

This new clause would require the Secretary of State to publish a strategy to address waiting times and geographical inequality in access to NHS speech and language therapy, and to report on progress against that strategy.

New clause 123—NICE technology appraisal recommendation: accountability scheme—

“(1) The Secretary of State must establish by regulations an accountability scheme relating to the implementation of NICE technology appraisal recommendations (the "scheme").

(2) Under the scheme, Health and Social Care bodies must take all reasonable steps to implement a NICE technology appraisal recommendation within three months of receiving such a recommendation.

(3) Any Health and Social Care body that fails to meet the requirement set out in subsection (2) must—

(a) publish an explanation of the reasons for the failure;

(b) specify any circumstances which have prevented implementation; and

(c) publish a plan setting out the steps it will take to implement the recommendation.

(4) Regulations under this section are subject to the affirmative procedure.”

New clause 131—Activities of religious groups in medical settings—

“(1) The Secretary of State must, within six months of the passage of this Act, make regulations concerning the activities of religious groups in medical settings in England.

(2) Regulations made under subsection (1) must make provision for—

(a) clinical oversight of training provided by representatives of religious groups to healthcare professionals and students on the treatment of patients who hold religious beliefs that may influence their choice of treatment;

(b) ensuring that the contacting of any religious group on behalf of a patient, or for advice on care, is made only at the request of the patient;

(c) requiring opportunities for patients to indicate final treatment preference in the absence of religious representatives, and ensuring religious representatives cannot later verify a patient’s final treatment choice; and

(d) any other matter that the Secretary of State deems appropriate.

(3) Regulations made under this section are subject to the affirmative procedure.”

This new clause would require the Secretary of State to make regulations governing the activities of religious groups in medical settings in England, to prevent medical coercion.

New clause 132—Non-therapeutic male circumcision—

“(1) The Secretary of State must, within six months of the passage of this Act, make regulations relating to non-therapeutic male circumcision (NTMC).

(2) Regulations made under subsection (1) must make provision for—

(a) a requirement that NTMC may only be performed by a suitably qualified healthcare professional and must be inspected by the Care Quality Commission;

(b) the inclusion of NTMC as a regulated activity under the Health and Social Care Act 2008;

(c) the creation of a statutory duty for integrated care boards to produce annual data on prevalence and complications of NTMC;

(d) a requirement that NTMC be included in the Single Patient Record; and

(e) any other matter that the Secretary of State deems appropriate.

(3) Regulations under this section are subject to the affirmative procedure.”

This new clause would require the Secretary of State to introduce regulation of non-therapeutic male circumcision, following several prevention of future death reports issued by coroners as a result of deaths arising from this procedure.

New clause 137—Cancer outcomes—

“(1) The National Health Service Act 2006 is amended as follows.

(2) After section 1GA insert—

“1GB Cancer outcomes

In exercising functions relating to the health service, the Secretary of State must treat objectives relating to cancer outcomes as having priority over any other objectives relating specifically to cancer.””

The Secretary of State is currently required to set cancer outcome objectives for NHS England, with those objectives taking priority over other cancer goals. The Health Bill removes this provision. This new clause would place a new duty on the Secretary of State to prioritise cancer outcomes such as survival by inserting a new section into Part 1 of the National Health Service Act 2006.

New clause 138—Report on occupational health screening for fire and rescue personnel—

(1) The Secretary of State must, within 12 months of the passing of this Act, publish a report on access to occupational health screening, including blood testing for biomarkers of exposure to carcinogens, for members of fire and rescue services in England.

(2) The report under subsection (1) must consider—

(a) the classification by the International Agency for Research on Cancer of occupational exposure as a firefighter as carcinogenic to humans;

(b) the current provision of occupational health screening for fire and rescue personnel by fire and rescue authorities, NHS bodies and integrated care boards;

(c) options for a national baseline entitlement to periodic health screening for fire and rescue personnel, informed by exposure risk;

(d) the resource and workforce implications of any such entitlement; and

(e) the interaction of any such entitlement with existing work by the Fire Brigades Union and the University of Central Lancashire on the UK Firefighters Cancer and Disease Registry.

(3) The Secretary of State must lay a copy of the report before Parliament.”

This new clause would require the Secretary of State to report on occupational health screening, including blood testing, for fire and rescue personnel, in recognition of their elevated risk of cancer arising from occupational exposure to carcinogens.

New clause 139—Duty on integrated care boards to share data with fire and rescue authorities concerning vulnerable persons—

“(1) An integrated care board must take reasonable steps to share, or to facilitate the sharing of, relevant data with a fire and rescue authority for the area, or part of the area, for which the integrated care board has responsibility, for the purpose of enabling the fire and rescue authority to identify and prioritise vulnerable persons in the event of an emergency.

(2) In this section, “relevant data” means data relating to a person’s vulnerability, including but not limited to age, disability or mobility, that is necessary and proportionate for the purpose in subsection (1).

(3) Data may only be shared under this section—

(a) in accordance with the requirements of the UK GDPR and the Data Protection Act 2018;

(b) subject to arrangements agreed between the integrated care board and the fire and rescue authority setting out the purpose, extent and security of the data sharing; and

(c) where a mechanism exists for a person to object to the sharing of their data under this section, save where doing so would be likely to endanger life.

(4) The Secretary of State must, within 12 months of this section coming into force, publish guidance for integrated care boards and fire and rescue authorities on the operation of this section.

(5) In this section, “fire and rescue authority” has the meaning given by section 1 of the Fire and Rescue Services Act 2004.”

This new clause would place a duty on integrated care boards to share relevant data concerning vulnerable residents with fire and rescue authorities, subject to data protection safeguards, to enable fire and rescue services to identify and prioritise vulnerable people in emergencies, including fires and flooding.

New clause 140—Corridor care—

“(1) The Secretary of State must end the practice of corridor care in NHS hospitals within one year of the passage of this Act.

(2) If the requirement under subsection (1) is not met, the Secretary of State must commission an independent inquiry into the Government's handling of corridor care.

(3) The inquiry under subsection (2) must—

(a) investigate the effectiveness of policies, funding and guidance relating to corridor care in the Department of Health and Social Care;

(b) assess the impact on patient safety and staff morale from the continued practice of corridor care; and

(c) recommend steps the Secretary of State should take to end the practice of corridor care.

(4) The inquiry under subsection (2) should be supported by patient safety professionals from the Health Services Safety Investigations Body and the Care Quality Commission.

(5) The inquiry under subsection (2) must be published and laid before Parliament as a final report within 6 months beginning on the day on which the inquiry is established.”

This new clause places a duty on the Secretary of State to end Corridor Care within 12 months, if they fail to do so they must order an independent inquiry into corridor care and the failure to eradicate the practice.

New clause 141—Suspension of Advice and Guidance pending HSSIB report and mitigation plan—

“(1) The Secretary of State must ensure that the operation and further rollout of Advice and Guidance services (including any targets, incentives, pathways or contractual requirements that treat Advice and Guidance as a prerequisite or preferred alternative to direct referral) are suspended until the conditions in subsection (2) are met.

(2) The conditions are that—

(a) the Health Services Safety Investigations Body (or, if its functions have already been transferred under section 63 of this Act, the Care Quality Commission exercising those functions) has laid its final report on Advice and Guidance services before Parliament, and

(b) the Secretary of State has published a written mitigation plan addressing the patient safety risks, harms and recommendations identified in that report (including any linked to patient deaths, near misses, treatment delays, resource and capacity gaps, workforce training, digital systems and incident reporting).”

New clause 142—Puberty blockers—

“(1) Within three months of the passage of this Act the Secretary of State must make regulations which ensure that puberty blockers may not be prescribed, dispensed or supplied to persons under 18 years of age for the purposes of treatment related to gender dysphoria, gender incongruence or a combination of both, in the United Kingdom.

(2) Regulations under this section must ensure that such drugs cannot be given out or used as part of clinical trials for the treatment of gender dysphoria, gender incongruence or a combination of both, unless that trial has specifically been approved by a resolution of both Houses of Parliament.

(3) For the purposes of this section, puberty blockers means—

(a) a “gonadotrophin-releasing hormone (“GnRH”) analogue” which means a medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin, and

(b) any other drug which has the effect of suppressing or delaying puberty that the Secretary of State may by regulation appoint.”

This new clause would create a requirement for the Secretary of State to make regulations which prevent puberty blockers from being prescribed to persons under 18 years of age for the purposes of treatment related to gender incongruence, or being given in clinical trials related to gender incongruence unless specifically approved by Parliament.

New clause 143—Single sex facilities—

“(1) The Secretary of State is required to ensure that there are single sex—

(a) changing rooms for NHS staff,

(b) toilets and washing facilities for NHS staff,

(c) wards for NHS patients, and

(d) toilets and washing facilities for NHS patients.

(2) The Secretary of State may make exemptions to the duty in subsection (1)(c) and (1)(d) where necessary for—

(a) children,

(b) intensive care units,

(c) critical care, and

(d) specialist high observation areas such as resuscitation in Accident and Emergency and the initial recovery area in theatres.”

This new clause creates a requirement for the Secretary of State to ensure certain single sex facilities are made available for NHS staff and patients. It provides exemptions in certain circumstances.

New clause 146—Fracture liaison services: delivery plan and annual reporting—

“(1) The Secretary of State must, within 90 days of the day on which this Act is passed, publish and lay before both Houses of Parliament a delivery plan for securing universal provision of fracture liaison services across England by 2030.

(2) The plan under subsection (1) must include—

(a) a baseline assessment of current access to, and quality of, fracture liaison services in each integrated care board area, distinguishing clearly between services established before and after July 2024;

(b) annual milestones for the number of patients identified, assessed and treated through fracture liaison services, sufficient to reach the level required for universal coverage;

(c) the specific steps the Secretary of State will take to support integrated care boards to commission and sustain high-quality fracture liaison services, including any use of directions, guidance, financial incentives, capital funding or other mechanisms;

(d) workforce, diagnostic (including DEXA capacity), digital and data requirements, with associated funding assumptions;

(e) arrangements for independent monitoring and public reporting of progress against the milestones; and

(f) an estimate of the expected reduction in fragility fractures, hip fractures, associated deaths and NHS bed days, drawing on available evidence including that published by the Royal Osteoporosis Society.

(3) The Secretary of State must, within 12 months of publishing the plan under subsection (1) and every 12 months thereafter until 2030, lay before Parliament a report setting out—

(a) progress against each annual milestone;

(b) the number of new fracture liaison services established and the number of patients identified in the preceding year;

(c) any revision to the milestones or timetable, with the reasons for any such revision; and

(d) action being taken to address any shortfall.

(4) In this section “fracture liaison service” means a service for the systematic identification, assessment, treatment and ongoing monitoring of people who have sustained a fragility fracture, for the purpose of reducing their risk of further fractures.”

This new clause would require the Secretary of State to publish a plan to roll out fracture liaison services across England and publish reports of progress.

New clause 147—Plan to manage acquired brain injury—

“(1) The Secretary of State must, within 30 days of the day on which this Act is passed, publish a plan for the management of acquired brain injury across England.

(2) A plan under subsection (1) must include but shall not be limited to—

(a) proposed government actions to prevent acquired brain injuries;

(b) proposed government actions to improve acute treatment for acquired brain injuries;

(c) a statement of priorities regarding the Secretary of State’s approach for rehabilitation and long-term support for persons with acquired brain injuries across public services delivered by—

(i) the Department of Health and Social Care,

(ii) the Department for Education, and

(iii) the Ministry of Justice;

(d) proposals for data sharing between government departments, health care, and rehabilitation providers to improve patient—

(i) identification,

(ii) care, and

(iii) support;

(e) a commitment to providing 95% of people with complex needs with a personalised care plan by 2027;

(f) commitments for research into acquired brain injuries in sport;

(g) any proposed use of directions, guidance, financial assistance, incentives or other mechanisms to secure delivery of the plan’s objectives;

(h) workforce, diagnostic, digital and data requirements for implementation of the plan; and

(i) arrangements for monitoring, publishing and reporting progress against the plan.

(3) The plan under subsection (1) must be laid by the Secretary of State before both Houses of Parliament.

(4) The Secretary of State must, within 12 months of publishing a plan under subsection (1), and every 12 months thereafter until 2030, lay before Parliament a report on progress made against the proposals and commitments in the plan.”

This new clause would require the Government to publish their action plan to manage acquired brain injury within 30 days of the passing of this Act.

New clause 148—Radiotherapy cancer treatment services—

“(1) The Secretary of State must publish and maintain a national framework for improving access to radiotherapy services in England.

(2) The framework must include nationally agreed metrics against which integrated care boards must measure and report their investment in, and delivery of, radiotherapy services.

(3) The metrics must include provisions relating to—

(a) waiting times for radiotherapy, including time to definitive treatment;

(b) patient travel times to radiotherapy services, including defining an appropriate recommended travel time;

(c) the number of cancer patients receiving radiotherapy and the quality of such radiotherapy;

(d) the age, capability and replacement needs of radiotherapy equipment, including the proportion of linear accelerators that are more than 10 years old or otherwise beyond the recommended replacement age;

(e) access to modern radiotherapy techniques and technologies;

(f) radiotherapy capacity against population need and the projected increase in number of cancer patients;

(g) variation in access to radiotherapy services between integrated care board areas;

(h) provision of sustainable, flexible workforce that is equipped to harness advances in radiotherapy for patient benefit; and

(i) investment in radiotherapy services and the extent to which such investment reflects clinical need.

(4) Each integrated care board must publish an annual report on its performance against the metrics in the framework.

(5) Before publishing or revising the framework, the Secretary of State must consult persons with clinical, technical, operational and patient expertise in radiotherapy which the Secretary of State considers appropriate.

(6) The Secretary of State must lay before Parliament, at least once in each financial year, a report on the implementation of the framework.”

This new clause would require the Secretary of State to publish and maintain a national framework for improving access to radiotherapy services in England.

New clause 149—Modern Service Framework for Respiratory Disease – prioritisation and reporting—

“(1) Within 12 months of the day on which this Act is passed, the Secretary of State must—

(a) publish a statement setting out the criteria and process by which the National Quality Board will assess proposals for future Modern Service Frameworks (including respiratory disease), and

(b) lay before both Houses of Parliament a report on the prioritisation of respiratory disease for a Modern Service Framework.

(2) The report under subsection (1)(b) must include—

(a) an assessment of the current burden of respiratory disease in England including—

(i) emergency admissions,

(ii) variation by integrated care board area,

(iii) outcomes;

(b) the evidence of potential for rapid and significant improvements in quality of care and productivity that a respiratory Modern Service Framework could deliver;

(c) the status of existing work on respiratory pathways including for—

(i) pulmonary fibrosis,

(ii) pulmonary rehabilitation,

(iii) diagnostics,

(iv) early detection and lung cancer screening,

(v) supported self-management,

(vi) access to medicines;

(d) the expected timetable for any decision by the National Quality Board on whether to prioritise a respiratory Modern Service Framework; and

(e) interim actions the Secretary of State and NHS England are taking to reduce unwarranted variation and emergency admissions attributable to respiratory disease pending any such decision.

(3) If the National Quality Board decides not to prioritise a respiratory Modern Service Framework within 18 months of the day on which this Act is passed, the Secretary of State must, within three months of that decision, publish and lay before Parliament an alternative national plan for improving respiratory care that addresses the matters set out in subsection (2)(a) to (c) and (e).

(4) The Secretary of State must publish an updated report under subsection (1)(b), or a progress report against any respiratory Modern Service Framework or alternative plan, at intervals of not more than three years.

(5) In preparing any report or plan under this section the Secretary of State must consult clinicians with expertise in respiratory medicine, organisations representing people with respiratory disease, integrated care boards, and NHS providers of respiratory services.”

New clause 150—Modern Service Framework for Musculoskeletal Care – prioritisation and reporting—

“(1) Within 12 months of the day on which this Act is passed, the Secretary of State must—

(a) publish a statement setting out the criteria and process by which the National Quality Board will assess proposals for future Modern Service Frameworks (including musculoskeletal conditions), and

(b) lay before both Houses of Parliament a report on the prioritisation of musculoskeletal care for a Modern Service Framework.

(2) The report under subsection (1)(b) must include—

(a) an assessment of the current burden of musculoskeletal conditions in England including—

(i) waiting times,

(ii) emergency admissions or unplanned care,

(iii) variation by integrated care board area,

(iv) impact on work and economic inactivity,

(v) outcomes,

(b) the evidence of potential for rapid and significant improvements in quality of care and productivity that a musculoskeletal Modern Service Framework could deliver;

(c) the status of existing national programmes including—

(i) the Getting It Right First Time (GIRFT) MSK Community Delivery Programme;

(ii) any related elective recovery or neighbourhood health initiatives,

(d) the expected timetable for any decision by the National Quality Board on whether to prioritise a musculoskeletal Modern Service Framework; and

(e) interim actions the Secretary of State and NHS England are taking to reduce unwarranted variation, waiting times and the impact of musculoskeletal conditions on patients and the wider economy pending any such decision.

(3) If the National Quality Board decides not to prioritise a musculoskeletal Modern Service Framework within 18 months of the day on which this Act is passed, the Secretary of State must, within three months of that decision, publish and lay before Parliament an alternative national plan for improving musculoskeletal care that addresses the matters set out in subsection (2)(a) to (c) and (e).

(4) The Secretary of State must publish an updated report under subsection (1)(b), or a progress report against any musculoskeletal Modern Service Framework or alternative plan, at intervals of not more than three years.

(5) In preparing any report or plan under this section the Secretary of State must consult clinicians with expertise in musculoskeletal medicine and related professions, organisations representing people with musculoskeletal conditions, integrated care boards, and NHS providers of musculoskeletal services.”

New clause 151—Patient safety recommendations: Government response—

“(1) This section applies where the Secretary of State commissions a review or a report into a patient safety issue.

(2) The Secretary of State must—

(a) decide within six months whether they are going to implement each recommendation of the review;

(b) publish a response to each recommendation with a statement indicating whether each recommendation will be implemented; and

(c) publish a timeline for implementation of recommendations which will be implemented.”

This new clause requires the Secretary of State to respond to patient safety recommendations.

New clause 159—Mental health waiting time standards and reporting—

“(1) The National Health Service Act 2006 is amended as follows.

(2) Section 12F (expected mental health spending) is amended as follows—

(a) in subsection (1), after paragraph (a) insert—

“(aa) stating the Secretary of State's expectations for that year regarding performance against the waiting time standards published under section 12FA;”;

(b) in subsection (1), after paragraph (aa) insert—

“(ab) stating the Secretary of State's expectations for that year regarding the relationship between performance against those waiting time standards and expenditure on mental health services, and”;

(c) for subsection (1)(b) substitute—

“(b) explaining the reasons for the expectations stated under paragraphs (a), (aa) and (ab).”.

(3) After section 12F insert—

“12FA Mental health waiting time standards

(1) The Secretary of State must adopt target national waiting time standards covering mental health services, including community and urgent care.

(2) In determining standards under subsection (1) the Secretary of State must have regard to advice from the Chief Medical Officer about the standards necessary to ensure safe and effective mental health care.

(3) The Secretary of State must publish waiting time standards under this section within 12 months beginning on the day on which this Act is passed.

(4) The Secretary of State may make regulations under section 14Z45A to give effect to the waiting time standards published under this section.””

The new clause would require the Secretary of State to adopt and publish waiting time standards for mental services having regard to advice from the Chief Medical Officer. It would expand the Secretary of State’s existing annual reporting duties to parliament to include reporting the NHS performance in meeting the NHS waiting times standards.

New clause 161—Report into the availability and quality of data relating to dementia care—

“(1) The Secretary of State must publish a report on the availability and quality of data relating to dementia care within 12 months of the passing of this Act.

(2) The report must include an action plan to address gaps in dementia data across prevalence, the health and social care interface, the dementia care pathway, experience of care, and workforce.

(3) The action plan must, in particular, address the absence of key performance measures, including but not limited to—

(a) waiting times to assessment and diagnosis;

(b) non-medication related interventions; and

(c) care and treatment outcomes.”

Amendment 82, in clause 62, page 45, line 37, at end insert—

“(8B) Provision under (8A) about the period within which a recommendation is to be complied with must—

(a) only apply to individual recommendations in the case of exceptional circumstances,

(b) follow a process aligned with NICE's health technology evaluation procedures,

(c) be subject to engagement from industry stakeholders.”

Amendment 106, page 45, line 37, at end insert—

“(8B) Regulations under subsection (8) must include provision about the period within which NICE guideline NG206 on myalgic encephalomyelitis (ME) must be complied with.

(8C) The Secretary of State must publish an annual statement on compliance with NICE guideline NG206, including the extent to which integrated care boards and relevant NHS bodies have implemented recommendations relating to ME specialist services and severe or very severe ME.”

This amendment would require that a period must be set within which the NICE guideline NG206 on ME must be complied with by ICBs and other health bodies. Furthermore, the Secretary of State must publish an annual statement on compliance with NICE guideline NG206 across the NHS in England.

Amendment 1, page 45, line 39, leave out clause 63.

Amendment 2, page 46, line 3, leave out clause 64.

Amendment 3, page 46, line 39, leave out clause 65.

Amendment 4, page 47, line 36, leave out clause 66.

Amendment 7, page 48, line 15, leave out clause 68.

This amendment removes the clause abolishing Healthwatch England.

Amendment 5, page 48, line 18, leave out clause 69.

Government amendments 65 and 66.

Amendment 6, page 52, line 34, leave out clause 75.

Government amendments 67 to 69.

Amendment 89, in clause 80, page 54, line 36, at end insert—

“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the condition in subsection (3B) has been met.

(3B) The condition is that the Secretary of State has published an impact assessment in respect of the abolition of NHS England that complies with subsection (3C) (a "qualifying impact assessment").

(3C) A qualifying impact assessment must include—

(a) a quantified estimate, expressed in monetary terms, of the total transition costs of abolishing NHS England, including in particular—

(i) redundancy costs;

(ii) the costs of integrating data, digital and information technology systems;

(iii) the costs of reorganising and rehousing staff and functions; and

(iv) productivity losses during the transition period;

(b) a quantified estimate, expressed in monetary terms, of the ongoing annual costs of the restructured Department of Health and Social Care following the abolition of NHS England, including any costs falling on integrated care boards as a result of the transfer of functions to them;

(c) a quantified estimate, expressed in monetary terms, of the estimated annual savings arising from the abolition, including savings from the elimination of duplicated corporate functions and reduced administrative costs;

(d) a quantified estimate, expressed in monetary terms, of the net present value of the abolition, being the difference between the total costs under paragraphs (a) and (b) and the total benefits under paragraph (c) over a period of not less than ten years;

(e) a statement of the key assumptions underlying the estimates in paragraphs (a) to (d) and an assessment of the sensitivity of those estimates to changes in those assumptions;

(f) an assessment of the risks to the delivery of the anticipated benefits, including the risk of disruption to NHS functions during the transition period; and

(g) a statement of the methodology used to produce the estimates, including any data sources relied upon.

(3D) Before publishing a qualifying impact assessment, the Secretary of State must submit it for independent scrutiny to the Regulatory Policy Committee (or any successor body) and must publish the Committee's opinion on the assessment alongside it.

(3E) The Secretary of State must lay the qualifying impact assessment and the Committee's opinion before both Houses of Parliament.

(3F) Regulations to commence section (1) are to be made by statutory instrument and may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.

(3G) A draft instrument under subsection (3F) may not be laid unless at least 60 sitting days have elapsed since the qualifying impact assessment was laid under subsection (3E).”

This amendment requires the Secretary of State to publish, and submit to independent scrutiny, an impact assessment on the abolition of NHS England, containing quantified cost and benefit figures, before making regulations to abolish the body.

Amendment 90, page 54, line 36, at end insert—

“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the condition in subsection (3B) is met.

(3B) The Secretary of State must publish a plan setting out how health services provided by or under arrangements made by NHS bodies are to work alongside and be integrated with the social care system in England (the "health and social care integration plan").

(3C) Before preparing the health and social care integration plan, the Secretary of State must have regard to—

(a) the recommendations made by the Independent Commission on Adult Social Care (or any successor body undertaking that Commission's work) in any report published by the Commission; and

(b) the need to reflect any recommendations of the Independent Commission on Adult Social Care in the plan which are relevant to the interface between health services and adult social care.

(3D) The health and social care integration plan must include—

(a) a description of the structural and operational arrangements for joint working between NHS bodies and local authority social care services following the abolition of NHS England;

(b) proposals for how the transfer of NHS England's functions to the Secretary of State will affect the coordination of health and social care commissioning, including commissioning of services for people with complex needs spanning health and social care;

(c) arrangements for reducing delayed discharges from hospital attributable to the absence of suitable social care provision;

(d) proposals for how the funding flows between the NHS and the social care system, including NHS Continuing Healthcare, will be managed following the abolition;

(e) the workforce implications for the health and social care sectors arising from the abolition of NHS England and the steps to be taken to address them; and

(f) a timetable for implementing the arrangements described in the plan.

(3E) The Secretary of State must lay the health and social care integration plan before both Houses of Parliament.

(3F) Regulations to commence section (1) must be subject to the affirmative procedure.

(3G) A draft instrument under subsection (3F) may not be laid before either House of Parliament until at least 60 sitting days after the health and social care integration plan has been laid under subsection (3E).

(3H) In this section—

“NHS body” has the same meaning as in the National Health Service Act 2006;

“social care system” means the system for the provision of care and support under the Care Act 2014 and services provided by local authorities in the exercise of their functions relating to adult social care.”

This amendment requires the Secretary of State to publish and lay before Parliament a plan setting out how health services will work alongside the social care system following the abolition of NHS England before using their powers for its abolition. The plan must address joint commissioning, funding flows (including NHS Continuing Healthcare), delayed hospital discharges, and workforce.

Amendment 25, page 112, line 18, leave out schedule 9.

Amendment 12, in schedule 9, page 130, line 16, at end insert—

“(2A) After paragraph 6(8) insert—

“(9) A committee of the Commission is to be appointed in accordance with regulations.

(10) The purpose of the committee is to oversee the health services safety investigation functions formerly conducted by HSSIB, transferred to the Care Quality Commission under the Health Act 2026.

(11) The committee is to be operationally independent from the Care Quality Commission.

(12) The committee is to consist of a chair appointed by the Secretary of State, and not less than six and not more than twelve other members appointed by the chair.

(13) A majority of the members of the committee must not be members of the Care Quality Commission.

(14) So far as is reasonably practicable, the persons appointed to the committee must include persons with knowledge or experience relevant to the discharge of functions under this paragraph.””

This amendment would ensure that oversight of HSSIB’s functions would remain operationally independent of the Care Quality Commission (CQC) following the transfer of its functions to the CQC.

Amendment 8, page 134, line 20, leave out schedule 10.

This amendment removes the schedule abolishing Healthwatch England.

Amendment 9, page 136, line 1, leave out schedule 11.

This amendment removes the schedule abolishing Local Healthwatch organisations.

Amendment 78, schedule 11, page 137, line 2, at end insert—

“(2A) In making arrangements under subsection (2), an integrated care board must have regard to the need to facilitate participation by persons who may experience barriers to engagement, including persons with long-term, complex or fluctuating health conditions.”

This amendment would require an integrated care board, in making arrangements for gathering patient views, to have regard to the need to facilitate participation by persons who may experience barriers to engagement, including persons with long-term, complex or fluctuating health conditions.

Government amendment 72.

Amendment 100, in schedule 12, page 155, line 5, at end insert—

“(10) An order under this section that establishes, varies the area of, abolishes or merges an integrated care board may not be made unless a draft of the order has been laid before, and approved by a resolution of, each House of Parliament.”

Amendment 33, in schedule 12, page 156, line 28, at end insert—

“(c) must publish any evidence the Secretary of State has received in respect of the impact of the proposal.”

Government amendments 73 to 75.

[Karin Smyth]

I know that many hon. Members want to talk about the provisions in the Bill covering many important issues. I will therefore speak briefly about two Government amendments relating to medical device licensing and information sharing.

I will first address new clause 94 regarding medical devices licensing, and consequential amendments new clauses 99 to 101 regarding medical devices disclosure. These amendments are about ensuring that Great Britain’s medical devices regulatory framework remains fit for the future. As we know, medical technology is evolving rapidly, particularly in areas such as software and artificial intelligence, while our current framework was designed for a very different technological landscape. This set of amendments establishes the statutory foundation for a future medical device licensing regime, applying to Great Britain only. EU medical devices legislation will continue to apply in Northern Ireland.

Such a regime would require medical devices to be licensed and certain persons operating within the supply chain to hold a licence. By placing the detail in the regulations, the amendment allows us to work with patients, healthcare professionals and the medical device sector to create a regulatory framework that protects patients, supports innovation and strengthens the UK’s life sciences sector.

[Jim Allister (North Antrim) (TUV)]

In the aftermath of the Windsor framework and the damage done to intra-UK trade, section 45B of the United Kingdom Internal Market Act 2020 was passed, which was said to promise that there would be no further export procedures that could impact adversely on trade from Northern Ireland to Great Britain. Yet, in new clause 94, we have such constraints in the imposition of a licensing programme, whereby to bring—I will not say “export”, as it is an internal market—a medical device from Northern Ireland to Great Britain, a licence is needed by the recipient. How is that compatible with section 45B of the United Kingdom Internal Market Act?

--- Later in debate ---

[Karin Smyth]

As the hon. and learned Gentleman knows—we have spent many long hours in this place discussing the arrangements with regard to our leaving the European Union—there are different regulations, as a result of Brexit, between Great Britain and Northern Ireland. As is currently the case, due to the Windsor framework, that results in Northern Ireland following the EU device regulations. This has been discussed with the Northern Ireland and Windsor framework taskforce in the Cabinet Office, and we are content that the provisions are right, given the framework’s application. I know and understand the point that the hon. and learned Gentleman makes, and I am sure that he will pursue it with the Government in other areas.

New clauses 95 and 98 update and clarify the Secretary of State’s information-sharing powers for medicines and medical devices. They provide a clearer legal framework for the Medicines and Healthcare products Regulatory Agency to share information with UK health systems, organisations and trusted international partners. The current legislative framework does not always provide the MHRA with the powers or clarity it needs to share information quickly and effectively, and this creates barriers to collaboration, including with the NHS. The new clauses will address these challenges, providing a clear statutory basis for information sharing.

There is currently no explicit statutory domestic information-sharing power for medicines, whereas there is for medical devices. The new clauses bring information-sharing powers about medicines in line with those for medical devices and updates the list of statutory purposes for which the MHRA may share information. Importantly, these reforms do not weaken existing safeguards. Patient information will not be shared internationally without consent, and domestic protections under the Data Protection Act 2018 and the UK General Data Protection Regulation remain unchanged. These new clauses and amendments will act in the interests of patients, and I commend them to the House.

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

Will the Minister give way?

--- Later in debate ---

[Sir Bernard Jenkin]

I would very much have liked to have discussed the medical devices questions arising from the Bill. The Minister made an incredibly short speech about that important matter. It is quite clear that these provisions are part of the covert dynamic alignment with the EU and the covert rejoin agenda being pursued by the Government. It raises all sorts of constitutional questions, but those are not for today.

I will concentrate on HSSIB. I rise to support amendments 1 to 4, which would remove the abolition of HSSIB from the Bill. The Government have singularly failed to make the case for removing this crucial safety investigation function. It did not exist until recently, and now they want to scrub it out. I suspect that is because too many people in the health system do not like being held to account by an independent investigative body.

[Karin Smyth]

indicated dissent.

[Sir Bernard Jenkin]

The Minister shakes her head, but she is yet to give a good reason as to why this measure is in the Bill.

When we had an Adjournment debate in July with the then Minister for patient safety, the hon. Member for Birmingham Edgbaston (Preet Kaur Gill), she could not answer the question of who would conduct independent safety investigations in the NHS after the abolition of HSSIB. She said that safety investigations would be conducted by the Care Quality Commission, but she could not actually claim that they would be independent; as my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) demonstrated, they would not be.

If, as it seems, it is intended that safety investigations should be carried out by the CQC unaffected by the transfer, why make the transfer at all? How much is this transfer going to cost? I asked the Minister, in a letter I sent her after the debate in July, to give us the information on how much the transfer of all this would cost. Nothing has arrived. I never had a reply to the letter. Of course, the Government have changed the Minister and the new Minister for patient safety, the right hon. Member for Kingston upon Hull North and Cottingham (Dame Diana Johnson), is not in the House today. I rather suspect that she is more sympathetic to this argument than the Minister sitting on the Front Bench today.

In our earlier exchanges we discovered and once again exposed how the safe space will be brutally compromised by the fact that it will be housed in a regulator with, inevitably, other ulterior motives. The chief executive of the CQC is wantonly conflicted in terms of looking after the safe space, so he cannot be the one left in charge of that function.

The real point here is that we are missing the opportunity to save so much money. Governments keep having public inquiries. The EPUT—Essex Partnership University NHS Foundation Trust—public inquiry, affecting my constituency, cost in its first year £5 million, and in its second year it is costing another £5 million. The whole budget for HSSIB was only £6.3 million a year, yet it does scores of investigations, not just one inquiry. The Ockenden inquiry cost £14 million. If we could save just a fraction of the cost of medical negligence, which is £3.6 billion a year, HSSIB would pay for itself.

--- Later in debate ---

[Madam Deputy Speaker (Caroline Nokes)]

That brings us to the Front Bench. I call the Minister.

[Karin Smyth]

We have genuinely had a wide-ranging and thoughtful debate, and I want to try to address all the points that have been raised. I think there is broad agreement across the House on the goals that we are seeking to achieve with the Bill: safer care, better outcomes and a stronger voice for patients. Every patient deserves safe and high-quality care, every community deserves to have its voice heard, and everyone should be able to access the care they need, when they need it. The question before us is how best to deliver those ambitions.

In general, we do not believe that the current landscape works, and that better outcomes are always achieved through new reporting requirements, additional layers of statutory process or more bureaucracy. Instead, we are committed to devolving responsibility and to empowering leaders in the NHS, while also holding them directly accountable, so that the NHS is focused on delivery and improving care.

I will begin with Healthwatch. I think there is broad consensus that we want to see patient voices heard strongly at every level of the healthcare system—it is something that all MPs feel strongly about, dealing with constituents as we do. Hearing the patient and user voice results in better decisions in a system that is designed around them—a system that is better able to correct when things go wrong.

Our ambition is to ensure that insight and experience from patients, service users and communities is part of commissioning and service planning decisions, rather than being held at arm’s length and outsourced. Our ambition is that this is done effectively everywhere. It is about strengthening the power of patients’ voices inside the NHS, where decisions are taken, not silencing criticism of those decisions. Within our approach, integrated care boards and local authorities will be expected to engage with people in their areas and will have a statutory duty to obtain their views.

That is a core part of the new strategic role of ICBs, and it involves transparency about what people have told the system, what the system has done in response and how learning is shared across partners. ICBs will be held to account if they do not demonstrate those elements. However, we have heard the strength of feeling in this place and in Committee, and as the Bill moves to the other place, I can commit to working closely with colleagues across this House and in the other place in order to review these provisions and ensure that our approach sufficiently empowers and devolves to local populations. We all want to ensure that the changes deliver for patients and service users, building public trust and ensuring that their voice is embedded in the care they receive.

[Adrian Ramsay (Waveney Valley) (Green)]

The CEO of Healthwatch Norfolk said today:

“To cease the statutory functions of Healthwatch without a suitable alternative in place…is to risk another major failing in patient safety and scrutiny of the health system.”

Did the Minister’s remarks just now suggest that the Government may be reviewing the plans to scrap Healthwatch?

[Karin Smyth]

It will not be a surprise to the hon. Gentleman that I do not agree with his proposition, although I commend the work that many people have done in Healthwatch. We want to work with people in the other place to make sure that this is the right way forward.

I am sorry that we do not have more time to debate HSSIB, because it requires more discussion, although we had a good debate in Committee. We have heard many discussions today. I have met the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), and I hear what he is saying; I will ensure that he gets a response to his letter from the new Minister for Patient Safety—asap, as they say.

It is an issue that we need to get absolutely right. We all know, from our experience with patients and families, about the importance of creating a culture in which concerns can be raised without fear and lessons are learned effectively. The Government fully agree with those objectives. Our view is that patient safety, in line with the Dash review, is best served by clear lines of accountability, effective independent scrutiny, and a relentless focus on learning and improvement. We are therefore transferring HSSIB’s functions to the CQC to ensure that learning from investigations can more readily inform improvement activity across the system.

We recognise the importance of ensuring that the investigation arm has the autonomy to investigate the qualifying incidents that it deems appropriate free from interference, and I can give the House the assurance that we will work with the executive of HSSIB and the CQC to ensure that their operating model upholds this operational independence.

In response to the Chair of the Health Committee, who is not in her place, let me say that there is obviously no one single metric by which to judge the suitability of the CQC. It is usual in the Department’s oversight of arm’s length bodies and independent regulators to look at things like stable leadership, IT capability, governance and operational effectiveness. This is something I am sure the Select Committee can help with.

[Sir Bernard Jenkin]

Will the Minister give way?

[Karin Smyth]

I apologise, but I am going to press on. There is a lot to get through.

We are committed to tackling health inequalities wherever they arise. There are strong duties on both ICBs and the Secretary of State to tackle these inequalities, and we remain firmly committed to doing so. We continue to drive forward improvement plans including the national cancer plan and the mental health strategy, which will transform mental health care into a system that responds and intervenes early, reduces waiting times for support, and ultimately supports people to participate fully in education. I note in particular that the Government are already making record investment in mental health. All ICBs are expected to meet the mental health investment standard over the next three years, and all are forecast to meet it for 2026-27.

We are also committed to delivering the national cancer plan and focused on driving improvements, including on diagnostic capacity, which is key to addressing waiting times and tackling variation in access to better treatment, as we have heard today from my hon. Friends the Members for Easington (Grahame Morris), whose work in this area I commend, and for Blaydon and Consett (Liz Twist).

[Freddie van Mierlo (Henley and Thame) (LD)]

Will the Minister give way?

[Karin Smyth]

I am going to press on a little bit, if I may.

I remind the House that we are doing this within the existing legal structures, and that our approach is not to put in place additional duties and layers of detail and specificity in primary legislation. I think we should avoid the temptation to create separate statutory obligations for each condition or patient group, particularly in an age where people are living longer and very often with more than one health condition. Instead, we should commit ourselves to tackling inequalities for everyone, everywhere.

We have again heard from the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), about corridor care. The Government have been consistently clear that corridor care is not an acceptable standard of care and should not be normalised, and it is our intention to reduce and ultimately eradicate it. I think it is worth reminding the House that corridor care does not occur everywhere; some places have made huge steps to avoid it, and we want to share that learning. I particularly commend Barnsley foundation trust, South Warwickshire foundation trust and the Dudley group foundation trust, where there have been zero incidents in the last reporting. We must recognise that corridor care is one of the most visible and distressing symptoms of systemic pressures across the urgent and emergency care pathway, and our focus is on taking action now to tackle those underlying pressures.

We are improving patient flow, strengthening discharge arrangements, investing in urgent and emergency care services, and providing targeted support to the systems and trusts facing the greatest challenges from corridor care, so that improvements can be delivered where they are needed most. To ensure that we can understand where these challenges are, we have already introduced a national definition of corridor care, and strengthened reporting and oversight arrangements.

[Deirdre Costigan (Ealing Southall) (Lab)]

I thank the Minister for giving way and wish her a happy birthday, too. The NHS trust in north-west London was recently found to be one of the most improved in London in terms of reducing waiting lists. Does she agree that all the changes that she is bringing in through the Bill, including those discussed today, will help us to bring down those waiting lists even further and address the issues with corridor care that she has outlined?

[Karin Smyth]

I thank my hon. Friend for her best wishes and commend the work that she and many other Members are doing directly with their trusts to understand the impact of the work that we are doing to bring down those waiting lists and improve access for patients. As I have said, corridor care is a sign of systemic failure in the system and is unacceptable. I think we have all witnessed it in our local trusts, but it is coming down in places, and we want to continue to see it eradicated.

I pay tribute to my hon. Friend the Member for North East Hertfordshire (Chris Hinchliff) for his championing of the families of children suffering from life-threatening illnesses. I know that Members on both sides of the House recognise the profound impact that receiving a diagnosis of a life-threatening condition has on a child and their family. It is vital that all these families feel supported, informed and cared for, and I wholeheartedly recognise that the support that they are offered now is often not proactive or joined up, with the onus, as he said, being on families to navigate the system and seek support themselves.

With that in mind, the Government commissioned a report on the mental health impacts of life-threatening childhood illness on families, named in the memory of Hugh Menai-Davis. I pay tribute to Hugh’s parents for their campaigning and offer them my deepest condolences.

The report process is progressing well, and I can commit to the report being published in this Parliament, with a full Government response issued within three months of publication. For too long, children’s health has not been a priority, which is why my right hon. Friend the Secretary of State for Health and Social Care has directed the Department to make maternal and child health central to its work. We know that a child’s health has ramifications for the wellbeing of the whole family, and there must be better solutions to join up support for parents of unwell children.

The new cross-Government mental health strategy will also address how we better support parents and families, and the Government intend to work closely with parents, families and campaigners to identify workable solutions and make available more proactive support.

I turn now to the Opposition amendments, starting with new clause 142, in the name of the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson).

[Rachel Taylor]

Will the Minister give way?

[Karin Smyth]

I will carry on.

As the hon. Member for Sleaford and North Hykeham knows well, provisions are already in place to appropriately control access to puberty-suppressing hormones for children and young people presenting with gender incongruence or dysphoria. Children and young people with gender incongruence deserve evidence-based care. The Cass review recommended a clinical trial to provide high-quality comparative evidence on the potential benefits and risks of the medicines. That is now under way.

I agree with the comments from the hon. Member for North Shropshire, but I have to disagree with the view of the hon. Member for Sleaford and North Hykeham that, uniquely, access to these types of medicines must be subject to the scrutiny and approval of Parliament. I think that, as a clinician, she understands that.

I would also like to address new clause 143. As the hon. Member for Sleaford and North Hykeham knows, the EHRC’s updated code of practice for services, public functions and associations commenced on 5 August. It provides guidance on how sex-based distinctions in the Equality Act can be applied, including in the NHS. This new clause is unnecessary. This legislation is the law and the law is clear. The NHS will obviously follow the law. New guidance has been drafted and will be published imminently. For the record, I am due next week to meet the Darlington nurses who she spoke for. I agree that they were brave; they should not have had to go through what they went through.

I want to address new clauses 41 and 42 on funeral regulation in the name of the hon. Member for Gosport (Dame Caroline Dinenage), who spoke powerfully on behalf of the whole House; I commend the work that she has done. My hon. Friend the Member for Kingston upon Hull West and Haltemprice (Emma Hardy) has spoken to me in great detail about this issue, as has my hon. Friend the Member for Leeds South West and Morley (Mark Sewards).

The Government were appalled by the offences committed by Robert Bush and the profound harm caused to bereaved families. Every deceased person must be treated with care, respect and dignity. We are undertaking urgent work to develop comprehensive proposals, including formal regulation of the funeral sector to drive out rogue operators and strengthen protection for bereaved families. As the hon. Member for Gosport said, operators that work well will also want to see this. We will begin sharing proposals shortly, and I am very happy to include hon. Members in the discussions.

[Mark Sewards (Leeds South West and Morley) (Lab)]

Does the Minister accept that the Prime Minister said in July that the sector needed to be regulated and that this continues to be a priority for his Government?

[Karin Smyth]

Absolutely, and I am committed to working with my hon. Friend and many other hon. Members across the House.

I was pleased to meet my hon. Friend the Member for Manchester Withington (Jeff Smith) to discuss his amendments concerning medicines. I hope that I reassured him—from his speech, I think that I did—that the Government do support well-designed research into innovative treatments using controlled drugs, where this is conducted safely and appropriately. We also understand the complexities involved, including the need to minimise the risk of harm and misuse. That is why we are working across government to consider how to implement the recommendations from the Advisory Council on the Misuse of Drugs to reduce barriers to research with schedule 1 controlled drugs. I committed to write to my hon. Friend to set that out further; I will do.

A number of hon. Members tabled amendments on issues with their local infrastructure. We have already published the capital plan and improved long-term capital planning to improve local infrastructure.

I think that I have addressed most things—

[Rachel Taylor]

Will my hon. Friend give way?

[Karin Smyth]

I am so sorry; I will to talk to my hon. Friend later. The debate has been wide ranging. If there are things that I have missed, I commit to getting back to hon. Members. I know that my noble Friend Baroness Merron is committed to working co-operatively with all Members as the Bill proceeds through the other House.

Health Bill

Karin Smyth Excerpts

Report stage
Monday 7th September 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I beg to move, That the clause be read a Second time.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

With this it will be convenient to discuss the following:

Government new clause 97—Care and support: involvement of others and visitors.

New clause 1—National Maternity Commissioner—

“(1) The Secretary of State must, within six months of the passing of this Act, appoint a National Maternity Commissioner, situated within the Department of Health and Social Care.

(2) The functions of the National Maternity Commissioner are to—

(a) oversee NHS maternity services;

(b) act as an independent voice for women and families;

(c) ensure lessons are learned from identified failures and that the recommendations of maternity reviews are acted upon;

(d) promote consistency, safety and accountability across NHS maternity services; and

(e) advise the Secretary of State on matters relating to the safety, quality and provision of maternity services in England.

(3) The person appointed as Commissioner must—

(a) be a person with knowledge, expertise and experience relevant to the discharge of functions of the role;

(b) have first-hand experience of working in maternity services, so far as reasonably possible; and

(c) not be a sitting Member of Parliament.”

This new clause would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services.

New clause 2—Assessment of risks posed by contracts with non-UK based suppliers—

“(1) Within six months of the passing of this Act, the Secretary of State must conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside of the UK.

(2) In conducting an assessment under this section, the Secretary of State must—

(a) pay particular regard to contracts which provide technology companies with access to confidential patient data;

(b) consult national security experts on the risks posed to UK sovereignty by such contracts;

(c) consider risks associated with the sharing of confidential patient data with organisations based outside of the UK;

(d) assess public and NHS staff attitudes to relevant suppliers and any implications such attitudes may have on the use and effectiveness of products or services provided under the contract; and

(e) consider the background of relevant suppliers, known contracts with other states and organisations, and any relevant ethical considerations.

(3) Where any significant risk is identified, the Secretary of State must set out the Government’s intentions to manage and mitigate such risks, including its intention to use or develop domestic technologies, systems or products in place of those provided under the relevant contract.”

This new clause would require the government to publish a risk assessment of contracts between NHS organisations and suppliers based outside of the UK.

New clause 3—Duty on the Secretary of State to prioritise domestic suppliers—

In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert—

1CD Duty to prioritise domestic suppliers

(1) In exercising functions in relation to the health and care service, the Secretary of State must prioritise the awarding of any contract that will involve the handling of NHS patient data to suppliers based in the United Kingdom.

(2) The Secretary of State may only seek to procure technology and information systems which will handle NHS patient data from suppliers based outside of the United Kingdom where a viable domestic alternative does not exist.

(3) Before signing any contract for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must consult with—

(a) patient groups,

(b) national security experts, and

(c) staff unions,

on the proposed contract and lay a report on such a consultation before Parliament.

(4) Where it is proposed to sign a contract for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must arrange for a motion agreeing to the signing of such a contract to be tabled in each House of Parliament, and no such contract may be signed where a motion for its agreement is negatived by either House of Parliament.

(5) If a contract is awarded for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must place a statement before both Houses of Parliament setting out whether the Government is taking, or is planning to take, steps to develop or support long-term domestic alternatives to the systems provided by the contract.”

This new clause would place a duty on the Secretary of State to prioritise domestic, UK-based, suppliers for technology systems and contracts handling NHS patient data, and places restrictions on the signing of contracts for such systems with non-UK based suppliers.

New clause 4—NHS Digital Sovereignty Strategy—

“(1) The Secretary of State must, within 12 months of the passing of this Act, publish a strategy (“an NHS Digital Sovereignty Strategy”) which sets out the Government's approach to maintaining the security and resilience of relevant NHS information systems by—

(a) assessing, managing and mitigating risks—

(i) associated with foreign interference,

(ii) arising from reliance on foreign-supplied technologies, and

(b) preventing over-reliance on foreign providers by building domestic capacity.

(2) For the purposes of this section, a “relevant information system” is an information system with access to NHS patient data.

(3) An NHS Digital Sovereignty Strategy published under this section must—

(a) include risks associated with—

(i) hardware,

(ii) software,

(iii) supply chains, and

(iv) procurement processes;

(b) include a specific focus on security and resilience in digital procurement processes, detailing how the Government intends to reduce strategic dependencies on foreign-owned service providers to mitigate the risk of systemic disruption;

(c) include a commitment to prioritise the use of technologies developed in the UK by UK organisations in relevant information systems to reduce reliance on foreign technologies;

(d) recommend steps to support and develop sufficient domestic capability where it does not currently exist;

(e) where risks are identified, state how the Government intends to address these risks by supporting the use or development of domestic technologies or systems.”

This new clause would require the Government to publish an NHS Digital Sovereignty Strategy setting out how it intends to address risks to relevant information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies.

New clause 5—Health Data Charter—

“(1) The Secretary of State must, within 6 months of the passing of this Act, establish an independent body (to be known as the "Sovereign Health Data Trust”) for the purpose of creating a Health Data Charter.

(2) The membership of the Trust should include—

(a) people with a diverse range of backgrounds; and

(b) health data experts, clinicians and patient representatives.

(3) The Charter must—

(a) set out the fundamental principles and responsibilities for assessing whether a data sharing partnership is in the interest of the public and the NHS;

(b) include the primary goal of protecting people’s privacy and their data from exploitation, while promoting trust in data systems and the handling of health data;

(c) ensure patients have control of their data, including providing relevant opt-outs;

(d) provide that all health data is held anonymously and accessed through a trusted research environment;

(e) set out ways to retain and protect the value of health data in England, including providing measures to invest a share of the income generated from new medicines or treatments developed with that health data to be invested back into the NHS;

(f) be designed in such a way as to render it interoperable with the European Health Data Space in technical terms, including through the promotion of Findable, Accessible, Interoperable and Reusable (FAIR) data principles within the NHS.

(4) The Sovereign Health Data Trust will—

(a) hold continuous oversight of all health data and oversee the trusted research environment;

(b) have power to recall or restrict an organisation’s access to data if it has reason to believe that the data is not being used for public or patient benefit;

(c) ensure that all data sharing arrangements with a non-NHS organisation are transparent, with all health data contracts entered into by a public body made publicly available;

(d) publish detailed minutes of all meetings discussing potential uses of health data; and

(e) ensure all health data collection and sharing initiatives are preceded by public consultation, involvement and awareness.”

New clause 6—Maternity Safety—

“(1) The Secretary of State must ensure that every NHS maternity unit is rated “good” or

“outstanding” by the CQC.

(2) The Secretary of State must, within 6 months of the passage of this Act, establish a scheme to support NHS trusts to deliver the requirement under subsection (1), which includes—

(a) 24/7 consultant obstetrician cover on every labour ward,

(b) one-to-one midwifery care,

(c) a Director of Midwifery in every maternity service,

(d) ringfenced maternity service development funding, and

(e) a dedicated neonatal workforce plan.

(3) Within 12 months of the commencement of the scheme under subsection (2), and every 12 months thereafter, an annual report should be laid before both Houses of Parliament on the effectiveness of the scheme.”

This new clause would place a duty on the Secretary of State to create a scheme to ensure that every maternity unit in the country achieves a “good” or “outstanding” rating by the CQC.

New clause 7—Healthy life expectancy target—

“(1) Within six months of the passage of this Act, the Secretary of State must—

(a) make regulations to set a statutory target for improving overall healthy life expectancy for the population of Great Britain, and

(b) publish a cross-governmental strategy, renewed every 24 months, to set out how the target set by regulations under subsection (1)(a) will be achieved.

(2) The strategy under subsection (1)(b) must be laid before both Houses of Parliament.

(3) Upon publication of a strategy under subsection (1)(b) the Secretary of State must make a statement before the House of Commons regarding progress made towards the target set by subsection (1)(a).”

This new clause would require the Secretary of State to make regulations to establish a statutory target for healthy life expectancy in Great Britain and publish a strategy every two years setting out how this target will be achieved.

New clause 8—Impact of trade deals on the NHS—

“(1) Any trade negotiation which would require NHS spending or funding to exceed £100 million must be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure.

(2) Before laying regulations under subsection (1) the Secretary of State must publish an impact assessment about how the trade negotiation will affect NHS frontline services and patients.”

This new clause would require any trade negotiation which would require NHS spending or funding to exceed £100 million to be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure.

New clause 11—Duty as respects waiting times for women’s health—

“In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert—

“1CD Duty as respects waiting times for women’s health

The Secretary of State must exercise functions in relation to the health service with a view to ensuring that average waiting times for the diagnosis and elective treatment of conditions primarily affecting women do not exceed the overall average waiting times for NHS diagnosis and elective treatment.””

This new clause would ensure that the average waiting time for diagnosis and treatment for elective conditions for women’s health issues do not exceed the average wait time for wider NHS elective treatment.

New clause 12—Inquiry into women’s health outcomes—

(1) The Secretary of State must, within six months of the passing of this Act, commission an independent inquiry into women’s health provision and outcomes in England.

(2) Any inquiry established under subsection (1) must consider—

(a) the causes of—

(i) poorer health outcomes, and

(ii) disparities in patient safety,

for women;

(b) the effectiveness of existing commissioning arrangements in meeting the needs of women, and

(c) recommendations to assist the Secretary of State in discharging the duty to reduce inequalities in health outcomes under section 1C of the National Health Service Act 2006.

(3) The Secretary of State must lay a report on the findings of the inquiry before Parliament within the period of 12 months beginning with the day on which this Act is passed.”

This new clause would establish an inquiry into the poorer health outcomes faced by women.

New clause 15—Public Health Committee—

(1) The Secretary of State must establish a Public Health Committee within six months of the passage of this Act to ensure a cross-governmental focus and consideration of the promotion of public health in government policy and address national health inequalities.

(2) The Public Health Committee under subsection (1) must—

(a) include at least one minister from each government Department in its membership,

(b) include all cabinet ministers in its membership,

(c) be chaired by the Prime Minister,

(d) meet once in each annual quarter.

(3) Under subsection 2(b), cabinet members must attend at least three quarters of the Public Health Committee's meetings each year.

(4) Each government Department must publish an annual report on their department's consideration of public health in its policy and the extent of joint policy formulation with other government Departments.

(5) The Secretary of State must establish a Health Creation Unit to support the Public Health Committee.

(6) The Health Creation Unit must submit an annual report on its activities, decision-making and cross-government progress to the Liaison Committee.”

This new clause would establish a Public Health Committee and Health Creation Unit to promote public health and cross-government policy making.

New clause 16—Duty to promote public health—

“All Ministers of the Crown have a duty to consider health outcomes and the promotion and protection of public health when exercising their duties.”

This new clause will place a duty on all ministers to consider health outcomes and the promotion of public health when exercising their duties.

New clause 17—Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing—

“(1) The Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing may be ratified only if—

(a) a Minister of the Crown has laid before the House of Commons a copy of the Arrangement, and

(b) the Arrangement has been approved by a resolution of the House of Commons on a motion moved by a Minister of the Crown.

(2) Before tabling a motion under subsection (1)(b) the Secretary of State must publish and lay before the House of Commons an impact assessment on the potential effects on the health service of implementation of the Arrangement.”

This new clause would require the Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing to be brought before the House for a vote.

New clause 18—Access to dental provision: Dental deserts—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must establish a scheme to improve access to dental provision (“the Scheme”).

(2) The purpose of the Scheme is to end dental deserts.

(3) A dental desert is defined as any local authority area with fewer than ten active dental practices per 100,000 people.

(4) The Scheme must make provision to support integrated care boards to—

(a) guarantee emergency access to an NHS dentist,

(b) provide free dental check-ups for—

(i) children,

(ii) mothers within one year of having given birth,

(iii) pregnant women, and

(iv) low-income households,

(c) guarantee dental appointments for persons commencing—

(i) surgery,

(ii) chemotherapy, or

(iii) transplant procedures.

(5) The Secretary of State must, before publishing the Scheme, issue a reformed dental contract.

(6) The Secretary of State must, within six months of the establishment of the scheme, publish a dental workforce plan to support delivery of the scheme.”

This new clause would establish a scheme to support integrated care boards to end dental deserts.

New clause 21—GP representation on integrated care boards—

“(1) An integrated care board must include as a member at least one individual who—

(a) is a registered medical practitioner, and

(b) has current or recent experience of providing primary medical services under Part 4 of the National Health Service Act 2006.

(2) In appointing a member under subsection (1) an integrated care board must have regard to the member’s potential contribution to improving—

(a) patient journeys across services,

(b) coordination and continuity of care,

(c) prevention and population health management, and

(d) integration of services at neighbourhood level.”

This new clause would ensure that each integrated care board includes at least one member who is a registered medical practitioner, and has current or recent experience of providing primary medical services under Part 4 of the National Health Service Act 2006.

New clause 22—Duty to engage primary care providers in integrated care boards—

“(1) An integrated care board must take all reasonable steps to secure the meaningful involvement of primary care providers in the exercise of its functions relating to—

(a) service redesign,

(b) integration of health services,

(c) development of neighbourhood health services, and

(d) population health planning.

(2) In this section, “primary care providers” includes—

(a) providers of primary medical services,

(b) community pharmacy contractors,

(c) providers of primary dental services, and

(d) providers of ophthalmic services.

(3) Under subsection (1), “meaningful involvement” includes—

(a) involvement at an early stage in the development of ICB proposals,

(b) provision of sufficient information to enable informed participation of primary care providers in ICB functions,

(c) opportunities for primary care providers to influence ICB decision making, and

(d) opportunities for primary care providers to deliver feedback on how their views have been taken into account in the delivery of ICB functions.

(4) An integrated care board must publish an annual statement describing—

(a) how it has complied with this section, and

(b) the impact of primary care providers’ involvement on decisions taken by the ICB.

(5) The Secretary of State may issue guidance about the application of this section to which integrated care boards must have regard.”

This new clause ensures a certain range of primary care providers are consulted by integrated care boards in the development of their healthcare plans.

New clause 23—Duty of care for victims of domestic abuse and violence against women and girls—

“The Secretary of State and integrated care boards have a duty of care to consider the needs of victims of domestic abuse and violence against women and girls when exercising their functions in relation to the provision of healthcare services.”

This new clause would place a duty of care on the Secretary of State and integrated care boards to consider the needs of victims of domestic abuse and violence against women and girls when exercising their functions in relation to the provision of healthcare services.

New clause 25—Continuity of care and clinical responsibility—

“(1) The Secretary of State must by regulations ensure that every patient has access to a named NHS General Practitioner.

(2) Regulations under this section must make provision for pregnant women to have access to a named clinician for the period of their pregnancy.

(3) Regulations under this section are subject to the affirmative procedure.”

New clause 29—Senior leadership training at NHS trusts—

“(1) Within six months of the passage of this Act, the Secretary of State must publish a review on the effectiveness of training for senior leadership in NHS trusts on—

(a) workplace culture standards,

(b) addressing bullying, and

(c) addressing discrimination on the basis of—

(i) sex,

(ii) race, and

(iii) any other protected characteristic which the Secretary of State considers appropriate.

(2) Within one month of the publication of the review under subsection (1), the Secretary of State must publish guidance based on the review for the Department of Health and Social Care to administer to NHS trusts.”

New clause 32—Privacy by design in NHS Single Patient Record and Federated Data Platform architecture—

“(1) The Secretary of State must ensure that there is privacy by design as part of the delivery of the NHS Federated Data Platform architecture.

(2) For the purposes of subsection (1), privacy by design includes—

(a) patient data anonymisation outside its usage by clinicians and within the National Data Integration Tenant; and

(b) patient consent for the processing of personal information by NHS.”

New clause 33—NHS ownership of connection software—

“(1) The Secretary of State must ensure that there is NHS ownership of any data connector software architecture used as part of the delivery of the NHS Single Patient Record or Federated Data Platform.

(2) In this section, a data connector means an interface or connection between the NHS Federated Data Platform and any other health system.”

New clause 34—Retendering of contract for the NHS Federated Data Platform—

“The Secretary of State must, before February 2027, commence a competitive retendering for the contract to provide the NHS Federated Data Platform.”

New clause 35—NHS contracting for IT or data services—

“(1) The Secretary of State must, within six months of the passing of this Act, by regulations establish a governance framework for the contracting of any IT or data services by the Department of Health and Social Care or any NHS organisation.

(2) The framework established under subsection (1) must include the following provisions—

(a) a party may not bid for any contract for services where such services have previously been provided by the party on a free trial basis;

(b) the automatic extension of contracts should be subject to audit by the National Audit Office;

(c) contract terms must include provision for the department or NHS organisation to take ownership of any bespoke system built or developed by the contractor during the delivery of the contract;

(d) the department or NHS organisation must, at the end of the contract period (or following any extensions) conduct a competitive retendering process; and

(e) where a retendering process takes place under subsection (2)(d), the contractor may not assist in the preparation of the contract specification.

(3) Regulations under this section are to be made by statutory instrument subject to the affirmative procedure.”

New clause 36—Transition strategy for the abolition of NHS England—

“(1) The Secretary of State must, before the abolition of NHS England takes effect, prepare and lay before Parliament a report setting out a transition strategy for the abolition of NHS England (the "strategy").

(2) The strategy must—

(a) identify and map critical functions and areas of expertise currently exercised by NHS England, including clinical, operational, analytical and patient engagement capabilities;

(b) assess the risk of loss of knowledge, skills and organisational capacity arising from the abolition of NHS England;

(c) set out the steps the Secretary of State proposes to take to ensure the retention and effective transfer of such functions, expertise, knowledge and skills; and

(d) assess the likely impact of the transition on the delivery of key health programmes and services, including cancer services.

(3) The Secretary of State must, at intervals of not more than 12 months, lay before Parliament a report on the implementation of the transition strategy.

(4) A report under subsection (3) must include—

(a) progress on workforce retention;

(b) arrangements for the transfer of knowledge, expertise and institutional capability; and

(c) any identified gaps in capability and the steps being taken to address them.”

This new clause would require the Secretary of State to prepare and lay before Parliament a formal transition strategy before the abolition of NHS England, setting out how critical functions and expertise will be identified, retained and transferred. It would also require the Secretary of State to report to Parliament at least annually on the implementation of that strategy.

New clause 38—General Ophthalmic Services: national framework, tariff and protected funding—

“(1) The Secretary of State must by regulations establish and maintain a national service specification for the primary ophthalmic services referred to in section 115 of the National Health Service Act 2006 (in this section referred to as general ophthalmic services, "GOS"), setting out the minimum standards of access and provision that integrated care boards are required to secure.

(2) Regulations under subsection (1) must establish and maintain a national tariff for GOS, setting out the prices at which GOS must be commissioned by integrated care boards.

(3) An integrated care board must commission GOS in accordance with the national service specification and national tariff established under subsections (1) and (2), and may not exercise any discretion to vary, restrict or reduce provision below the standards so specified.

(4) The Secretary of State must ensure that funding for GOS is allocated to integrated care boards as a ring-fenced, protected funding stream, which—

(a) may not be applied by an integrated care board to purposes other than GOS; and

(b) may not be reduced by an integrated care board in order to meet expenditure requirements in respect of other services.

(5) In determining any expenditure limits or resource allocations for integrated care boards under the National Health Service Act 2006, the Secretary of State must calculate and separately identify the GOS component of each board's allocation.

(6) The Secretary of State must lay before Parliament a report in each calendar year assessing the extent to which integrated care boards have complied with their obligations under this section.”

New clause 39—Community equipment and wheelchair services: standards, performance and outcomes—

“(1) Each integrated care board must publish standards which apply in its area in relation to the assessment for and supply of community equipment and wheelchair services.

(2) Each integrated care board must monitor its performance against the standards under subsection (1).

(3) Each integrated care board must publish an annual report including—

(a) performance against the standards under subsection (1),

(b) waiting times for the assessment for and supply of community equipment and wheelchair services,

(c) the number and proportion of people waiting longer than 18 weeks for such equipment or services,

(d) outcomes achieved for people by the provision of community equipment and wheelchair services, and

(e) steps taken by the integrated care board to improve the assessment for, and supply of, community equipment and wheelchair services.

(4) For the purposes of this section—

“community equipment and wheelchair services” means equipment, aids, home adaptations or appliances provided to support a person’s independence, safety, care or daily living at home or in the community, including hoists, hospital beds, pressure-relieving mattresses, commodes, shower chairs, walking frames, grab rails, ramps, specialist seating, postural support equipment, associated mobility equipment, and wheelchairs.”

This new clause would require each integrated care board must publish standards which apply in its area in relation to the assessment for and supply of community equipment and wheelchair services and publish an annual report on their adherence to these standards.

New clause 40—Regulation of online fertility services—

“(1) The Human Fertilisation and Embryology Act 1990 is amended as follows.

(2) After section 5 insert—

“5A. Regulation of online fertility services

(1) The Human Fertilisation and Embryology Authority shall be responsible for the licensing of organisations providing online fertility services in England and Wales.

(2) The Secretary of State may by regulations make further provision regarding the arrangements for the licensing of organisations under subsection (1).

(3) Regulations made under subsection (2) are subject to the affirmative procedure.””

This new clause would implement a recommendation of the Human Fertilisation and Embryology Authority to extend its regulatory remit to include organisations providing online fertility services.

New clause 43—Duty to reduce variation in clinical research funding—

“In exercising functions in relation to the health service, the Secretary of State must have regard to the need to—

(a) reduce inequalities between the people of England with respect to their ability to access clinical research opportunities and participate in clinical trials, and

(b) reduce regional variation in the distribution of clinical research funding across England.”

This new clause would require the place a duty on the Secretary of State to reduce inequalities across England with respect to access to clinical research opportunities and participate in clinical trials and the distribution of clinical research funding across.

Amendment 46, in schedule 12, page 151, leave out paragraph 98.

This amendment is consequential on NC67.

New clause 48—National Maternity and Neonatal Investigation final report and recommendations—

“(1) The Secretary of State must, within six months of the passing of this Act, publish a response to the final report and recommendations of the National Maternity and Neonatal Investigation.

(2) The response under subsection (1) must include an action plan covering each of the recommendations of the Investigation.

(3) The action plan must have regard for hospitals—

(a) where negligent care has been identified in the provision of maternity and neonatal services, or

(b) where risk factors have been identified that are associated with potential negligent care in the provision of maternity and neonatal services.

(4) The Secretary of State must report to Parliament each year on the progress made in delivering the action plan.”

This new clause would require the Secretary of State to produce an action plan in response to the final report and recommendations of the National Maternity and Neonatal Investigation.

New clause 50—Independence of appointments—

“The Secretary of State must make provision to ensure that operational decisions regarding the appointment, suspension or removal of—

(a) chairs and directors of NHS trusts and NHS foundation trusts, and

(b) chief executives of integrated care boards,

are made exclusively by persons employed in the civil service, upon strictly merit-based criteria.”

This new clause would ensure that any decisions over NHS trusts and ICB leadership are made by civil servants, rather than the Secretary of State, to ensure appointments are made on merit.

New clause 51—Accident and Emergency: waiting times”

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision relating to Accident and Emergency Department admission.

(2) Provision under subsection (1) must by regulations amend the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 to place a right in the NHS Constitution for England for every patient to be admitted into an Accident and Emergency Department within 12 hours of approval of their admission being made.

(3) The Secretary of State must establish and implement an Accident and Emergency Scheme (“the Scheme”) to support NHS hospital trusts to achieve the requirement set out in subsection (2).

(4) The Scheme must consider—

(a) creating safety-net social care beds,

(b) increasing step-down care,

(c) publishing a dedicated accident and emergency care workforce plan, and

(d) mandating a qualified clinician is present in every Accident and Emergency waiting room.

(5) The Secretary of State must have due regard to the final report of the Independent Commission on Adult Social Care in establishing the scheme.”

This new clause gives patients a new right in the NHS constitution to be admitted into A&E within 12 hours from decision to admit and requires the Secretary of State to introduce a scheme to achieve this.

New clause 53—Right to a GP appointment—

“(1) The Secretary of State must by regulations, within six months of the passing of this Act, establish a scheme to provide every patient with the right to a GP appointment within seven days of seeking one, or 24 hours if urgent.

(2) The Secretary of State must amend the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 to make the right under subsection (1) a right in the NHS constitution.

(3) The Secretary of State may review the scheme every three years from the day on which this Act is passed and amend it through regulations made by statutory instrument.

(4) A statutory instrument under this section may not be made unless a draft has been laid before and approved by a resolution of each House of Parliament.

(5) For the purposes of this section—

“GP appointment” means an appointment with an appropriate clinician within a GP practice.

“Urgent” means the current definition under GP triaging protocols.”

This new clause requires the Secretary of State to give patients a new right in the NHS constitution to receive a GP appointment within 7 days, or 24 hours if urgent, and establishes a scheme to deliver this.

New clause 54—Duty to identify and record unpaid carers—

“After section 14Z44 of the NHS Act 2006 insert—

“Duty to identify and record unpaid carers

(1) An integrated care board must take reasonable steps to identify persons within its area who are unpaid carers.

(2) An integrated care board must make arrangements to ensure that NHS bodies and providers of NHS services within its area—

(a) maintain appropriate systems for recording whether a person is an unpaid carer,

(b) use consistent coding standards for the recording of unpaid carers in health records,

(c) review and update records relating to unpaid carers at appropriate intervals, and

(d) ensure that the identification and recording of unpaid carers forms part of—

(i) primary care registration processes,

(ii) hospital discharge procedures,

(iii) care planning processes, and

(iv) other relevant patient contact pathways.

(3) For the purposes of this section, "unpaid carer" means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work.””

This new clause would introduce a duty for integrated care boards to identify and record unpaid carers when they come into contact with NHS services.

New clause 55—Duty to promote the health and wellbeing of carers—

“After section 14Z44 of the NHS Act 2006 insert—

“Duty to promote the health and wellbeing of carers

(1) Each integrated care board must exercise its functions with a view to improving and maintaining the physical health, mental health, and wellbeing of carers within its area.

(2) In exercising its duties under this section, an integrated care board must have regard to—

(a) reduction of health inequalities experienced by carers,

(b) prevention of deterioration in carers’ physical and/or mental health,

(c) involvement of carers in decisions relating to the care of persons for whom they provide care, and

(d) the need to ensure carers are able to access appropriate preventative and other health services and support.

(3) An integrated care board must take reasonable steps to ensure that NHS bodies and providers of NHS services within its area—

(a) consider the health and wellbeing needs of carers in care planning and discharge processes,

(b) involve carers appropriately in decisions relating to care and treatment, and

(c) provide carers with information about support available to them for their health and wellbeing.

(4) In preparing a Joint Forward Plan, an integrated care board must include—

(a) an assessment of the health and wellbeing needs of carers within its area,

(b) steps the integrated care board proposes to take to improve outcomes for carers, and

(c) measures for reducing inequalities experienced by carers.

(5) For the purposes of this section, “unpaid carer"” means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work.””

This new clause would introduce a duty for integrated care boards to promote the health and wellbeing of carers.

New clause 56—National Respite Care Scheme—

“(1) Within six months of the passage of this Act, the Secretary of State must establish a National Respite Care Scheme.

(2) The scheme under subsection (1) must make provision for—

(a) where a local authority carries out an assessment of the needs of an unpaid carer, under any enactment for the time being in force in England, it must assess whether the unpaid carer is able to take sufficient breaks from their caring responsibilities,

(b) unpaid carers to receive support to take breaks from their caring responsibilities to—

(i) maintain their physical and mental health and emotional wellbeing,

(ii) participate in work, education, training or recreation, and

(iii) participate in family and community life,

(c) a carer to receive appropriate support if a local authority carrying out an assessment under subsection (2)(a) determines that a carer is unable to take sufficient breaks from caring.

(3) Under subsection (2), “support” may include—

(a) replacement care for the cared-for person;

(b) respite services;

(c) any other steps a local authority considers appropriate as support.

(4) The Secretary of State must provide sufficient support to local authorities to ensure the scheme under subsection (1) is delivered in every local authority.

(5) For the purposes of this section—

“unpaid carer” means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work;

“parent carer” has the same meaning as in section 17ZD of the Children Act 1989;

“young carer” has the same meaning as in section 96 of the Children and Families Act 2014.”

New clause 57—Integrated Care Boards: Scrutiny Committee—

“(1) Each integrated care board must establish a Scrutiny Committee.

(2) Each Committee established under subsection (1) must—

(a) oversee the operation of the integrated care board,

(b) ensure accountability of the integrated care board with regards to—

(i) allocation of resources;

(ii) grievance and complaint management;

(iii) innovation and service redesign in line with Government objectives;

(iv) delivery of services;

(v) integration with social care;

(vi) advancing public health objectives;

(vii) issues relating to workforce or estate; and

(viii) any other issues as designated by the Secretary of State.

(c) have the power to undertake inquiries into innovation on services delivery and outcomes.

(3) The Committee must comprise—

(a) Members of Parliament representing constituencies in the area covered by the integrated care board,

(b) Chairs of local government health and social care committees in the area covered by the integrated care board,

(c) representatives from Healthwatch England or any patient participation network designated by the Secretary of State, and

(d) Representatives from trade unions including—

(i) two representatives from unions involved in negotiations on Agenda for Change, and

(ii) one representative from a trade union representing doctors or dentists.

(4) The Committee must meet six times each year.

(5) The Chair of the Committee must be elected at an annual general meeting of the Committee.

(6) The Committee must report to the Board of the integrated care board.

(7) The Chair and Chief Executive of each integrated care board and leaders of health providers and services must attend a meeting of a Committee when requested to do so.

(8) Each Committee will report to the Secretary of State for Health and Social Care.”

New clause 66—Maternity services: safe staffing levels—

“(1) The Secretary of State must ensure that maternity staffing levels are sufficient to ensure all residents in England can access a staffed maternity unit within 45 minutes of their home.

(2) The Secretary of State must ensure adequate workforce planning, including through delivery of a consultant obstetrician and gynaecologist recruitment and retention plan, to ensure that maternity units are not required to close as a result of staffing issues.

(3) The Secretary of State must lay before Parliament an annual report on the progress made on national maternity staffing levels under this section.”

This new clause would ensure that no maternity units are forced to close as a result of staffing issues and that every person in England has access to a maternity unit within 45 minutes of their home.

New clause 67—Workforce planning and supply—

“(1) After section 1 of the National Health Service Act 2006 insert—

“1ZA Secretary of State’s duty as to workforce planning and supply

(1) The Secretary of State must promote in England a comprehensive system of workforce planning and supply designed to secure that there are sufficient people with the necessary skills and experience to provide services as part of the health service.

(2) In meeting the requirement under subsection (1), the Secretary of State must exercise the functions conferred by this Act so as to secure that the workforce needs of the health service are assessed and met.

(3) The Secretary of State retains ministerial responsibility to Parliament for workforce planning and supply for the health service in England.”

(2) For section 1GA of the National Health Service Act 2006 substitute—

“Workforce strategy

(1) The Secretary of State must prepare and publish a strategy setting out how the Secretary of State proposes to discharge the duty under section 1ZA.

(2) The strategy must include—

(a) an assessment of the current workforce of the health service;

(b) projections of the workforce required to meet the needs of the health service over periods of five, ten and fifteen years beginning with the day on which the strategy is published;

(c) an assessment of the expected supply of people available to meet those requirements;

(d) an assessment of any difference between the projected workforce requirements and expected workforce supply;

(e) the measures that the Secretary of State proposes to take to address any such difference; and

(f) an assessment of the financial and other resources required to implement those measures.

(3) In preparing or revising the strategy, the Secretary of State must consult—

(a) integrated care boards;

(b) NHS trusts and NHS foundation trusts;

(c) persons providing services as part of the health service;

(d) trade unions representing persons employed or otherwise engaged in the provision of those services;

(e) professional bodies and professional regulators;

(f) persons concerned with the provision of education and training for the workforce;

(g) persons representing patients; and

(h) such other persons as the Secretary of State considers appropriate.

(4) The first strategy under this section must be published before the end of the period of 12 months beginning with the day on which this section comes into force.

(5) The Secretary of State must—

(a) review the strategy before the end of the period of five years beginning with the day on which it was last published, and

(b) following each review, publish a revised strategy.

(6) The Secretary of State may revise the strategy before the end of that period if the Secretary of State considers it appropriate to do so.

(7) The Secretary of State must lay before Parliament a copy of each strategy published under this section.

(8) The Secretary of State must have regard to the strategy when exercising functions in relation to the health service.””

This new clause places responsibility for workforce planning and supply for the health service in England on the Secretary of State, including ministerial responsibility to Parliament. It also requires the Secretary of State to publish a strategy setting out projected workforce requirements and supply, and the measures and resources needed to meet those requirements.

New clause 69—Self-care—

“In the National Health Service Act 2006, after section 1C insert—

“1CA Duty as to self-care

In exercising functions in relation to the health service, the Secretary of State must have regard to the importance of—

(a) promoting self-care and improving health literacy as part of the prevention of illness and the improvement of health and wellbeing;

(b) supporting people to manage self-treatable conditions independently where appropriate; and

(c) the role of community pharmacy in supporting self-care and prevention and helping people to access appropriate care.””

This new clause would require the Secretary of State, when exercising functions in relation to the health service, to have regard to the importance of promoting self-care and improving health literacy, supporting people to manage self-treatable conditions, and the role of community pharmacy in supporting self-care and prevention.

New clause 74—Protection of pharmacy staff during provider failure—

“(1) The Secretary of State must establish arrangements to protect the pay and essential employment protections of staff employed by a provider of pharmaceutical services where the provider—

(a) becomes insolvent,

(b) ceases to provide pharmaceutical services,

(c) has its arrangements for providing pharmaceutical services suspended or terminated, or

(d) is otherwise unable to meet its obligations to its employees.

(2) Arrangements under subsection (1) must provide for—

(a) the continuation, so far as reasonably practicable, of payment of wages to affected staff,

(b) the preservation of essential employment protections during the period of emergency intervention,

(c) the maintenance of staffing necessary for the safe provision of pharmaceutical services, and

(d) the transfer, continuation or replacement of employment arrangements where necessary to secure continuity of pharmaceutical services.

(3) The Secretary of State may make payments to, or in respect of, affected staff for the purposes of this section.

(4) The Secretary of State may recover from the failed provider any sums paid under subsection (3).

(5) Arrangements under this section must be capable of operating at the same time as arrangements made under section 133 of the National Health Service Act 2006 to secure alternative provision of pharmaceutical services.

(6) The Secretary of State must publish guidance about the operation of arrangements under this section.”

This new clause would protect pharmacy staff's pay and essential employment rights when a provider fails, while supporting continuity of services.

New clause 75—Integrated primary care teams—

“(1) Each integrated care board must make arrangements to promote the provision of joined-up primary care services across general practice, primary dental services and pharmaceutical services.

(2) Arrangements under subsection (1) must, so far as reasonably practicable, provide for—

(a) general practitioners, dentists, pharmacists and other relevant primary care professionals to work together as part of integrated local primary care teams;

(b) the sharing of relevant patient information between those professionals through secure and interoperable digital systems;

(c) the use of common or interoperable care records, so that relevant clinical information can be accessed by an authorised professional involved in a patient's care;

(d) appropriate mechanisms for referral and communication between general practice, dental practices and community pharmacies;

(e) the reduction of duplication in assessments, prescribing, referrals and administrative processes; and

(f) improved continuity and coordination of care for patients with multiple or ongoing health needs.

(3) In exercising its functions under this section, an integrated care board must have regard to the need to ensure that patients can move between general practice, primary dental services and pharmaceutical services without unnecessary duplication, delay or loss of relevant clinical information.

(4) The Secretary of State may by regulations make provision about—

(a) minimum interoperability standards for systems used by providers of primary medical, dental and pharmaceutical services;

(b) standards for the secure exchange of patient information;

(c) common data standards and clinical terminology;

(d) electronic referrals and communications between providers; and

(e) such other matters as the Secretary of State considers necessary to support integrated primary care.

(5) Regulations under subsection (4) must include appropriate safeguards for patient confidentiality, information governance and the lawful processing of personal data.

(6) In this section—

“primary care team” means a group of health professionals and providers working together to provide or coordinate primary care services;

“primary dental services” has the meaning given by section 98C of the National Health Service Act 2006; and

“pharmaceutical services” includes services provided under Part 7 of that Act.”

This new clause would promote joined-up working between GPs, dentists and pharmacists to improve coordination and continuity of care.

New clause 79—Voluntary sector role in neighbourhood health plans—

“(1) In preparing a neighbourhood health plan, a responsible local authority and integrated care board must take and demonstrate reasonable steps to ensure the plan is co-produced with meaningful involvement by the local voluntary, community and social enterprise sector in that area, including the development, design, implementation, monitoring and evaluation of the plan.

(2) In meeting the requirement under subsection (1) a local authority and integrated care board must in particular have regard to—

(a) organisations representing people with lived experience of health conditions;

(b) organisations working with underserved or marginalised populations; and

(c) the role of voluntary, community and social enterprise organisations in delivering community-based services.

(3) The responsible local authority and integrated care board must demonstrate how they have ensured ongoing and meaningful representation of voluntary, community and social enterprise organisations across the governance, decision-making and commissioning arrangements relating to neighbourhood health plans at all stages of the planning process.”

This new clause would require local authorities and integrated care boards to take and demonstrate reasonable steps to ensure neighbourhood health plans are co-produced with meaningful involvement by the local voluntary, community and social enterprise sector in the local area.

New clause 80—Power to enable reservation and prioritisation of contracts for the voluntary, community and social enterprise sector—

“(1) In exercising their commissioning functions, integrated care boards must take reasonable steps to secure the participation of voluntary, community and social enterprise organisations in the provision of services.

(2) The Secretary of State must through regulations enable integrated care boards to reserve and/or prioritise contracts to be delivered by voluntary, community and social enterprise organisations as part of their commissioning process.

(3) Circumstances in which contracts may be appropriate to be reserved or prioritised under subsection (2) include—

(a) services that are, or could be, community-based;

(b) services that are intended to reach populations that are underserved, marginalised, or experiencing health inequalities; or

(c) where voluntary, community and social enterprise organisations are best placed to deliver person-centred and/or culturally competent care.

(4) In exercising functions under this section, integrated care boards must have regard to—

(a) the need to reduce health inequalities;

(b) the importance of securing equitable access to services across different areas; and

(c) the sustainability of voluntary, community and social enterprise provision.”

This new clause would require integrated care boards to take reasonable steps to secure the participation of voluntary, community and social enterprise organisations in the provision of services through the ICB commissioning process.

New clause 85—Duties on integrated care boards regarding education, health and care plans—

“(1) The Secretary of State must exercise the powers in Part 3 of the Children and Families Act 2014 (children with special education needs) with a view to securing that integrated care boards (“ICBs”) are subject to the same relevant requirements as local authorities in relation to the duty to secure the specified special educational provision for a child or young person in the preparation of education, health and care plans (“EHC plans”) under that Part.

(2) For the purposes of subsection (1), the relevant requirements are—

(a) that the special educational provision set out in section F of an EHC plan meets the needs identified by an EHC needs assessment;

(b) that ICBs can be required to provide such special educational provision;

(c) that ICBs must provide such special educational provision from the date the EHC plan is finalised or issued;

(d) that ICBs are subject to appeals to the First-tier Tribunal in accordance with section 51 of the Children and Families Act 2014; and

(e) that any duty on ICBs to provide such special educational provision does not impact upon an ICB’s duty to arrange health care provision, where this is required by an EHC plan.”

This new clause would require the Secretary of State to make regulations placing a statutory duty on integrated care boards to ensure that where an EHC plan specifies special education provision, they are subject to the same duty as local authorities to ensure that this is arranged for the child or young person.

New clause 90—Duty to reduce health inequalities—

“(1) Section 2B of the National Health Service Act 2006 (functions of local authorities and Secretary of State as to improvement of public health) is amended as follows.

(2) In the heading, after “health” insert “and reduction of health inequalities”.

(3) In subsection (2)—

(a) for “may” substitute “must”; and

(b) after “England” insert “and reducing health inequalities between the people of England”.

(4) In subsection (3), after paragraph (g) insert—

“(h) collaborating with any government department or local authority.”

(5) After subsection (5) insert—

“(6) In this section, “health inequalities between the people of England” means health inequalities between persons, or persons of different descriptions, living in England or in different parts of England.

(7) In this section, “health inequalities” means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.

(8) In subsection (7), “general health determinants” include—

(a) standards of housing, transport services or public safety;

(b) environmental factors, including air quality and access to green space and bodies of water;

(c) employment prospects, earning capacity and any other matters that affect levels of prosperity;

(d) the degree of ease or difficulty with which persons have access to public services;

(e) the use, or level of use, of tobacco, alcohol or other substances, and any other matters of personal behaviour or lifestyle, that are or may be harmful to health; and

(f) any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors.

(9) In subsection (2), the reference to reducing health inequalities includes mitigating any increase in health inequalities which would otherwise be occasioned by the exercise of the Secretary of State’s functions.””

New clause 91—Health improvement and health inequalities strategy—

“(1) The Secretary of State must, within six months beginning on the day on which this Act is passed, publish a health improvement and health inequalities strategy.

(2) In preparing the strategy, the Secretary of State must consult such persons as the Secretary of State considers appropriate.

(3) The strategy must include—

(a) long-term targets relating to health improvement and the reduction of health inequalities in England throughout a person's life;

(b) provision for the establishment of a public authority with functions relating to the additional monitoring of, and reporting on, progress towards the targets included in the strategy in accordance with paragraph (a); and

(c) such other provision as the Secretary of State considers appropriate.

(4) The long-term targets included in the strategy in accordance with subsection (3)(a) must include—

(a) at least one target relating to the improvement of the health of persons under the age of 18 in England; and

(b) at least one target relating to the improvement of the health of persons aged 18 or over in England.

(5) A Minister of the Crown must, in exercising the Minister’s functions, have regard to the strategy.

(6) The Secretary of State must prepare and publish a report on the implementation of the strategy—

(a) within 12 months of the publication of the strategy; and

(b) at intervals of no more than 12 months thereafter.

(7) In this section, “health inequalities” means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.”

New clause 93—State of NHS Dentistry report—

“(1) The Secretary of State must publish and lay before Parliament a report on the state of NHS dentistry in England (“the State of Dentistry Report”) at least once every two years.

(2) The State of Dentistry Report must include an assessment of—

(a) access to NHS dental services and levels of unmet need;

(b) the adequacy, distribution and sustainability of the NHS dental workforce, including general dental services, community dental services, hospital dental services, dental public health consultants and dental academia;

(c) geographical inequalities in access to NHS dental services and oral health outcomes;

(d) inequalities in access to NHS dental services and oral health outcomes between different socioeconomic groups and populations, including but not limited to people living in care homes and people experiencing homelessness;

(e) demand and waiting times for dental treatment in community dental services and secondary care;

(f) the extent to which inadequate access to NHS dental services contributes to avoidable pressure on other parts of the NHS, including primary medical care, urgent and emergency care, hospital services and the prescribing of medicines; and

(g) the measures required to address any deficiencies or inequalities identified under paragraphs (a) to (f).

(3) The report must include such indicators as the Secretary of State considers appropriate for assessing each of the matters set out in subsection (2), and those indicators must, wherever appropriate, be presented in a manner that enables comparisons to be made between different areas and populations and over time, including by reference to population size, full-time equivalent workforce and other relevant measures.

(4) In preparing the report, the Secretary of State must have regard to the need to ensure that NHS dental services are sufficient to meet the current and projected need for dental care in England.

(5) The Secretary of State must, within six months of publishing a State of Dentistry Report, set out the measures the Government intends to take in response to the findings of the report.

(6) The Secretary of State must make arrangements for each State of Dentistry Report, and the Government's response to it, to be debated in each House of Parliament.

(7) The first State of Dentistry Report must be published within 12 months of the passing of this Act.”

This new clause would require the Secretary of State to publish and lay before Parliament a regular report on the state of NHS dentistry in England, assessing access to and unmet need for NHS dental services, workforce capacity and distribution, geographical and wider inequalities, and the pressure that inadequate access to NHS dental services places on other parts of the NHS. It would also require the Government to respond to each report and ensure that both the report and response are debated in Parliament.

New clause 104—NHS-funded In Vitro Fertilisation—

“(1) Within six months of the passage of this Act, the Secretary of State must by regulations make arrangements for the standardised provision of NHS-funded In Vitro Fertilisation (IVF).

(2) Provision under this section must, in accordance with any existing NICE guidelines, set requirements for all integrated care boards in England relating to NHS-funded IVF.

(3) Requirements under subsection (2) include—

(a) standardisation of the minimum number of rounds of IVF available to one individual, and

(b) standardisation of the maximum and minimum age at which an individual can access IVF.”

This new clause would require the Secretary of State to make regulations standardising NHS-funded IVF provision across all integrated care boards in England, in accordance with existing NICE guidelines, including the number of rounds available to an individual and the age limits for access.

New clause 106—Report on the duty to co-operate—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must lay a report before both Houses of Parliament on—

(a) the operation of the duty to co-operate under section 72 of the National Health Service Act 2006 (co-operation between NHS bodies) and section 82 of that Act (co-operation between NHS bodies and local authorities), and

(b) the impact of those duties on the integration of health and social care in England.

(2) The report under subsection (1) must consider co-operation between—

(a) relevant NHS bodies, and

(b) relevant NHS bodies and local authorities,

in the delivery and commissioning of health and social care.

(3) Within six months of the report under subsection (1) being laid, the Secretary of State must—

(a) make provision to update guidance on the duty to co-operate, and

(b) implement actions to strengthen integration in the report which the Secretary of State considers most appropriate.”

This new clause would place a requirement on the Secretary of State to report to Parliament, within six months of the Act passing, on how well NHS bodies and local authorities are working together to integrate health and social care in England. It would also place a requirement on the Secretary of State to update the related guidance and take action to strengthen this cooperation six months later.

New clause 108—NHS ethical and sustainable procurement framework—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must conduct a review of the NHS’s ethical and sustainable procurement framework.

(2) Following the review under subsection (1), the Secretary of State must by regulations ensure that contracting authorities can exclude companies from bidding for a tender on the basis of any proven—

(a) involvement in violations of international law and/or,

(b) breaches of internationally accepted standards of business conduct including—

(i) the UN Guiding Principles and,

(ii) OECD Guidelines for Multinational Enterprises.”

New clause 109—Artificial intelligence governance and auditing—

“(1) Within 12 months beginning on the day on which this Act is passed, the Secretary of State must publish guidance on the—

(a) governance,

(b) monitoring,

(c) assurance, and

(d) audit of artificial intelligence (AI) systems used in health and care settings.

(2) The guidance under subsection (1) must include—

(a) requirements for healthcare organisations to maintain an inventory of AI systems used in clinical and operational processes,

(b) requirements for proportionate monitoring, by the healthcare organisations, of AI systems throughout their operational lifecycle, including safety, performance and effectiveness,

(c) processes for identifying, investigating and responding to material deterioration in AI system performance,

(d) arrangements for documenting accountability and decision-making responsibilities relating to AI deployment and use,

(e) expectations regarding transparency, reporting, and ability to audit AI enabled services.

(3) Each health and care setting required to implement guidance under this section must designate a senior individual who is responsible for—

(a) the monitoring, assurance and audit of AI systems under subsection (1) in their health or care setting;

(b) supporting AI providers and vendors to perform their post market surveillance as required;

(c) addressing the governance of legacy AI systems; and

(d) addressing the governance and impact of decommissioning of AI systems.

(4) The Care Quality Commission must have regard to the guidance published under subsection (1) when exercising its functions.

(5) The Care Quality Commission should assess whether providers have appropriate arrangements in place for the—

(a) governance,

(b) monitoring, and

(c) safe use of artificial intelligence systems, and may require evidence that such arrangements are operating effectively.”

New clause 119—Report into digital health services in rural and coastal areas—

“(1) The Secretary of State must publish a report on the equality of access to and quality of digital health services in rural and coastal areas within 12 months of the passing of this Act.

(2) The report under subsection (1) must include an action plan to ensure rural and coastal practices are able to provide remote consultations and electronic prescription services.”

This new clause would require the Secretary of State to publish a report on equality of access to and quality of digital health services in rural and coastal areas.

New clause 120—Farmer friendly accredited general practice scheme—

“(1) The Secretary of State must create a farmer friendly accredited general practice scheme to recognise and resource GP practices that proactively reach farming communities.

(2) The scheme under subsection (1) should be modelled on Royal College of GPs’ Veteran Friendly Accreditation scheme.

(3) The Secretary of State must instruct the CQC to develop clear guidance for the farmer friendly accredited general practice scheme which supports delivery of care in non-clinical community settings with proportionate hygiene protocols that reflect the setting.”

This new clause places a duty on the Secretary of State to create a farmer friendly accredited general practice scheme.

New clause 121—Continuity of specified national diabetes programmes—

“(1) The Secretary of State must secure that the programmes listed in subsection (2) continue to be provided, to at least the same extent as immediately before the abolition of NHS England.

(2) The programmes referred to in subsection (1) are—

(a) the NHS Diabetes Prevention Programme;

(b) the NHS Type 2 Diabetes Path to Remission Programme;

(c) national provision for continuous glucose monitoring (CGM) for people with diabetes;

(d) the national roll-out of hybrid closed loop (“artificial pancreas”) technology for people with type 1 diabetes;

(e) the National Diabetes Audit programme, including the National Diabetes Footcare Audit and the National Diabetes Inpatient Safety Audit;

(f) any other programme specified for the purposes of this section in regulations made by the Secretary of State.

(3) Before making a scheme under section 2 for the transfer of property, rights or liabilities relating to a programme listed in subsection (2) the Secretary of State must publish a statement explaining how continuity of that programme is to be maintained.

(4) Before the end of the period of 12 months beginning with the day on which this section comes into force, and at least once every subsequent period of 12 months, the Secretary of State must lay before Parliament a report on the provision of the programmes listed in subsection (2), including information on patient access, waiting times and outcomes.

(5) Regulations under subsection (2)(f) are subject to annulment in pursuance of a resolution of either House of Parliament.”

This new clause would require the Secretary of State to maintain existing national diabetes prevention, treatment and audit programmes following the abolition of NHS England, to explain how continuity will be secured before transferring related functions, and to report annually to Parliament on their provision.

New clause 122—Report on effect of abolition of NHS England on diabetes services—

“(1) Before the end of the period of 12 months beginning with the day on which section 1 comes into force, and no less frequently than every 12 months thereafter for the following 3 years, the Secretary of State must publish and lay before Parliament a report assessing the effect of the abolition of NHS England on the planning, funding and delivery of diabetes prevention, treatment and care services in England.

(2) A report under subsection (1) must include an assessment of—

(a) any change in funding allocated to diabetes prevention, treatment and care programmes;

(b) any change to the operation or continuation of national clinical audits relating to diabetes;

(c) the impact on patient access to diabetes technology, including glucose monitoring and insulin delivery systems;

(d) the impact on workforce capacity in specialist diabetes services.”

This new clause would require the Government to monitor and report to Parliament on the impact of NHS England's abolition specifically on diabetes services.

New clause 133—England and Wales cross-border healthcare: statement of values and principles—

“(1) The Secretary of State and each integrated care board must, in exercising functions relating to the provision or commissioning of health services to persons residing in an area of England or Wales close to the border between England and Wales, have regard to the 2018 England / Wales Cross-border Healthcare Services: Statement of Values and Principles.

(2) For the purposes of this section, “the England / Wales Cross-border Healthcare Services: Statement of Values and Principles” means the statement published by NHS England and the Welsh Ministers on 6 November 2018, or a revised statement designated by regulations under subsection (3).

(3) The Secretary of State may by regulations designate a revised version of the Statement for the purposes of this section.

(4) Before making regulations under subsection (3), the Secretary of State must consult—

(a) the Welsh Ministers;

(b) each integrated care board whose area is close to the border between England and Wales;

(c) each Local Health Board whose area is close to the border between England and Wales; and

(d) such organisations representing patients affected by cross-border healthcare arrangements as the Secretary of State considers appropriate.

(5) Regulations under subsection (3) are to be made by statutory instrument.

(6) A statutory instrument containing regulations under subsection (3) may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.”

This new clause would require the Secretary of State and integrated care boards to have regard to the England / Wales Cross-border Healthcare Services: Statement of Values and Principles when exercising relevant functions in areas close to the England-Wales border. It would also enable the Secretary of State to designate a revised version of the Statement, following consultation with the Welsh Ministers, relevant integrated care boards and Local Health Boards, and organisations representing patients affected by cross-border healthcare arrangements.

New clause 134—England and Wales cross-border healthcare arrangements—

“(1) The Secretary of State must, within 18 months of the passing of this Act, seek to agree with the Welsh Ministers a revised England / Wales Cross-border Healthcare Services: Statement of Values and Principles.

(2) In preparing the revised Statement under subsection (1), the Secretary of State must consider—

(a) the effectiveness of existing arrangements for the provision and commissioning of cross-border health care services;

(b) the interests of patients who live in England or Wales and receive, or may receive, health services on the other side of the border;

(c) arrangements for the commissioning and funding of cross-border healthcare services;

(d) arrangements for resolving disputes between relevant bodies in England and Wales; and

(e) the appropriate means of placing the principles governing England and Wales cross-border health care services on a statutory footing.

(3) The Secretary of State must, within two years of the passing of this Act—

(a) publish the revised Statement agreed under subsection (1), or, where no revised Statement has been agreed, publish a report setting out the steps taken to seek such agreement and the reasons why agreement has not been reached;

(b) lay the revised Statement or report before Parliament; and

(c) lay before Parliament proposals for placing the principles governing England and Wales cross-border healthcare services on a statutory footing.”

This new clause would require the Secretary of State to seek agreement with the Welsh Ministers on a revised England / Wales Cross-border Healthcare Services: Statement of Values and Principles within 18 months of the passing of the Act. It would also require the Secretary of State, within two years, to lay the revised Statement, or a report where agreement has not been reached, before Parliament and to bring forward proposals for placing the principles governing England and Wales cross-border healthcare services on a statutory footing.

New clause 135—Reporting on mortality inequalities for autistic people and people with learning disabilities—

“(1) Within 12 months of the passage of this Act, the Secretary of State must prepare and publish a report on the mortality inequalities experienced by autistic people and people with a learning disability.

(2) The report under subsection (1) must specify targets for reducing mortality inequalities between people without a learning disability and autistic people and people with any learning disability.

(3) Within 3 months of the publication of the report under subsection (1) the Secretary of State must make regulations which require ICBs to publish an annual report which includes—

(a) mortality rates for—

(i) autistic people,

(ii) people with any learning disability,

(iii) people without a learning disability.

(b) identification of any areas in which data collection on mortality inequalities experienced by autistic people and people with learning disabilities is inadequate,

(c) a review of the reasons for any inequalities in mortality rates,

(d) a plan for reducing inequalities in mortality rates between people without a learning disability and autistic people and people with any learning disability.

(4) Regulations under subsection (3) must make provision for the annual reports to continue for as long as mortality inequalities between people without a learning disability and autistic people and people with any learning disability exist.

(5) The Secretary of State must publish an annual report summarising the information in the ICB reports under subsection (3), identifying national trends in—

(a) mortality rates,

(b) reasons for inequalities in mortality rates,

(c) potential actions to reduce inequalities in mortality rates.”

This new clause would require the Secretary of State to publish a report on the mortality inequalities experienced by autistic people and people with a learning disability and make provision for ICBs to publish annual reports on such inequalities in their area and proposed actions for remedying such inequalities.

New clause 136—North Cornwall: Dental appointments—

“(1) Within one year beginning on the date on which this Act is passed, the Secretary of State must ensure that there is adequate provision of NHS dentistry in North Cornwall.

(2) Adequate provision under subsection (1) means—

(a) access to urgent dental appointments for any person with an urgent need, and

(b) improved access to routine dental appointments.

(3) The Secretary of State must explain any failure to meet the requirement set out in subsection (1) at a public event in the local area.”

This new clause places a duty on the Secretary of State to ensure there is adequate provision of NHS dental appointments in North Cornwall.

New clause 144—Prioritising British citizens for the UK foundation programme—

“(1) The Medical Training (Prioritisation) Act 2026 is amended as follows.

(2) In section 4, after subsection (4) insert—

“(4A) A person is within this subsection if they—

(a) are a British citizen, and

(b) hold a primary medical qualification from an international branch campus of a higher education institution in the United Kingdom.””

This new clause amends the Medical Training (Prioritisation) Act 2026 so that British citizens who have studied at international branch campuses of UK higher education institutions can be prioritised for foundation programme training places.

New clause 145—Response to the Hughes Report: options for redress for those harmed by valproate and pelvic mesh—

“The Secretary of State must, within 30 days of the day on which this Act is passed, publish the Government’s response to the Hughes Report.”

This new clause would require the Secretary of State to publish the Government’s response to the Hughes Report within 30 days of this Act being passed.

New clause 152—Requirement for merit-based job allocations for doctors—

“(1) The Medical Training (Prioritisation) Act 2026 is amended as follows.

(2) In section 1, at end insert—

“(2) Applicants eligible under this section shall be prioritised based on merit, determined by reference to the applicant’s—

(a) qualifications,

(b) professional competence,

(c) clinical experience,

(d) skills, and

(e) ability to perform the duties of the post.”

(3) In section 2, after subsection (1) insert—

“(1A) Applicants eligible under subsection (1) shall be prioritised based on merit, determined by reference to the applicant’s—

(a) qualifications,

(b) professional competence,

(c) clinical experience,

(d) skills, and

(e) ability to perform the duties of the post.”

(4) In section 3, after subsection (1) insert—

“(1A) Applicants eligible under subsection (1) shall be prioritised based on merit, determined by reference to the applicant’s—

(a) qualifications,

(b) professional competence,

(c) clinical experience,

(d) skills, and

(e) ability to perform the duties of the post.””

New clause 153—Redundancies—

“The Secretary of State must publish, within 12, 24, and 48 months of the passage of this Act, the number of persons—

(a) employed by the Department for Health and Social Care, and

(b) made redundant following the abolishment of NHS England under subsection (1) of this Act.”

This new clause would require the Secretary of State to publish the number of staff in the Department for Health and Social Care and the number of people made redundant following the abolishment of NHS England.

New clause 154—Medical training places—

“The Secretary of State must increase the number of medical school training places to 15,000 by the year 2031-32.”

This new clause would put a duty on the Secretary of State to double the number of medical school training places.

New clause 155—Self-care and health literacy in neighbourhood health plans—

“(1) Guidance issued by the Secretary of State under section 14Z58 of the National Health Service Act 2006 as amended by section 24(4) of this Act (neighbourhood health plan) must require that every neighbourhood health plan includes arrangements for—

(a) supporting self-care and self-management, including by enabling people to manage minor and long-term conditions, and conditions that are self-limiting, themselves where it is safe and appropriate to do so;

(b) improving health literacy and ensuring that people living or working in the area have access to trusted, quality-assured information, advice and digital tools to support them in managing their own health and wellbeing;

(c) facilitating access to community pharmacy services, including pharmacy services that support self-care, the management of minor ailments and medicines optimisation;

(d) supporting patients to access the most appropriate level of care for their needs, including through patient-facing digital services connected to any system established under section 250E of the National Health Service Act 2006 (single patient record); and

(e) reducing avoidable demand on NHS services through the promotion of self-care and prevention.

(2) In preparing guidance under section 14Z58 of the National Health Service Act 2006 as amended by section 24(4) of this Act, the Secretary of State must have regard to—

(a) improving health literacy,

(b) the role of community pharmacy as an accessible point of contact for self-care support and health advice, and

(c) the contribution of digital tools and patient-facing services to enabling self-care, self-management and appropriate care navigation.

(3) The Secretary of State must, within 12 months of the date on which this Act is passed, publish a self-care strategy for England (the "self-care strategy") which must set out—

(a) the national framework within which neighbourhood health plans will be required to embed self-care and self-management, including the management of self-limiting conditions, as a core component of local health and care services;

(b) the steps the Secretary of State will take to promote self-care and health literacy as part of the prevention and early intervention agenda across the NHS;

(c) the role of community pharmacy in delivering the self-care strategy, including the services and information that community pharmacy is expected to provide in support of self-care;

(d) the role of patient-facing digital services, including any system established under section 250E of the National Health Service Act 2006, in supporting self-care, self-management and navigation to appropriate care;

(e) the steps the Secretary of State will take to reduce avoidable demand on NHS services through the promotion of self-care; and

(f) the measurable outcomes against which progress in implementing the self-care strategy will be assessed, and the arrangements for reporting on progress.

(4) The Secretary of State must lay the self-care strategy before Parliament on the day on which it is published and must review and update it at least every three years.

(5) In this section—

“neighbourhood health plan” has the same meaning as in section 24 of this Act;

“self-care” means the actions taken by individuals to maintain their own health, manage minor or long-term conditions, including conditions that are self-limiting, and prevent ill health, including through the use of over-the-counter medicines, health information and digital tools.”

This new clause would require neighbourhood health plans to include arrangements for supporting self-care and self-management. It would require guidance to the responsible local authority and integrated care boards to reflect the guidance and require the Secretary of State to publish a national self-care strategy.

New clause 157—Report on delivery of transformative technology commitments—

“(1) The Secretary of State must, within 12 months of the day on which this Act is passed, publish and lay before Parliament a report setting out the Government’s approach to delivering the transformative technology commitments in the document entitled “Fit for the Future: the 10 Year Health Plan for England” published in July 2025.

(2) The report under subsection (1) must cover the following areas—

(a) data quality, interoperability and the use of NHS data for research and innovation,

(b) artificial intelligence,

(c) genomics and predictive analytics,

(d) wearables and real-time monitoring, and

(e) robotics and precision technologies.

(3) The report must include—

(a) the principal milestones and intended outcomes for patients and the health service in each of the areas listed in subsection (2),

(b) the main risks to delivery and the steps being taken to mitigate them, and

(c) how progress will be measured.”

New clause 158—Progress reports on the women’s health strategy—

“(1) The Secretary of State must, within 12 months of the day on which this Act is passed and at least once every two years thereafter, publish and lay before Parliament a report on progress in delivering the renewed Women’s Health Strategy for England (published April 2026) or any successor strategy.

(2) A report under this section must include—

(a) a summary of delivery against the actions listed in the strategy’s action summary tables, including which actions are on track, delayed or revised and the reasons why that is the case;

(b) data from the women’s health data dashboard (or any successor data publication) on performance, access, outcomes and experience at national and neighbourhood level; and

(c) a summary of ongoing engagement with women, including through the women’s voices partnership and patient-reported experience and outcome measures, and how that engagement has informed delivery.

(3) The report may incorporate or cross-refer to existing published material (including the action summary tables and the women’s health data dashboard) where this meets the requirements of subsection (2).”

New clause 160—Annual report on specialised services—

“(1) Within 12 months of the passage of this Act, and every 12 months thereafter, the Secretary of State must publish a report on the commissioning and performance of specialised services commissioned by integrated care boards.

(2) A report under subsection (1) must include information relating to—

(a) patient outcomes;

(b) access to services;

(c) waiting times;

(d) workforce capacity;

(e) service sustainability;

(f) geographical variation in services;

(g) compliance with national service specifications; and

(h) arrangements for the coordination of specialist, community and neighbourhood care.

(3) A report under subsection (1) must be laid before both Houses of Parliament.”

This new clause would require the Secretary of State to publish an annual report on specialised services commissioned by integrated care boards.

New clause 162—Specialised services: annual report and published data—

“(1) The Secretary of State must, prepare a report on the performance of specialised services in England, measured against the relevant national standards for those services.

(2) The Secretary of State must lay a report under subsection (1) before each House of Parliament as soon as reasonably practicable after the end of the financial year to which it relates.

(3) The Secretary of State must make arrangements for the regular publication of data on the quality and outcomes of specialised services, including, but not limited to, data of the kind currently published as Specialised Services Quality Dashboards.

(4) In this section, "specialised services" has the same meaning as in section 3B of the National Health Service Act 2006 (as amended by this Act).”

This new clause would place a duty on the Secretary of State to report annually to Parliament on the performance of specialised services against national standards, and to maintain regular publication of data on their quality and outcomes, equivalent to the Specialised Services Quality Dashboards currently produced by NHS England.

Amendment 102, in clause 1, page 1, line 2, at end insert—

“(2) Before NHS England is abolished, the Secretary of State must publish a document setting out the operating model for the exercise of functions by the Department of Health and Social Care following the abolition of NHS England (the "operating model document").

(3) The Secretary of State must publish a plan for the management of personnel affected by the abolition of NHS England and the transfer of its functions to the Department of Health and Social Care (the "workforce transition plan").

(4) The operating model document must include—

(a) a description of how each of the functions exercised by NHS England is to be exercised following its abolition;

(b) the governance and accountability arrangements for the exercise of those functions;

(c) the organisational structure of the Department of Health and Social Care as it will operate following the abolition; and

(d) the proposed timetable for the transition.

(5) The workforce transition plan must include—

(a) an assessment of the number of personnel whose employment is affected by the abolition of NHS England;

(b) the arrangements for the transfer, redeployment or redundancy of affected personnel; and

(c) proposals for consultation with recognised trade unions and staff representative bodies in connection with the abolition.”

This amendment would require the Secretary of State to publish an operating model for the merged DHSC/NHSE and associated plan to manage personnel before NHS England is abolished.

Amendment 19, in clause 4, page 3, line 29, at end insert—

“(c) reduce inequalities between the people of England with respect to the access to health services and outcomes achieved for them between coastal and inland areas, and

(d) reduce inequalities between the people of England with respect to the access to health services and outcomes achieved for them between rural and urban areas.”

This amendment would create a duty for the Secretary of State to reduce inequalities between coastal and inland areas and rural and urban areas.

Amendment 80, page 3, line 29, at end insert—

“(c) reduce inequalities in the prevention, diagnosis and treatment of diabetes, including variation in access to structured education, glucose monitoring technology and insulin pump therapy.”

This amendment would make diabetes-related health inequalities an explicit, named consideration within the Secretary of State's general duty to reduce inequalities, rather than leaving diabetes provision to be addressed only implicitly.

Amendment 95, in clause 5, page 4, leave out lines 2 to 4 and insert—

“(1) In exercising functions in relation to the health service, the Secretary of State must act with a view to enabling patients to make choices with respect to aspects of health services provided to them, including to make choices as to the provider of those services.

(2) For the purposes of subsection (1), the Secretary of State must ensure that patients referred for a service to be provided outside a hospital setting (“out-of-hospital services”) are offered a choice of provider of that service from among the providers available in their integrated care board area and, where relevant, in neighbouring areas, in accordance with regulations made under section 14Z45B.

(3) Regulations under section 14Z45B must provide that, where an out-of-hospital service is to be provided to a patient, the integrated care board must—

(a) offer the patient a choice of at least two providers capable of providing the service, which may include NHS bodies and independent sector providers approved to provide that service under arrangements with the integrated care board;

(b) provide the patient with information about each available provider to support an informed choice, including—

(i) indicative waiting times,

(ii) the location at which the service would be provided,

(iii) the quality ratings or outcomes data applicable to that provider for that service where such data is available, and

(iv) whether any costs may be incurred by the patient in travelling to or receiving the service with each provider;

(c) not exclude from the list of available providers any provider approved solely on grounds of commercial interest or organisational type; and

(d) take all reasonable steps to give effect to the patient's choice within a clinically appropriate timeframe.

(4) For the purposes of this section, “out-of-hospital services” means services—

(a) provided in community, primary care or ambulatory settings rather than in a hospital inpatient or outpatient department, and

(b) which the Secretary of State specifies by regulations as being within the scope of the choice obligation under subsection (2).

(5) For the purposes of this subsection (4)(b), out of hospital services which the Secretary of State may specify by regulations may include—

(a) diagnostic services,

(b) audiology and hearing aid care,

(c) podiatry,

(d) dietetics and nutrition,

(e) physiotherapy,

(f) ambulatory cardiac monitoring, and

(g) such other services as the Secretary of State considers appropriate.

(6) In specifying services under subsection (4)(b), the Secretary of State must have regard to—

(a) the potential for the expansion of choice to reduce waiting times for the relevant service,

(b) the availability of sufficient independent and NHS providers to make genuine choice meaningful, and

(c) the desirability of ensuring access to choice for patients in all parts of England, including in rural and deprived areas.

(7) The Secretary of State must publish, and lay before Parliament, within 12 months of the date on which this Act is passed, a statement setting out—

(a) the out-of-hospital services for which choice obligations under subsection (2) will initially apply,

(b) the timetable for extending the choice obligation to further services, and

(c) the support that will be made available to patients, in particular those with limited digital access or literacy, to exercise the choices to which they are entitled under this section.

(8) The Secretary of State must review and update the statement required by subsection (6) at intervals of not more than two years.”

This amendment strengthens the new patient choice duty inserted by Clause 5 from a general aspiration into a specific, enforceable right to choose between providers for out-of-hospital services.

Amendment 37, in clause 6, page 4, line 11, at end insert—

“(1A) For the purposes of subsection (1) the Secretary of State must ensure that innovation in the provision of health services is supported and developed equitably across all regions of England, including by reducing inequalities in clinical research funding and clinical research capacity between different regions of England.”

This amendment would ensure that in exercising their duty to promote innovation in the provision of health services, the Secretary of State must ensure that innovation in the provision of health services is supported and developed equitably across all regions of England.

Amendment 81, page 4, line 11, at end insert—

“(1A) The duty in subsection (1) includes, in particular, promoting innovation in the prevention, diagnosis and treatment of diabetes, including through the adoption of glucose monitoring and automated insulin delivery technologies.”

This amendment would ensure that the existing duty to promote innovation is understood to cover the specific diabetes technologies (flash/CGM and hybrid closed loop systems) currently being rolled out by NHS England ,so that momentum on adoption is not lost through the transfer of functions.

Amendment 97, page 6, line 12, leave out clause 10.

Amendment 38, in clause 11, page 6, line 28, leave out lines 28 and 29 and insert—

“(1) Where the geographic area covered by an integrated care board sits within a Mayoral Combined Authority, the relevant Mayor may give integrated care boards directions as to the exercise of their functions.

(1A) Where the geographic area covered by an integrated care board does not sit within a Mayoral Combined Authority, the Secretary of State may give integrated care boards directions as to the exercise of their functions.”

This amendment would give direction-making powers over integrated care boards to Combined Authority Mayors where boards sit within their authority. The Secretary of State would retain direction-making power where there is no relevant Combined Authority Mayor.

Amendment 39, page 7, line 4, after “Secretary of State” insert “or relevant Combined Authority Mayor”.

This amendment is consequential on Amendment 38.

Amendment 40, page 7, line 11, after “Secretary of State” insert “or relevant Combined Authority Mayor”.

This amendment is consequential on Amendment 38.

Amendment 103, in clause 12, page 9, leave out lines 33 to 39 and insert—

“(2) Before prescribing a service or facility under subsection (1)(b), the Secretary of State must publish an assessment of the likely impact of such a prescription on—

(a) patient safety;

(b) clinical outcomes;

(c) equality of access to services;

(d) workforce capacity and specialist expertise;

(e) service sustainability; and

(f) geographical variation in access to, and outcomes from, services.

(2A) The Secretary of State must lay the assessment under subsection (2) before both Houses of Parliament.

(2B) In deciding whether it would be appropriate to prescribe a service or facility under subsection (1)(b), the Secretary of State must have regard to the assessment published under subsection (2).

(2C) Where regulations made under subsection (1)(b) prescribe a service or facility for commissioning other than by the Secretary of State, the Secretary of State must publish and maintain a national service framework for that service or facility.

(2D) A framework under subsection (2C) must include provision relating to—

(a) service standards;

(b) care pathways;

(c) workforce requirements;

(d) rehabilitation and long-term follow-up;

(e) collection and publication of outcome data;

(f) coordination between specialist, community and neighbourhood services; and

(g) coordination of care for persons receiving treatment through multiple clinical pathways.”.

This amendment would require the Secretary of State to publish an impact assessment before they make a decision to prescribe a service or facility under subsection (1)(b) of section 3B of the National Health Service Act 2006 and maintain a national service framework for any specialised service no longer commissioned directly by the Secretary of State.

Amendment 101, page 10, line 10, at end insert—

“(5) The Secretary of State must, within six months of this section coming into force, publish a specialised commissioning plan setting out—

(a) which services or facilities the Secretary of State intends to commission nationally under section 3B(1)(b), and

(b) the principles and criteria that will be used to decide whether a service or facility should be commissioned nationally or by integrated care boards.

(6) Before making regulations under section 3B(1)(b) that would make a significant change to the range of services or facilities commissioned nationally, the

Secretary of State must—

(a) publish a transition plan explaining the reasons for the change, the impact on patients, and the arrangements for continuity of care and clinical standards,

(b) consult such persons as the Secretary of State considers appropriate (including patients who use the affected services or their representatives, clinicians, and the bodies that would gain or lose commissioning responsibility), and

(c) publish a summary of the consultation responses and the Secretary of State’s response to them.

(7) The specialised commissioning plan under subsection (5) must be kept under review and revised as appropriate, and any revised plan must be published.”

Amendment 53, Clause 14, page 10, leave out lines 40 to 44 and insert—

“(a) confers functions on integrated care boards in relation to commissioning primary care services, including the provision of alternative general medical services for patients who—

(i) are unable to obtain appropriate care from the general practice responsible for their usual catchment area, or

(ii) no longer reasonably feel able or comfortable to receive care from that general practice,

(b) requires integrated care boards to make arrangements to support access to such alternative provision where it is necessary to meet the reasonable requirements of those patients,

(c) transfers related functions from NHS England to the Secretary of State, and

(d) contains other amendments relating to primary care services.”

This amendment would require integrated care boards to support and arrange alternative general practice provision for patients who cannot access appropriate care from their usual catchment GP practice, or who reasonably no longer feel able or comfortable receiving care from that practice.

Amendment 76, in clause 15, page 11, line 33, at end insert—

“(4A) The Secretary of State must take reasonable steps to ensure that arrangements under subsection (2) are accessible and inclusive, having particular regard to the needs of persons with disabilities and persons with long-term, complex or fluctuating health conditions.”

This amendment would require the Secretary of State to take reasonable steps to ensure that arrangements for public involvement in commissioning are accessible and inclusive, with particular regard to the needs of persons with disabilities and persons with long-term, complex or fluctuating health conditions.

Amendment 79, in clause 16, page 11, line 10, at end insert—

“(3) Regulations under this section must, in relation to children and young people referred to child and adolescent mental health services, require integrated care boards to make arrangements for appropriate interim support during any period between referral and the commencement of substantive treatment or assessment.

(4) The arrangements under subsection (3) may include—

(a) regular appointments or check-ups with a GP or other primary care professional;

(b) support from a family support worker;

(c) regular wellbeing checks or support provided through a school, including by a school nurse or other appropriate professional; and

(d) access to appropriate peer support, youth clubs or other community-based support.

(5) The purpose of arrangements under subsection (3) is to ensure that a child or young person does not remain without appropriate support solely because they are awaiting the commencement of substantive assessment or treatment.”

This amendment would require interim support for children and young people referred to CAMHS while they are waiting for substantive assessment or treatment.

Amendment 32, page 12, line 10, at end insert—

“(3) Regulations under this section must make provision requiring integrated care boards to make arrangements which ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services.

(4) For the purposes of subsection (3)—

“community equipment and wheelchair services” means equipment, aids, home adaptations or appliances provided to support a person’s independence, safety, care or daily living at home or in the community, including hoists, hospital beds, pressure-relieving mattresses, commodes, shower chairs, walking frames, grab rails, ramps, specialist seating, postural support equipment, associated mobility equipment, and wheelchairs.”

This amendment would require the Secretary of State to make regulations which would require integrated care boards to ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services.

Amendment 98, page 12, line 10, at end insert—

“(3) Regulations under subsection (1) must require the publication, at least monthly, of statistics on consultant-led referral-to-treatment pathways that include a breakdown of unreported removals, and the reasons for those removals, including distinguishing between—

(a) removals attributable to validation exercises (including administrative, technical or clinical validation), and

(b) other unreported removals.

(4) The statistics required by subsection (3) must be published—

(a) at national level,

(b) by integrated care board area, and

(c) by NHS trust and NHS foundation trust.

(5) In this section—

“unreported removals” means the residual figure calculated as the waiting list at the start of the period plus new RTT periods minus completed pathways minus waiting list at the end of the period;

“validation exercises” includes any systematic review of pathways for the purpose of removing those that should not remain on the waiting list.””

Amendment 99, page 12, line 10, at end insert—

“14Z45AA Prohibition on administrative minimum waiting times

An integrated care board must not adopt or apply any policy, contract term, activity planning assumption or other arrangement that has the effect of requiring or incentivising a minimum period of waiting before a patient may receive treatment, assessment, or a diagnostic test, where that minimum period is imposed for administrative, financial or capacity management reasons rather than clinical reasons.”

Amendment 34, page 12, line 16, at end insert—

“(1A) The regulations must impose a duty on integrated care boards to make provision for any person with a terminal illness diagnosis to be offered a conversation with a relevant healthcare professional about their needs for end-of-life care, including their—

(a) mental and physical health support needs, and

(b) financial support needs.

(1B) For the purposes of subsection (1A), if a person with a terminal illness diagnosis is unable to have the conversation, an integrated care board must ensure that the person’s next-of-kin are offered a conversation.

(1C) The regulations must make provision for any relevant authorities to have regard to the needs identified in a conversation under subsection (1A).”

This amendment would require the Secretary of State to make regulations which make provision for the any person with a terminal illness diagnosis to be offered a conversation with a relevant authority about their needs for end-of-life care.

Amendment 28, page 12, line 22, at end insert—

“14Z45BA Patient choice: community services substituting for consultant-led elective care

(1) The Secretary of State must by regulations make provision to enable patients to make choices in respect of non-consultant-led community services where those services are commissioned as a direct substitute for, or to prevent a referral to, consultant-led elective services.

(2) For the purposes of subsection (1), a service is to be regarded as a direct substitute for, or intended to prevent a referral to, consultant-led elective services if it—

(a) provides assessment, treatment or management for a condition that would otherwise be referred to a secondary care specialist; or

(b) is commissioned by an integrated care board for the purpose of reducing or managing demand on secondary or elective care.

(3) Services to which this section applies include, but are not limited to—

(a) community audiology services;

(b) community glaucoma management and monitoring services; and

(c) minor eye conditions services.

(4) Regulations made by virtue of this section must ensure that—

(a) patients are offered a choice of any clinically appropriate provider commissioned under a qualifying NHS contract for the relevant service;

(b) no limitation on the number of providers from which a patient may choose is imposed solely on grounds of cost or demand management; and

(c) patients are provided with information enabling them to make an informed choice, including information about waiting times and quality.

(5) An integrated care board must not commission a community service of a kind falling within subsection (2) in a manner which has the effect of restricting patient choice below the standard that would apply to an equivalent consultant-led elective service.”

Amendment 36, in clause 20, page 15, line 25, at end insert—

“(2A) Performance assessments must include details of how each integrated care board is meeting its duty to provide palliative care services or facilities to meet the reasonable requirements of the people for whom it has responsibility.

(2B) For the purposes of subsection (2A) the following guidance are considered reasonable requirements—

(a) NICE guideline [NG31] “Care of dying adults in the last days of life 2015”,

(b) NICE guideline [NG142] “End of life care for adults: service delivery 2019”,

(c) NICE quality standard [QS13] “End of life care for adults 2021”,

(d) NHS England “Palliative and End of Life Care” Statutory Guidance for Integrated Care Boards (September 2022).”

This amendment would require annual performance assessments to incorporate an assessment of whether each integrated care board is providing a reasonable standard of palliative and end of life care.

Amendment 104, in clause 20, page 15, line 28, at end insert—

“(4) In conducting a performance assessment under this section, the Secretary of State must assess the discharge by an integrated care board of any functions relating to specialised services.

(5) An assessment under subsection (4) must consider—

(a) patient outcomes;

(b) access to services;

(c) compliance with national service specifications;

(d) workforce capacity;

(e) service sustainability; and

(f) geographical variation in access to, and outcomes from, services.

(6) The report published under subsection (3) must include a summary of the assessments undertaken under subsections (4) and (5).”

This amendment would require the Secretary of State to undertake and publish a national assessment of the performance of integrated care boards in relation to specialised services.

Amendment 45, page 15, line 29, leave out clause 21.

Amendment 91, in clause 21, page 15, leave out line 32 and insert—

“(a) for sub-paragraph (4), substitute—”

Government amendment 60.

Amendment 29, page 15, line 38, at end insert—

“(2A) The constitution must provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include at least one member nominated jointly by the local authorities whose areas coincide with, or include the whole or any part of, the integrated care board's area.”

This amendment would require integrated care boards to have a member jointly nominated by local authorities from within the board's area.

Government amendment 61.

Amendment 30, page 16, line 3, leave out from “mayor” to “must” and insert

“or local authority nominating an ordinary member as mentioned in sub-paragraphs (2) and (2A)”

This amendment is consequential on Amendment 29 and would require a local authority involved in nominating a member of an integrated care board to have regard to guidance published by the Secretary of State.

Amendment 83, page 16, line 6, at end insert—

“(5) The constitution of an integrated care board must provide for the appointment of one or more members of the board with explicit responsibility for—

(a) people with learning disabilities;

(b) autistic people;

(c) people with Down syndrome; and

(d) children and young people with special educational needs and disabilities.

(6) The integrated care board must publish details of the member or members appointed under sub-paragraph (5).”

This amendment would require each Integrated Care Board to appoint one or more board members with responsibility for people with learning disabilities, autistic people, people with Down syndrome, and children and young people with special educational needs and disabilities (SEND), placing existing NHS England board-level leadership guidance on a statutory footing following the abolition of NHS England.

Amendment 92, page 16, line 6, omit subsection (b).

Amendment 96, page 16, line 7, leave out subsection (b) and insert—

“(b) for sub-paragraph (5) substitute—

“(5) The constitution must provide for the ordinary members of the integrated care board to include—

(a) at least one qualified, professionally registered, consultant in public health who provides wholly independent, transparent, leadership and advice to the board on preventing and reducing disease and improving the health of the population it serves,

(b) at least two clinicians with current experience of providing primary care services, at least one of whom is a general practitioner, and

(c) at least one medical practitioner with current experience of providing secondary care services.

(5A) A person appointed under sub-paragraph (5) must not be appointed to represent the interests of a provider organisation whose services are commissioned by the integrated care board.””

This amendment would require every Integrated Care Board to include an independent qualified and registered consultant in public health, at least two clinicians from primary care, and a clinical representative from secondary care.

Amendment 93, page 16, leave out line 8 and insert—

“after sub-paragraph (7) insert—”

Government amendment 62.

Amendment 31, page 16, line 9, at end insert—

““local authority” has the meaning given by section 2B;”

This amendment is consequential on Amendments 29 and 30 and defines the term “local authority”.

Amendment 94, page 17, line 12, leave out clause 23.

Amendment 77, in clause 24, page 17, line 35, at end insert.

“A neighbourhood health plan must include consideration of how health services will meet the needs of persons with long-term, complex or fluctuating health conditions”

This amendment would require neighbourhood health plans to include consideration of how health services will meet the needs of persons with long-term, complex or fluctuating health conditions.

Government amendment 63.

Amendment 84, in clause 29, page 21, leave out line 7.

This amendment would retain the requirement for NHS Foundation Trusts to have a Council of Governors.

Government amendment 64.

Amendment 55, in clause 42, page 30, line 29, at end insert—

“(5) After subsection (6) insert—

“(7) Where the Secretary of State is satisfied that a pharmacy provider has materially failed to comply with contractual, patient-safety or workforce obligations, the Secretary of State may by direction require the relevant integrated care board—

(a) to suspend or terminate arrangements with that provider, where appropriate,

(b) to make arrangements with another provider for the provision of pharmaceutical services,

(c) to secure continuity of the supply of medicines and other pharmaceutical services, and

(d) to take such other emergency measures as may be specified in the direction.

(8) A direction under subsection (7) may be given where the Secretary of State considers that there is a significant risk to patient safety, continuity of medicines supply or the provision of pharmaceutical services.

(9) The Secretary of State must ensure that arrangements made under subsection (7) are implemented as soon as reasonably practicable.

(10) A direction under subsection (7) must specify the period for which it has effect and must be published.””

This amendment would enable intervention where a pharmacy provider seriously fails to meet contractual, safety or workforce obligations, ensuring continuity of services and medicines supply.

Amendment 58, page 30, line 29, at end insert—

“(7) Where a situation or event has resulted, or is likely to result, in the closure, failure or disruption of a provider of pharmaceutical services, the Secretary of State and the relevant integrated care board must provide such assistance and support as is necessary to enable a new provider to establish or continue the provision of pharmaceutical services.

(8) Assistance or support under subsection (7) may include facilitating and establishing a relationship between a new provider and the manufacturers or suppliers of medicines and other pharmaceutical products.

(9) The assistance and support under subsection (7) must be available, in particular, where a new provider is—

(a) taking over premises previously operated by a provider of pharmaceutical services that has failed or closed,

(b) taking over premises where there has been evidence of serious misconduct, including malpractice or failure to pay staff, or

(c) an independent provider or a provider which is not part of a large company operating multiple pharmacy premises.

(10) The purpose of assistance and support under this section is to enable the new provider to secure supplies of medicines and other pharmaceutical products as quickly as reasonably practicable and to minimise any interruption in the provision of pharmaceutical services.”

This amendment would require the Government and integrated care boards to support new and independent pharmacy owners taking over failing, closed or disrupted pharmacies, including by helping them establish relationships with pharmaceutical manufacturers and suppliers so that they can secure medicines and other supplies quickly and maintain continuity of service.

Amendment 59, in clause 47, page 32, line 15, after subsection (4) insert—

“(4A) In determining the amount to be allotted to an integrated care board under subsection (1), the Secretary of State must have regard to the additional costs of providing health services in rural and coastal communities.

(4B) The matters to which the Secretary of State must have regard under subsection (4A) include—

(a) rurality,

(b) population age,

(c) transport and travel costs,

(d) seasonal changes in demand,

(e) recruitment and retention difficulties,

(f) the loss of economies of scale arising from sparsely populated communities, and

(g) unmet need for primary medical, dental and pharmaceutical services.

(4C) The Secretary of State must ensure that the methodology used in determining allotments does not rely predominantly on measures of deprivation where those measures fail adequately to reflect the costs or unmet need as set out in subsection (4B).

(4D) The Secretary of State must publish the methodology used in determining allotments under this section and must review that methodology at intervals of not more than five years.”

This amendment would require ICB funding allocations to reflect the additional costs and unmet health needs of rural and coastal communities.

Amendment 10, page 32, line 30, at end insert—

“(2A) The Secretary of State must give integrated care boards directions to increase spending on mental health services at least in line with the change in level of their total programme funding.”

This amendment would place the original mental health investment standard on a statutory footing, requiring integrated care boards to increase spending on mental health services at least in line with the growth in their total programme (healthcare) funding.

Amendment 17, page 32, line 30, at end insert—

“(2A) The Secretary of State must give integrated care boards directions to increase spending on Primary Care services.

(2B) The increase in spending set out in subsection (2B) must be in line with the change in level of their total programme funding.”

This amendment would introduce the primary care Investment standard, requiring integrated care boards to increase spending on primary care services at least in line with the growth in their total programme (healthcare) funding.

Amendment 11, page 32, line 34, after “subsection (1)” insert “and (2A)”.

This amendment is consequential on Amendment 10 and would enable the Secretary of State to implement financial penalties if an integrated care board fails to comply with a direction to increase spending on mental health services in line with the growth in their total programme (healthcare) funding.

Amendment 18, in clause 47, page 32, line 34, after “subsection (1)” insert “and (2A) and (2B)”.

This amendment is consequential on Amendment 17 and would enable the Secretary of State to implement financial penalties if an integrated care board fails to comply with a direction to increase spending on primary care services in line with the growth in their total programme (healthcare) funding.

Amendment 26, in clause 51, page 35, line 38, after “available” insert

“for the purpose of delivering or improving patient health or social care”.

Amendment 42, page 36, line 1, leave out “health” and insert “direct patient”.

This amendment clarifies that the Secretary of State’s regulation-making powers in respect of the single patient record are limited to the provision of direct patient care and social care.

Amendment 105, page 36, line 8, at end insert—

“(ba) enabling a patient, following diagnosis of a health condition, to consent to the sharing of such information as is necessary for the purpose of enabling the organisation to offer or provide condition-specific support to the patient with an approved voluntary, community or charitable organisation providing condition-specific support services;

(bb) facilitating referral, where consent has been provided, to such an organisation under subsection (ba);”

This amendment would ensure that regulations establishing the Single Patient Record may include provision enabling patients, following diagnosis, to consent to referral and information sharing with approved voluntary, community and charitable organisations providing condition-specific support services.

Amendment 43, page 36, line 11, leave out “including” and insert “solely for the purposes of”

This amendment would ensure that regulations requiring or authorising the making available of patient information through the single patient record system can only make provision in respect of the circumstances set out in the Bill.

Amendment 15, page 36, line 13, after “behalf” insert “, including nominated carers”

This amendment makes it explicit that nominated carers can access the single patient record on behalf of those they care for.

Amendment 27, page 36, line 21, leave out lines 21 to 23.

Amendment 35, page 36, line 21, at end insert—

“The regulations must make provision for patient information to be readily available to providers of palliative and end-of-life care including voluntary sector providers.”

This amendment would ensure the single patient record is available to all palliative and end of life care providers.

Amendment 23, page 36, line 23, at end insert—

“(3A) The regulations must make provision for medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record.

(3B) The regulations must include a requirement for the Secretary of State to prepare and publish a report on the potential merits of introducing a statutory requirement for mandatory medical markers for firearms licence holders to be used by those relevant in providing patient care.”

This amendment would require medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record.

Amendment 24, page 36, line 23, at end insert—

“(3A) The regulations must make provision for prior membership in the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record.

(3B) The regulations must include a requirement for the Secretary of State to prepare and publish a report on the potential merits of making prior membership in the armed forces visible on the single patient record.

(3C) A report under subsection (3B) must consider—

(a) the ability of veterans to access the necessary NHS support, and

(b) the ability of medical staff to provide former members of the armed forces with appropriate care.”

This amendment would require prior membership in the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record and require the Secretary of State to publish a report on making prior membership in the armed forces visible on the single patient record.

Amendment 88, page 36, line 26, at end insert—

“(4A) Regulations may not be made under this section unless the Secretary of State has first published and laid before both Houses of Parliament a Single Patient Record Outline Plan.

(4B) The Outline Plan under subsection (4A) must set out, as a minimum—

(a) the intended high-level design and scope of the single patient record, including the core data categories expected to be included and the principal care settings to be connected in the first phase;

(b) the proposed technical and architectural approach, including how existing source systems will be linked rather than replaced;

(c) the proposed timetable and phased rollout plan, including priority pathways;

(d) the intended access model for patients, clinicians and other relevant care professionals, including arrangements for proxy access and digital inclusion;

(e) the key safeguards for privacy, security, audit and prevention of inappropriate access; and

(f) the proposed approach to public engagement and awareness before the system becomes operational.

(4C) The Outline Plan must be published at least three months before any regulations under this section are laid.”

Amendment 22, page 36, line 32, at end insert—

“(6A) Before making regulations under this section, the Secretary of State must prepare and publish a risk assessment on the potential for digital exclusion under the establishment of a single patient record.

(6B) In preparing a risk assessment under subsection (6A) the Secretary of State must consult all stakeholders the Secretary of State considers relevant, including patient representation groups.

(6C) In preparing a risk assessment under subsection (6A) the Secretary of State must have particular regard for—

(a) those without access to a suitable electronic device,

(b) those without access to suitable broadband connectivity,

(c) those with physical and/or mental disabilities,

(d) those belonging to groups considered socially excluded, and

(e) those considered lacking digital skills.

(6D) The Secretary of State must lay a copy of the risk assessment under subsection (6A) before both Houses of Parliament.”

This amendment would require the Secretary of State to prepare and publish a risk assessment on the potential for digital exclusion under the establishment of single patient record.

Amendment 87, page 36, line 32, after subsection (6) insert—

“(6A) Regulations under this section must make provision to ensure that the system—

(a) complies with the Accessible Information Standard, DAPB1605, or any standard which replaces it;

(b) uses and is interoperable with the Reasonable Adjustment Digital Flag, DAPB4019, or any system or standard which replaces it;

(c) enables patients’ communication, information and reasonable adjustment needs to be identified, recorded, flagged, shared, met and reviewed without avoidable repetition by the patient; and

(d) enables patients to receive and access information relating to their care in formats appropriate to their communication and accessibility needs.

(6B) In preparing regulations under this section, the Secretary of State must secure the participation of disabled people, including blind and partially sighted people, and organisations representing them, in the design, development, testing and review of the system.”

This amendment seeks to ensure that the Single Patient Record supports the communication, information and reasonable adjustment needs of blind and partially sighted people and other disabled patients by embedding existing NHS accessibility standards within the system. It also requires disabled people and their representative organisations to be involved in the design, development, testing and ongoing review of the Single Patient Record to ensure accessibility is embedded from the outset.

Amendment 52, in schedule 1, page 57, line 15, at end insert—

“83B Primary care estate investment programme

(1) The Secretary of State must establish and maintain a programme for providing capital funding for the improvement and modernisation of premises used for the provision of primary medical services.

(2) The programme must prioritise practices where premises—

(a) are no longer fit for purpose,

(b) require substantial repair, adaptation or modernisation, or

(c) otherwise materially restrict the provision of safe, accessible or effective primary medical services.

(3) The Secretary of State must ensure that the process for applying for and accessing capital funding under this section is proportionate and does not impose unnecessary administrative burdens.

(4) The arrangements must be designed to ensure that a viable provider of primary medical services is not prevented from carrying out essential improvements because of insufficient access to capital funding.

(5) In this section “premises” includes premises owned, leased or otherwise occupied for the provision of primary medical services.”

This amendment would establish a capital funding programme to improve and modernise primary care and General Practice premises.

Amendment 50, page 57, line 26, at end insert—

“5A after section 87 insert—

“87A Sustainable funding for general practice

(1) The Secretary of State must ensure that arrangements for payments under general medical services contracts provide for sustained investment in general practice.

(2) In exercising functions under this section, the Secretary of State must have regard to the role of general practice in—

(a) preventing illness,

(b) managing long-term conditions,

(c) providing care in the community, and

(d) reducing avoidable hospital admissions.

(3) Arrangements for funding general practice must have regard to the volume, complexity and value of care delivered through general practice.

(4) The Secretary of State must publish, for each financial year, a statement setting out how the arrangements for payments under general medical services contracts are intended to support the matters in subsections (1) to (3).””

This amendment would require sustained investment in general practice reflecting the volume, complexity and value of care provided.

Amendment 51, page 57, line 26, at end insert—

“5A After section 87 insert—

“87A Rural and coastal general practice funding

(1) Arrangements for payments under general medical services contracts must take account of the additional costs of delivering primary medical services in rural and coastal communities.

(2) The factors to which arrangements under subsection (1) must have regard include—

(a) rurality,

(b) the age profile of the population,

(c) transport and travel costs,

(d) seasonal changes in demand,

(e) difficulties in recruiting and retaining staff, and

(f) the loss of economies of scale arising from sparsely populated communities.

(3) The Secretary of State must ensure that the funding arrangements under this section are reviewed periodically and amended where necessary to reflect changes in the costs of providing services in rural and coastal areas.””

This amendment would require GP funding to reflect the additional costs of providing services in rural and coastal areas.

Amendment 47, page 60, line 6, at end insert—

“99C Dental training hubs

(1) The Secretary of State must make arrangements for the establishment and support of dental training hubs in areas where there is an unmet need for NHS dental services.

(2) The arrangements under subsection (1) must include provision for dental training hubs in Dorset, including provision in west Dorset.

(3) In exercising the duty under subsection (1), the Secretary of State must work with—

(a) universities and other providers of approved dental education and training,

(b) local authorities, and

(c) integrated care boards and other NHS bodies.

(4) The purpose of dental training hubs is to—

(a) increase the capacity for dental education and training,

(b) increase the availability of NHS dental services in areas of unmet need,

(c) strengthen the recruitment and retention of the dental workforce, and

(d) support the development of the long-term dental workforce.

(5) Arrangements under this section must provide for students in the final year of an approved course of dental education to provide NHS dental treatment under appropriate supervision.

(6) Treatment provided by a student under subsection (5) must—

(a) be NHS treatment carried out on an NHS patient,

(b) be provided under the supervision of a suitably qualified dental professional, and

(c) be free at the point of use to the patient where the supervising provider is receiving, or is entitled to receive, the relevant NHS tariff or other NHS payment in respect of that treatment.

(7) A dental training hub must provide, or participate in, structured pathways into dental apprenticeships and other appropriate employment-based dental training.

(8) Arrangements under this section must include measures to support retention of dental professionals trained through the hubs to meet future workforce commitments.

(9) In this section “dental training hub” means a facility or network of facilities at which dental education, supervised clinical training and NHS dental service provision are integrated.”

This amendment would establish dental training hubs in areas of unmet need, including Dorset and west Dorset, to expand training, improve NHS dental access and strengthen the workforce.

Amendment 48, page 60, line 6, at end insert—

“99C Allocation of NHS dental funding according to unmet need

(1) The Secretary of State must make arrangements to ensure that NHS dental funding is allocated according to local unmet need.

(2) Where funding allocated for primary dental services in a financial year is not used for the purpose for which it was allocated, the Secretary of State must ensure that, so far as reasonably practicable, that funding is redirected to measures designed to increase access to NHS dental services.

(3) Measures under subsection (2) may include—

(a) additional NHS dental capacity,

(b) additional NHS dental appointments,

(c) measures to reduce waiting times,

(d) outreach dentistry,

(e) domiciliary dental services, and

(f) dental services provided in or in connection with schools.

(4) The arrangements must include mechanisms to ensure that funding allocated for the purpose of increasing access results, so far as is reasonably practicable, in additional NHS dental capacity, appointments or reduced waiting times.

(5) In making arrangements under this section, the Secretary of State must have particular regard to people who face barriers to travelling to dental services, including older people, people with disabilities, vulnerable people and schoolchildren.”

This amendment would require dental funding to reflect local unmet need and redirect unused funding towards improving access.

Amendment 49, page 60, line 22, after paragraph 18 insert—

“18A After section 103 insert—

“103A Rural and local-need factors in NHS dental funding

(1) Directions made under section 103 must provide for NHS dental funding arrangements to take account of local need.

(2) In making provision under subsection (1), the Secretary of State must have proper regard, in particular, to—

(a) the rurality of the area,

(b) the age profile of the population,

(c) the population who have disabilities,

(d) local transport and travel costs,

(e) seasonal changes in demand for services,

(f) difficulties in recruiting and retaining dental professionals, and

(g) the loss of economies of scale arising from sparsely populated communities.

(3) Provision made under section 103 must proportionately weight other measures alongside deprivation when determining the level of NHS dental funding required in an area.

(4) The Secretary of State must every three years review and by regulations amend the factors mentioned in subsection (2).””

This amendment would require dental funding to properly take account of rurality, local need, travel costs, workforce challenges and other factors alongside deprivation.

Amendment 56, page 64, line 34, at end insert—

“45A After section 133 insert—

“133A Emergency intervention in pharmaceutical services

(1) Where an integrated care board considers that a person providing pharmaceutical services is failing, or is likely to fail, materially to comply with—

(a) a contractual obligation,

(b) a patient-safety requirement, or

(c) a workforce obligation,

the board must consider whether emergency intervention is required to protect patients or continuity of pharmaceutical services.

(2) Where the board considers that emergency intervention is required, it may—

(a) require the provider to take specified remedial action,

(b) suspend specified arrangements,

(c) terminate arrangements with the provider,

(d) make arrangements with another provider for the provision of pharmaceutical services, or

(e) take any combination of the steps in paragraphs (a) to (d).

(3) The powers in subsection (2) must be exercised with regard to the need to maintain continuity of medicines supply and protect patients from avoidable disruption.

(4) An integrated care board must not continue arrangements with a provider where it is satisfied that the provider is demonstrably unfit to provide pharmaceutical services safely and effectively.

(5) Before exercising a power under subsection (2), the board must, except in an emergency, give the provider a reasonable opportunity to make representations.

(6) Nothing in this section prevents an integrated care board from taking immediate action where delay would materially risk patient safety or continuity of medicines supply.””

This amendment would give integrated care boards powers to intervene where a pharmacy provider is failing to provide their required services to protect patients and medicines supply.

Amendment 57, page 72, line 40, at end insert—

“(3D) Regulations made under subsection (1) must ensure that the remuneration arrangements for pharmaceutical services take account of the costs of providing those services in rural and sparsely populated areas.

(3E) In making provision under subsection (3D), the determining authority must have regard to—

(a) rurality,

(b) the age profile of the population,

(c) transport and distribution costs,

(d) seasonal changes in demand,

(e) difficulties in recruiting and retaining staff, and

(f) the loss of economies of scale arising from sparsely populated communities.

(3F) The remuneration arrangements must be designed to support the financial sustainability of pharmacies providing essential NHS services in rural and sparsely populated areas.

(3G) The Secretary of State must review the operation of the remuneration arrangements periodically and make such changes as are necessary to ensure that the matters in subsections (3D) to (3F) continue to be reflected.”

This amendment would require pharmacy funding to reflect the additional costs of providing services in rural and sparsely populated areas.

Government amendments 70 and 71.

Amendment 85, in schedule 3, page 86, line 14, leave out paragraphs 5 to 8.

This amendment would retain the requirement for NHS Foundation Trusts to have a Council of Governors.

Amendment 86, page 86, line 30, leave out paragraph 14.

This amendment would retain the requirement for NHS Foundation Trusts to have a Council of Governors.

Amendment 16, page 88, line 19, at end insert—

“(1A) The function under sub-paragraph (1) must be exercised by a person employed in the civil service of the State, and a Minister of the Crown or a special adviser must not be involved in any decision relating to such an appointment, suspension or removal.”

This amendment would ensure that civil servants are responsible for the decision making and appointment processes for trust and ICB leaders, rather than Ministers or Special Advisers.

Amendment 54, in schedule 8, page 106, line 33, at end insert—

“5A After section 254 insert—

“254A Interoperability of health and social care information systems

(1) The Secretary of State must make regulations requiring providers of NHS health services to use interoperable digital information systems.

(2) Regulations under subsection (1) must apply, so far as appropriate, to—

(a) providers of primary medical services,

(b) providers of primary dental services,

(c) providers of pharmaceutical services,

(d) NHS trusts,

(e) NHS foundation trusts, and

(f) providers of community health services.

(3) The regulations must provide for the secure exchange of relevant patient information between providers using interoperable systems.

(4) The regulations must include provision for electronic prescribing across NHS care settings where prescribing is clinically appropriate.

(5) The Secretary of State must ensure that the arrangements under this section are designed to—

(a) reduce duplication,

(b) reduce unnecessary administrative work,

(c) improve continuity of care,

(d) reduce avoidable delays in diagnosis, treatment and referral, and

(e) enable clinicians to access relevant information securely when providing care.

(6) Regulations under this section must include appropriate requirements relating to information governance, cyber security, patient confidentiality and the lawful processing of personal data.

(7) Before making regulations under this section, the Secretary of State must consult such persons as the Secretary of State considers appropriate, including representatives of general practice, hospitals, community services and patients.””

This amendment would require interoperable NHS digital systems to improve information sharing, reduce duplication and support continuity of care.

Amendment 13, page 106, leave out lines 34 and 35 and insert—

“For section 255 (power to request NHS England to establish information systems), substitute—

“255 Powers to request the Secretary of State to establish information systems

(1) Any person (including a devolved authority) may request the Secretary of State to establish and operate a system for the collection or analysis of information of a description specified in the request.

(2) A request may be made under subsection (1) by a person only if the person considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the person to have in relation to the person's exercise of functions, or carrying out of activities, in connection with the provision of health care or adult social care.

(3) The Secretary of State must comply with a mandatory request unless the Secretary of State considers that the request relates to information of a description prescribed in regulations.

(4) For the purposes of this Chapter a request under subsection (1) is a mandatory request if—

(a) it is made by a principal body, and

(b) the body considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the body to have in relation to its discharge of a duty in connection with the provision of health services or of adult social care in England.

(5) Subsection (6) applies where the Secretary of State has discretion under this section as to whether to comply with—

(a) a mandatory request, or

(b) other request under subsection (1).

(6) In deciding whether to comply with the request, the Secretary of State—

(a) must, in particular, consider whether doing so would interfere to an unreasonable extent with the exercise by the Secretary of State of any of its functions, and

(b) may take into account the extent to which the principal body or other person making the request has had regard to—

(i) the code of practice prepared and published by the Secretary of State under section 263, and

(ii) advice or guidance given by the Secretary of State under section 265.

(7) In this section “principal body” means—

(a) the Care Quality Commission,

(b) the National Institute for Health and Care Excellence, and

(c) such other persons as may be prescribed in regulations.

(8) In this Chapter “health care” includes all forms of health care whether relating to physical or mental health and also includes procedures that are similar to forms of medical or surgical care but are not provided in connection with a medical condition.””

This amendment would enable the Care Quality Commission and NICE to continue to make mandatory requests to the Secretary of State to establish an information system, following the transfer of NHS England’s functions.

Amendment 14, page 110, line 37, leave out paragraph 14.

This amendment is consequential on Amendment 13.

Amendment 41, page 112, leave out lines 1 and 2 and insert—

“23 For section 274A (Secretary of State’s guidance about NHS England data functions) substitute—

“274A Secretary of State’s guidance in respect of their data functions

(1) The Secretary of State must publish guidance about the exercise of—

(a) their relevant data functions, and

(b) their other functions in connection with their relevant data functions.

(2) Before publishing guidance under this section the Secretary of State must consult any other persons that the Secretary of State considers appropriate in relation to the guidance.

(3) The Secretary of State must have regard to the guidance published under this section.””

This amendment would transfer the existing statutory requirement for published guidance about data functions from NHS England to the Secretary of State.

Amendment 46, in schedule 12, page 151, leave out paragraph 98.

[Karin Smyth]

I wish at the start to take a moment to thank the Members on both sides of the House who served on the Public Bill Committee during what was a very hot end of June and July—if we can remember back that far. As part of that process, the Committee scrutinised every clause of the Bill and debated over 195 amendments, and we on the Government Benches are grateful for their diligence. The implementation of the Bill is better for all that hard work. I also welcome the spirit of collaboration that has greeted the main provisions of the Bill from both sides of the House, most notably on Second Reading but also in Committee, and I hope that we can continue in that spirit at this stage. For our part, we remain committed to working with MPs and peers across the House and other stakeholders to ensure that the end result is a Bill that strengthens the NHS.

I know that we have a large number of amendments on a variety of topics, so I will keep my remarks short. New clauses 96 and 97 relate to visiting rights. They strengthen the role of integrated care boards and local authorities in promoting visiting, supporting people to have someone with them and ensuring the involvement of family, friends and carers in decisions. They complement the existing legal requirements and the work already under way to drive a change in culture and practice by embedding visiting at the heart of the responsibilities of commissioners.

New clause 96 explicitly places duties on integrated care boards to promote opportunities for visiting and accompaniment, while new clause 97 builds on local authorities’ existing wellbeing duties by emphasising the importance of involving other people in decision making, receiving visitors and maintaining opportunities to take trips outside the care home. Maintaining meaningful contact and connection with family, friends and carers is critical to the health and wellbeing of so many people in our health and care settings. They provide invaluable practical help, emotional support and advocacy for their loved ones in accessing care and treatment, and commissioners should do what they can to support these relationships.

I turn to Government amendments 60 to 62. The question of who is required to sit on ICBs has raised comments from all across this House. I am grateful to all Members who have raised the importance of local government having a voice in ICBs, including my hon. Friend the Member for Birmingham Erdington (Paulette Hamilton) and the other members of the Health and Social Care Committee, who have continually advocated on this issue. We agree. It was never the intention to weaken the voice of local government in the NHS. We recognise that local authority board members are an important voice for commissioning on the ICB, and often provide helpful challenge and a very different perspective on commissioning decisions.

[Layla Moran (Oxford West and Abingdon) (LD)]

I thank the Minister for accepting our amendment on this issue. We pressed her and her colleagues over and over again—to the extent that we got a letter back that we honestly thought had been generated by AI, because the logic in it had no follow-through at all. I am delighted that she has listened. On what else does she intend to listen to us? In particular, there are amendments on the Health Services Safety Investigations Body, Healthwatch and health inequalities, which we will consider tomorrow, and, most importantly, the special needs amendment, which we are considering today. What else will she listen to us on?

[Karin Smyth]

I thank the Chair of the Select Committee —I can assure her that I am Karin, not Claude. She tempts me to go further on the rest of the Bill, but I genuinely thank her and the Committee; I hope she would agree that I spent a lot of time over the past months, before Report stage and Committee stage, meeting her, members of the Committee and many hon. Members from across the House. We have some provisions—we might call them simple provisions—in the Bill to democratise the NHS’s accountability, to reinforce the single patient record, and to improve the patient experience and patient safety landscape. We recognise that there is a lot of complexity within those simple propositions, and we will continue to listen to hon. Members. We want to ensure that the NHS is strengthened.

In relation to the ICBs and local authority voice, it was particularly significant over the summer to have heard from my right hon. Friend the Prime Minister about his commitment to rewiring the state and our ongoing reform to social care. With that in mind, I am pleased that amendments 60 to 62 will re-establish a requirement for ICBs to have at least one board member jointly nominated by local authorities in their area. That will sit alongside the existing duty to have a member nominated by the mayor of each mayoral strategic authority, as well as duties on ICBs and local government to work together, including on health and wellbeing boards. In Committee, we had a useful discussion about health and wellbeing boards, neighbourhoods and local accountability. I should also note that ICBs can appoint other people to their boards if they would benefit from their expertise. That is a decision to be taken locally.

Finally, let me briefly pre-empt the hon. Member for North Shropshire (Helen Morgan) by making a few comments about new clause 1. I thank her for the way she worked with me in Committee on the issue of a maternity commissioner—an issue that I think unites the House. As the hon. Member knows, we have accepted the recommendation from Baroness Amos’s national investigation into maternity and neonatal care. I can announce that, to deliver on this commitment, we will table an amendment to the Bill in the other place to establish a statutory maternity and neonatal commissioner. We are determined to get this right. For too long, too many women, babies and families have not received the care and support they deserve. The establishment of a commissioner represents a significant opportunity to strengthen accountability and champion their interests across the system. I hope that will give the hon. Member the reassurance she needs not to press her amendment.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Before I call the shadow Minister, I must tell hon. Members that this debate is heavily oversubscribed; Back Benchers will immediately be on a speaking limit and not everybody will get in. I call the shadow Minister.

--- Later in debate ---

[Andy McDonald (Middlesbrough and Thornaby East) (Lab)]

I rise as the chair of the all-party parliamentary group on spinal cord injury to speak to amendments 103 and 104, new clause 160 and amendment 105 in my name. I thank the Minister for meeting me during the passage of the Bill and for her subsequent letter. I also thank the Spinal Injuries Association for its support for the APPG and, crucially, for people living with spinal cord injury. These amendments are not about preventing reform; they are about ensuring that when responsibility for highly specialised services changes, patients continue to receive safe, equitable and nationally consistent care.

Spinal cord injury is a relatively low volume but complex lifelong condition requiring specialist expertise, rehabilitation and long-term follow-up. National commissioning exists to prevent fragmented services and postcode variation. If commissioning moves to integrated care boards, we need confidence that specialist workforce capacity, national standards and the sustainability of specialist centres will be protected. I therefore ask the Minister to clarify how those safeguards will work in practice, particularly around workforce, rehabilitation and geographical variation. I also seek clarity on whether spinal cord injury services will transfer to ICBs and what criteria will determine that decision.

Amendment 104 and new clause 160 would provide national assurance and parliamentary accountability for outcomes, access, workforce and geographical variation. Amendment 105 addresses the single patient record. Specialist charities provide vital practical and peer support after life-changing injury, even where they are not part of the clinical care. That is why this appeal is so resonant. If we can engage with those providers at that early stage, the outcomes will undoubtedly be improved. The amendment would allow referral, with patient consent, to approved condition-specific organisations sharing only necessary information.

I will not press these amendments to a vote today. I hope that the Minister will consider further safeguards and clarification during the Lords stages of the Bill. The care and access to support for patients dependent on specialist services should not depend on where those patients live.

[Karin Smyth]

I thank Members across the House for their contributions. As we would expect for a Bill of this size, it has been a wide-ranging debate, and I will not be able to address every single amendment, but I will try to cover them all in the time I have. If necessary, I will get back to people afterwards. As a Government, we know that what we have set out to do through this Bill is ambitious. We do not resile from that; we want to be ambitious. We are determined to make a real and positive change for people up and down the country who use the NHS, and throughout the Bill, we have remained focused on the key objectives. Those are to strengthen democratic accountability, strip back bureaucracy and empower patients.

--- Later in debate ---

[Several hon. Members rose—]

[Karin Smyth]

I am going to move on, because there is a lot to get through.

My hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis) made a powerful speech, based on his own experience and the terrible experiences of his constituents. I will write to him about what we want to do with ICBs to make that situation better.

I now turn to new clause 56, tabled by the hon. Member for Mid Sussex (Alison Bennett). I also thank my hon. Friend the Member for Blaydon and Consett (Liz Twist) for her ongoing work on, and interest in, carers throughout the passage of this Bill. I can assure the House that the Government fully recognise the importance of supporting carers’ health and wellbeing, including ensuring that they can take breaks from their caring responsibilities where needed. The Care Act 2014 already includes duties to assess and address carers’ current and future needs, and of course, we want to ensure that carers get the full benefit of the single patient record. To achieve this, we intend to use our regulation powers, which are already in the Bill.

The topic of inequalities has been highlighted a lot today. We are committed to ensuring that local areas are empowered to make decisions, tackle the specific health challenges they face and make real progress on health inequalities. I want to reassure the House that reducing health inequalities remains a priority for this Government. I know that the Chair of the Health and Social Care Select Committee, and the Committee as a whole, takes a great interest in this issue, and we are committed to working with them. I thank my hon. Friends the Members for Stoke-on-Trent South (Dr Gardner) and for Uxbridge and South Ruislip for their championing of this important issue and for our meeting last week.

I am not, however, convinced about new clause 91. Our focus is, and must remain, on delivering improvements in health outcomes, supporting prevention and tackling the causes of ill health, rather than creating additional statutory red tape. We already have a wide range of duties from the 2006 Act, and we have a new duty on combined authorities. There was a duty on ICBs in the Health and Care Act 2022, and there is a duty on foundation trusts. We have the public sector equality duty, as well as our commitment in the 10-year health plan. Again, the issue is making it work and empowering local leaders to do just that.

I commend the work of my hon. Friend the Member for Lewisham East (Janet Daby) on the APPG on sickle cell and thalassaemia, and I will write to her specifically on the issues she raised. She talked about specialised commissioning, a topic that was also raised by my hon. Friend the Member for Middlesbrough and Thornaby East (Andy McDonald). We know that this is an ongoing concern across many areas, and I commit to keeping in touch with them and with other Members.

Turning to women’s health—including mental health—and maternity services, again, I can assure the House that this is a priority for the Secretary of State. That is why we published the action-focused renewed women’s health strategy. It is why we are undertaking a single national action plan on maternal health, overseen by the national maternity and neonatal taskforce, to drive improvements where it matters to families, clinicians and other experts. I know that many Members of this House are committed to improving mental health, but I take this opportunity to thank my hon. Friend the Member for Sherwood Forest (Michelle Welsh) for all her work in this area as the national maternity adviser.

Opposition Members mentioned the Hughes report, and I assure the House that the Government recognise the importance of providing a response. I do not have time to go into all the ongoing work at the moment, but I commit to doing so at the earliest opportunity. [Interruption.] The Conservatives had a long time. The hon. Member for Sleaford and North Hykeham (Dr Johnson) says that they were about to do it before the election, but that is not what we found when we came into power. The Conservatives left us a lot of work to do in this and many other areas, but we are committed to doing it.

Fertility services and reducing inequalities in maternity services has been raised by my hon. Friend the Member for Stockport (Navendu Mishra) and the right hon. Member for Stone, Great Wyrley and Penkridge (Sir Gavin Williamson), who has been a tireless advocate in this area, as have many others. I have recently written to him. NICE guidelines inform how ICBs should commission in this area, but I know that things are not uniformly implemented. We will continue to work with ICBs to evaluate the next steps.

There was a lot of discussion on primary care, and dental access across the country in particular. We are committed to rebuilding dentistry in England, but actions speak louder than words. We are making great strides in improving access, ensuring an urgent care safety net across the country, reforming the dental contract and developing a 10-year workforce plan. More broadly, we think it is right that under this Bill, primary medical services become the responsibility of ICBs. They have the right knowledge of their areas to make commissioning decisions, and that includes on eye care. They have responsibility for all primary medical services, but rightly they will be accountable to the Secretary of State for their performance.

The right hon. Member for Godalming and Ash (Sir Jeremy Hunt) is right that we will say that he could have dealt with the issues he raises while he was in power, but we do not always say that, and he is absolutely right about continuity of care. I have also visited the practice he talks about in Horfield in Bristol, and not just because I was on the primary care trust board when the 2004 changes happened. Broadly, Bristol does have different standards on some of these issues, and that highlights our point. We do not need to put some of these provisions in legislation. Exactly this sort of good practice can be shared in local systems through neighbourhood care plans, neighbourhood work and the work in primary care networks.

The single patient record is fundamental to the Government’s mission to create a modern, joined-up NHS that puts patients at the centre of their care. On amendments 26, 42 and 43, I assure Members that the overarching purpose of making regulations to create and operate the single patient record is limited to the direct care of patients, and clause 51 is already explicit about that. Crucially, the clause does not create any new data sharing gateways for secondary purposes such as planning and commissioning, so these amendments are not necessary. On data safeguards, the security and privacy of people’s health and social care data are paramount. As Members would expect, we will build the strongest safeguards into the record. On new clause 32, I can assure Members that the SPR will be designed to protect personal data by default, with the highest standards of cyber-security and information governance ensuring that only the right people can access the right information at the right time and only for the right reasons.

Finally, I have heard how important it is that the single patient record is accessible and inclusive. I thank my hon. Friend the Member for Battersea (Marsha De Cordova) for amendment 87 and the important work she is doing to publicise this hugely important area. I assure her and Members that we are confident that the Bill is drafted to enable information related to support needs and reasonable accommodations to be included in the SPR. The Department will have regard to the accessible information standard as the SPR is developed.

We are also committed to tackling digital exclusion. We have considered that as part of the single patient record equality impact assessment, and work is already under way to help address barriers around connectivity, skills and confidence. I heard what my hon. Friend the Member for Middlesbrough and Thornaby East said about the need to engage him and others about the single patient record as we go forward.

On the federated data platform, decisions about public contracts must be made through fair, open and non-discriminatory processes. That is governed by UK procurement law, which recognises certain international treaty obligations. NHS England is reviewing the federated data platform contract to determine whether it should continue with standard contract management processes. It will look at evidence of delivery and the impact of the platform, and that should be the basis on which a contract continuation is decided.

[Martin Wrigley]

Will the Minister give way?

[Karin Smyth]

I will not. We have heard a lot from the hon. Gentleman, and I want to make some clear points to the House this evening.

We have heard a great deal of discussion about commercial processes, and Members—including the hon. Member for Newton Abbot (Martin Wrigley)—have raised important points about data security, governance and ethical standards of contracts, and support for domestic suppliers and for voluntary, community and social enterprise organisations. Contracts involving NHS data and digital services must be subject to proper scrutiny. The Government’s approach is to assess risks on the basis of the nature of the data, service and supplier access. Crucially, we already have the tools that we need to carry out appropriate due diligence through legal powers and robust contractual provisions.

I agree with the spirit of new clause 108, tabled by my hon. Friend the Member for Liverpool West Derby (Ian Byrne). I fully recognise the importance of ensuring that the NHS does not inadvertently support exploitation or rights abuses. UK legislation already incorporates some international laws: for example, the Human Rights Act 1998 incorporates the European convention on human rights into UK law. Similarly, we can use existing legislation and guidance to exclude suppliers from NHS procurements. Both the Procurement Act 2023 and the provider selection regime allow us to exclude providers when there has been serious misconduct or illegality. For instance, we could exclude a supplier under the Procurement Act for breaches of modern slavery and/or human trafficking laws. We have very high standards and expect all suppliers —including whichever companies go on to provide the single patient record—to meet them.

On a related note, the Chancellor has already written to the Secretary of State to ask that the NHS procurement better support British industry. In the light of that, the Secretary of State has commissioned, within the health family, a review of strategic procurement pipelines to find opportunities for the new social value model to support more British jobs, skills and innovation. The First Secretary of State, my right hon. Friend the Member for Sheffield Heeley (Louise Haigh), who is leading work on procurement across Government, would be happy to meet my hon. Friend the Member for Liverpool West Derby as part of this important work as it progresses, and I can assure him that the actions that we take will be fully in line with the principle of international law.

[Steve Barclay]

Will the Minister give way?

[Karin Smyth]

I thank my hon. Friend the Member for Stroud (Dr Opher)—with his example of the sore throat—for his help in driving down demand for healthcare. Indeed, I thank Members in all parts of the House for their contributions to what has been an interesting and helpful discussion. Their expertise and their scrutiny will continue to strengthen the Bill.

[Steve Barclay]

Will the Minister give way?

[Rachael Maskell (York Central) (Lab/Co-op)]

Will my hon. Friend give way?

[Karin Smyth]

I will give way to my hon. Friend. [Interruption.]

[Rachael Maskell]

I have listened carefully to the debate. May I refer to my new clause 57? The challenge of the NHS is that so much significant, unaccountable power is being held that we, as Members of Parliament, cannot even deliver for our constituents. Will my hon. Friend look at her my new clause, and work with me to ensure that we get the Bill in the right place with regard to accountability before it goes to the Lords?

[Karin Smyth]

As my hon. Friend knows, I spoke from the Opposition Benches for many years about the lack of accountability of our local systems to local members of Parliament. I think that that was a great loss in the Lansley Bill. It was one of the things that drove me to become a member of Parliament, and in my role as the Minister of State I have endeavoured to make sure that local Members of Parliament have—

[Steve Barclay]

Will the Minister give way?

[Karin Smyth]

I will not. The right hon. Member was Secretary of State for Health twice, so he had his chance to put all the right things into legislation. [Interruption.] I am not helping my own sore throat.

As my hon. Friend mentioned, the Bill is about returning that democratic accountability directly to the Secretary of State. We have had a lot of pushback in different places, but that is what this Bill does. It returns accountability to the Secretary of State, it devolves that responsibility for delivering on the ground to NHS organisations, and, crucially, it empowers patients. Our new clause strengthens the Bill, and I commend it to the House.

Question put and agreed to.

New clause 96 accordingly read a Second time, and added to the Bill.

New Clause 97

Care and support: involvement of others and visitors

“In section 1 of the Care Act 2014 (promoting individual well-being), in subsection (3)—

(a) after paragraph (e) insert—

“(ea) the importance of the individual being able to involve other people in such decisions and of those people receiving the information and support necessary to facilitate that involvement;”;

(b) after paragraph (f) insert—

“(fa) the importance of the individual having appropriate opportunities to receive visitors;

(fb) in the case of a person who is provided with accommodation in a care home, the importance of them having appropriate opportunities to take trips outside of the care home;”.”—(Karin Smyth.)

Section 1(3) of the Care Act 2014 lists matters to which local authorities must have regard when exercising functions under Part 1 of that Act. The amendments refer to the importance of an individual being able to involve other people in decisions and to receive visitors etc.

Brought up, read the First and Second time, and added to the Bill.

NHS Pension Scheme

Karin Smyth Excerpts

Wednesday 2nd September 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

Over the past year, I have made regular statements about the implementation of the McCloud remedy in the NHS pension scheme. This hugely complex undertaking across the public sector pension schemes is required to address age discriminatory policy legislated for by the coalition Government in 2013.

The NHS pension scheme is administered on behalf of the Department by the NHS Business Services Authority. In 2025, the NHSBSA failed to meet its McCloud delivery deadlines. In response, in July 2025, I commissioned Lisa Tennant in her capacity as chair of the NHS pensions board to carry out an independent review of the NHSBSA’s delivery of the McCloud remedy. The report from this review has been published today on www.gov.uk. Copies have been placed in the Library of the House.

The review was an extensive and forensic undertaking. It has identified and made recommendations across two broad categories of findings:

Strategic factors: including governance, leadership, organisational culture and systemic issues

Operational factors: including the operating model, operational readiness, digital and data, customer experience and change management.

Lisa Tennant’s final report makes clear that further action is required to put the NHS pension scheme on a secure footing and to prepare it for long-overdue modernisation.

Since July 2025, I have regularly met Lisa to hear her emerging findings and I have increased the Department’s oversight and support for the NHS pension scheme:

NHSBSA is now required to provide much more frequent and detailed reporting of scheme performance to the Department;

I have ensured that McCloud planning and delivery resources were increased;

I have visited the NHSBSA’s headquarters in Newcastle to see at first hand its work to strengthen delivery arrangements at the NHS pension scheme.

The NHSBSA has also acted. A dedicated new leadership team for the NHS pension scheme has been created. When the McCloud planning was largely complete, the NHSBSA team started to reassess in June how the pension scheme’s rules were being applied. They reported to the Department at the end of July that there were issues in the administration of a small proportion of members’ records, with the earliest dating back to 2008. Most of these issues built up between 2014 and today, and in a small number of cases, I regret to say that some are ongoing. As a result, while the vast majority of members are receiving the correct pension amount, some will have been entitled to more.

To establish with absolute certainty that all the affected members have been properly identified, I have this week appointed the Government Actuary’s Department to lead a comprehensive audit of the scheme’s administration. I will report back to the House on the audit’s progress and findings. A new departmental board has been established, with external and independent expertise, to oversee the NHSBSA’s implementation of the audit’s findings and its wider pensions operations. This board will meet regularly from next week, reporting to me.

Based on what we know today, around 95% of members will be unaffected. Many of those who are will already be retired and receiving a pension. The NHSBSA will continue to pay pensions promptly and reliably, and to process retirement applications.

Each member who is directly affected will be contacted personally by the NHSBSA, and I will make sure that this happens as quickly as possible. No action is needed by anyone who is a member of the NHS pension, whether working or retired. NHSBSA will ensure that information for members is available on its website and is updated regularly. Records will be corrected and, where appropriate, pension awards will be updated. Where payments or increases are due, interest will be payable.

There has rightly been much scrutiny of progress in delivering the McCloud remedy, which resulted from poor decision making by previous Governments. McCloud implementation introduced significant additional pressure on the administration of the NHS pension scheme, which was already strained, due to growth in scheme membership numbers, complexities in scheme design and an outdated technology infrastructure.

In the light of the new issues that have been uncovered, I have directed the NHSBSA to reassess the deliverability of its McCloud plans. I will continue to hold the authority to account for the delivery of the NHS pension scheme and to provide regular updates to the House, setting new statutory deadlines for McCloud when I can do so with confidence.

I am making this statement today because I want to be transparent about these concerning issues at the NHS pension scheme, and to confirm this Government’s commitment to addressing them in full. I will shortly visit the NHSBSA and will make it clear that if progress is not made at sufficient pace, I will consider what further action is required. I will keep the House updated on progress.

[HCWS307]