Health Bill (Fifteenth sitting)

Karin Smyth Excerpts

Committee stage
Thursday 9th July 2026 Public Bill Committees

[The Chair]

I remind the Committee that with this we are discussing the following:

New clause 56—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 include the requirement 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 legal right 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 84—Publication of data on avoidable deaths—

“(1) The Secretary of State must publish every quarter the number of avoidable deaths where waits of more than 12 hours in accident and emergency departments was a contributory factor.

(2) The Secretary of State must make the data under subsection (1) available by integrated care board area.”

This new clause would require the Secretary of State to publish data on avoidable deaths caused by waits over 12 hours in A&E departments.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to see you in the Chair, Ms Lewell. I will speak first to new clause 84, tabled by the hon. Member for Sleaford and North Hykeham. I reconfirm the Government’s focus on reducing long waits by improving patient flow, increasing productivity and delivering better emergency care for patients. Last night in the Chamber, we had a good discussion about corridor care in particular; all our comments are on the record, so I will not delay the Committee by repeating everything, but I will take some time to answer the questions raised in Committee this morning.

We are clear that the Government will end corridor care in this Parliament. It is completely unacceptable. Longer waits for emergency care can be associated with poorer patient outcomes. That is why, through the urgent and emergency care plan in 2025-26, we are investing more than £450 million to expand urgent and emergency care capacity, including new same-day emergency care services, urgent treatment centres, additional mental health crisis provision and nearly 1,000 replacement ambulances. Alongside that, we are implementing new clinical standards and improving patient flow across hospitals, all to reduce the number of patients waiting more than 12 hours.

[Sojan Joseph (Ashford) (Lab)]

I was pleased to take part in the debate in the Chamber yesterday. I raised some examples from my local hospital, which is expanding its same-day emergency care because of the funding that we received from the Labour Government. We also have a safe haven for mental health patients who do not need to go into accident and emergency. Lots of work is happening in my local hospital area, which will make a big improvement to corridor care and wider emergency care pressures. Does the Minister agree that that is what we need to do, and that the Labour Government are doing it?

[Karin Smyth]

My hon. Friend has been a strong campaigner. His health community has a lot of problems, as he well knows, but he is always there first, challenging me about the challenges in his healthcare system. He ensures that the people of Ashford are duly represented. He is absolutely right that what will make a difference to patients is improvement on the ground. I do not minimise how far there is to go, but I think patients are already starting to feel that improvement.

In the debate last night, we heard about some great work that is happening. We heard from, among others, my hon. Friend the Member for Ashford; from my hon. Friend the Member for Rossendale and Darwen (Andy MacNae), who talked about the challenged system and the challenged hospital in Blackburn, and the real improvements there; from my hon. Friend the Member for Watford (Matt Turmaine); and from my hon. Friend the Member for Bury St Edmunds and Stowmarket, who talked about progress in West Suffolk. That is really encouraging to see.

Earlier in the debate, statistics in the public domain were raised by, I think, the hon. Member for North Shropshire and others on deaths due to long waits and so on. That is a completely unacceptable situation, but I want to put it on the record that those statistics are not Government statistics. We had a bit of a debate about that. My hon. Friend the Member for Bury St Edmunds and Stowmarket highlighted how one can attribute cause of death to certain provisions. It is a really important measure. We do not want anyone waiting, full stop, but the statistics are not verified as Government statistics. I want to be clear about that.

On new clause 84, I assure the Committee that trusts are already held to account on the number of patients waiting 12 hours from arrival in A&E to admission, discharge or transfer. The medium-term planning framework published in October 2025 sets out the expectation that trusts will reduce the percentage of patients waiting 12 hours or more, year on year until 2028-29, as part of our overall ambitions to return to meeting the NHS constitutional standards.

The Government already produce comprehensive data on urgent emergency care performance, including on waiting times and on 12-hour waits. Those data provide transparency, support the oversight of the NHS’s performance and enable independent analysis of patient outcomes. We have been very keen to ensure that those statistics are published.

Another issue raised this morning was bed numbers. We had a bit of a historical throwback to the 1990s; I will not detain the Committee further by doing that again. My hon. Friend the Member for Bury St Edmunds and Stowmarket talked about changes in clinical practice, mental health beds and so on. I could talk for many hours about that. As a junior manager coming into the health services, one of my first tasks was to define what a bed is. That is not an easy thing to do. Most people think they know what a bed is but, as we discussed earlier, a trolley without wheels could be a bed. Counting beds and defining what they are and what they are used for is a complicated business in the health service. I know you will tell me not to deviate from the new clause, Ms Lewell, but this is important. Practice changes, and it is important that we make the most effective and efficient use of NHS resources. That means making changes to bed numbers, where they are and how we count them.

In June 2026, an average of 13,618 adult patients in acute hospitals per day were waiting for delayed discharge. We have improved data collection, so we have a better sense of the scale of the problem and, crucially, where it is; it is different in different places. We are seeking to improve that data. I gently remind the Committee that the NHS England website produces an awful lot of really good data so that Members of Parliament and our constituents are able to keep track. As my hon. Friend the Member for Bury St Edmunds and Stowmarket made clear, we need to keep up with best clinical practice, as well as the best use of resources. We are very happy to share that information and keep it transparent.

New clauses 12 and 56 were tabled by the hon. Member for North Shropshire, who is right to raise the unacceptable waits for care that some patients experience in A&E after the decision has been made to admit them. That includes patients being treated and cared for in corridors at times because of hospitals’ lack of capacity to admit them. As we discussed last night, the Government are clear that corridor care is not an acceptable standard of care and must not be normalised. We inherited an NHS under severe pressure with long waits and increasing numbers of patients receiving care in non-designated clinical areas. It is unacceptable, but I am afraid it was allowed to happen under the Conservatives. We are committed to eradicating corridor care, and we have a plan to do so.

To improve transparency, we have already established a clear national definition of corridor care. Again, the Conservatives could have done so in the past 14 years but chose not to. We have introduced daily reporting arrangements and strengthened the data quality processes. We are working hand in hand with stakeholders, including the royal college. In addition, we have published national guidance to support safe care where such situations cannot be avoided.

We are working hard to tackle the causes of corridor care; we are not just reporting on the consequences. That is why we want to improve patient flow. We have had good discussions about patient flow, both pre-admission and post-discharge, involving social care and primary and community care to support people who need care homes. We do not want people—particularly frail, elderly people—turning up at hospitals if it is better for them clinically to be treated where they are. We are improving patient flow, strengthening the discharge arrangement and investing £215.5 million in new and expanded urgent care services across England. We are also providing targeted support to the trusts facing the greatest challenges in relation to corridor care so that improvements can be delivered where they are needed most.

I gently remind the hon. Member for North Shropshire—and the hon. Member for Sleaford and North Hykeham, as a clinician, will be clear on this information about admissions—that when a patient presents at A&E, a clinician decides whether to admit them to the hospital, provide treatment, transfer their care to another location or discharge them. Under the current reporting rules, the clock starts running on a patient’s arrival in A&E and stops when one of those actions is taken. As a result, no decision is made to admit to A&E itself. Instead, if someone requires admission, it should be to somewhere elsewhere in the hospital.

Although I fully recognise the concerns that underpin these new clauses, I do not believe that further statutory requirements are the right approach. In the debate last night, we outlined in full the Government’s absolute commitment to addressing the issues and improving the situation for all our constituents. I hope that I have suitably reassured hon. Members that these new clauses are not required, and that they will not press them.

[Helen Morgan (North Shropshire) (LD)]

I will speak briefly to new clauses 12 and 56, about which we had quite a long debate this morning. Let me respond to a couple of questions. The shadow Minister asked about the role of Healthwatch in selecting the panel that would interrogate the Secretary of State, as we envisage in new clause 12, given that Healthwatch will be abolished by the Bill. She also asked about new clause 56, which would require the Secretary of State to have due regard to Baroness Casey’s final report. The shadow Minister said that those things are essentially inconsistent, but, considered as a suite of amendments, the provisions we have tabled are consistent. We oppose the abolition of Healthwatch; had that been successful, Healthwatch would still be there. We have also tabled new clause 60, which we will get to later and which would require Baroness Casey’s commission to report much more quickly. That is why that apparent inconsistency exists; I hope I have sorted that out for the shadow Minister.

The right hon. Member for Melton and Syston, a former Minister, talked about capacity in the system as a whole and its impact on corridor care. His concern was that if we focus on corridor care, we will end up with more people being treated in ambulances, have longer ambulance handover times and very long ambulance wait times. He will know, having been the responding Minister to my first Adjournment debate, that ambulance wait times have been a significant problem where I live. I am pleased to say that they are becoming less of a problem, because the new management of the hospital have focused relentlessly on the A&E department and on ensuring that ambulance patients can be taken into it very quickly, or certainly much more quickly than they used to be. I recognise his concern, but I think it is a manageable one.

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[Karin Smyth]

I am grateful to hon. Members for bringing this discussion to the Committee. The Government are clearly committed to enabling people to live longer. It is one of the successes of recent years that, at the foundation of the health service, the average life expectancy was I think 60 or 62, while, now, it is in the early to mid-80s. That is a massive change in the last 80 years or so.

As well as improving the healthy life expectancy of the population, we are determined to address the stark inequalities that blight our nation’s health. We know that the most disadvantaged in society often face the biggest health challenges, and that the current model of care works least well for those who already experience disadvantage, who are also far more likely to have complex needs.

In fact, my own entry into working for the NHS, back in the 1990s, was on the back of the 1980 Black report, which some Members might remember well. The then Conservative Government sat on that for ages; it was such an awful reflection on the first 35 years of the health service, that health inequalities had not improved, that they sought not to publish it. That struck me as so shocking that it led me to want to pursue a life doing something about it.

I see that in my own constituency, where the legacy of the tobacco industry—which my hon. Friend the Member for Bury St Edmunds and Stowmarket mentioned—has led to a very high prevalence of smoking-related disease. In some parts of my constituency, that is up to 34%.

[Liz Twist]

I would point to examples such as in the north-east of England, where the work on smoking has been incredibly effective and still continues, and makes that real shift and change. Does my hon. Friend agree that it is those practical examples that we need to see, and to support along the way?

[Karin Smyth]

I thank my hon. Friend for that point about prevalence in the north-east. Often, the prevalence of these diseases is also to do with post-industrial work, which many people had to do without concern or knowledge about the effects on their health.

My hon. Friend the Member for Croydon East mentioned practical examples as well: the opening and building of things such as community diagnostic centres in places that are accessible and open to the public, and neighbourhood health. That is entirely the drive that we have: for services where people are, and where the greatest health need is, and not expecting people to travel.

In terms of smoking, one of the greatest legacies of the last Labour Government was of course the ban on indoor smoking. My mother was a barmaid for all her adult life; it is hard to imagine that people were just standing there at her place of work, blowing smoke at her while she was working. I tell my children, “Yes, we used to sit on aeroplanes with people smoking,” and that, unbelievably, some people smoked at the back of buses on the way back from school, and so on and so forth. It is really quite shocking.

The Tobacco and Vapes Act 2026, which we have also talked about in this Committee, is also a real testament to the work of this House, but didn’t it take a long time, Ms Lewell? I pay tribute to the right hon. Member for Richmond and Northallerton (Rishi Sunak) for pursuing that in the face of great adversity from his own party at the time. That was not, obviously, by the Members present, who all have a high concern about health, but perhaps by others on the Conservative Benches at the time, and then indeed in the Lords, who sought to thwart it—thwart is a strong word in this context; obviously, they made their points, but they sought to stop that Bill making progress at various stages.

Some of my colleagues were coming back at different times, saying that they were working on the Tobacco and Vapes Bill, and I said, “What, still? Really? Has it not come through yet?” That showed how hard it is, when something so well evidenced and so supported by public health experts, on something so detrimental to public health—particularly for people living in poorer communities, such as the one I represent in Bristol South—still takes such a time to get through.

[Dr Johnson]

The Minister is very, very aware of my views and opinions on the Tobacco and Vapes Act, particularly on vaping and stopping vaping among children. That Act, a bit like this Bill, left lots of opportunities for the Government to provide for regulations. Anyone who has been in a shop in the past few days will have seen vapes still behind the counter, still very visible, very colourful and in lots of different flavours and suchlike. Can the Minister update the Committee, and therefore the House, on when she expects the regulations provided for by the Tobacco and Vapes Act to come into force, so that we can actually apply the law, as opposed to just having it sat on the statute book?

[Karin Smyth]

Well, I thank the hon. Member for her support. As I said, I did not expect that people here present, who understand the impact of that work, were the ones who were thwarting that. I do not have off the top of my head exactly when the regulations under that Act will come forward, but I am sure we can furnish the hon. Member with details as soon as possible. We all want to see that happening—in particular, the work going on around high streets, such as prevention of fraud by shops for all sorts of things, not just vapes. Obviously, that is high on the agenda, as it is for some of my colleagues as well. Those places and people are blighting our high streets.

[Dr Prinsley]

I sit on the Home Affairs Committee, and we have lately been discussing the matter of serious organised crime, and vape shops in particular. It turns out that many of the vape shops are in fact not really shops; they are places for laundering money. Specifically, they launder money in relation to drug businesses and the drug trade, which is another huge public health matter that I am sure the Minister will agree needs to be dealt with. We were informed that about 10% of this country’s adult population are using illicit drugs, and that for the most part those are being delivered via the post office. Does the Minister agree that that is a massive public health issue that will also need to be urgently addressed?

[Karin Smyth]

I thank my hon. Friend for his expertise and that work on the Home Affairs Committee. Again, it shows the Committee the wide range of work that goes on. Of course, many hon. Members are campaigning and working hard. Those shops are blights on our communities, and as with most illicit drug dealing, they affect the most vulnerable in places where they can pick on the most vulnerable. They are in areas of high deprivation, and that is something we need to stop. I commend all the communities and community leaders that work so hard to stop that happening in their areas. We must address it.

Returning to new clause 14, while I fully recognise and share the ambition that sits behind the new clause, introducing a new statutory duty is not the right way to achieve it. A healthy life expectancy is a long-term outcome shaped by a wide range of factors across society and Government, many of which cannot be meaningfully addressed through a rigid statutory timetable. Requiring the Secretary of State to set a statutory target within six months, publish a refreshed cross-Government strategy every two years and make formal statements to Parliament risks creating a process-heavy framework that prioritises reporting over delivery.

What matters most is sustained practical action to improve prevention, tackle health inequalities, expand access to care and address those wider determinants of health. That is why the Government have already published our 10-year health plan to improve the nation’s health, of which healthy life expectancy is one measure. That is central to us in bringing forward the 10-year plan. Publishing a new strategy every two years would be duplicative and would not help to deliver the plan that we already have in place. Work is already underway, and I am sure the House will hold us to account for the progress we make, as it rightly should. I believe we share the same aim that the new clause seeks, but we differ on the best means to get there.

On new clause 79, I assure the Committee that the Government are already working across Departments to improve health and reduce inequalities, ensuring that action on health is embedded across Government. For example, through the warm homes plan and rented sector reform, we are supporting healthier homes and reducing health harms associated with poor housing. Through the “Keep Britain Working” review, we are addressing the links between work, health and wellbeing. Through the environment improvement plan, we are tackling the health harms of air pollution, and in lifting hundreds of children out of poverty, we will transform their health and life chances.

Those endeavours demonstrate that improving health outcomes is already embedded across Government activity and does not depend on the creation of a new statutory committee. While I have considerable sympathy with the aim of the new clause, and I am a strong supporter, as I hope I have assured the Committee, of supporting those wider determinants of health, I am not persuaded that placing detailed internal Government structures into primary legislation is either necessary or desirable. We heard well from my hon. Friend the Member for Lichfield about some of the unintended complications about the new clause.

As we have repeatedly said, in the Bill we are not seeking to be unduly prescriptive or create unnecessary bureaucracy that may risk slowing down delivery. Indeed, we are aiming to reduce that bureaucracy. Furthermore, the Government must retain the flexibility to organise in a way that best supports delivery as the context evolves. The Government already bring Departments together to advance shared goals and will continue to strengthen collaboration wherever it is needed.

On new clause 80, I am again not convinced that creating a new statutory duty on every Minister is either necessary or the most effective means of achieving the objective of the hon. Member for Winchester. The Secretary of State for Health and Social Care already has a statutory duty to protect public health and powers to take the appropriate steps to improve the health of the people of England. We have already discussed clause 4, which reformulates the Secretary of State’s duty on health inequalities. Those provide a clear statutory framework for improving health and addressing inequalities.

Beyond that, the Government do not operate in departmental silos. Ministers consider the implications of decisions and work collectively in the public interest, including on health impacts where relevant, which is particularly important to this Government. The proof is in the action we have started to take across Government to improve health. Although I agree entirely that health should be considered across Government, imposing a broad new legal duty on every Minister would risk creating unnecessary bureaucracy without meaningfully improving outcomes, as my hon. Friend the Member for Lichfield highlighted.

Creating new procedure and reporting requirements is not in the spirit of this Bill, which has flexibility and a focus on delivery at its heart. We also heard that from the shadow Minister. 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. The objective of new clause 80 can be achieved without placing a new statutory requirement on every Minister.

The shadow Minister asked me about plans for a modern service framework for MSK, and we currently do not have plans to develop one. The national quality board will assess all proposals for new MSFs against clear criteria, which we have highlighted before, ensuring that we prioritise the area where a framework will have the greatest impact for patients.

[Dr Johnson]

I understood that one of the Government’s greatest priorities was to reduce waiting lists, but one of the things that people are waiting for the most is musculoskeletal or orthopaedic treatment. Why is it not a priority for the Government?

[Karin Smyth]

There is a long priority list for MSFs that was left by the last Government for different reasons. There are lots of things will bring down MSK waiting lists, such as more diagnostic facilities. As the shadow Minister knows, 80% of people on the waiting list are waiting for diagnostics, which is why we are fast-tracking and pushing more. As my hon. Friend the Member for Croydon East said, community diagnostic centres in places such as Croydon East will get people through for the diagnostics they need. There are also some things that the shadow Minister’s party seems to continue to oppose, such as advice and guidance for GPs so that, if there are alternatives to deal with MSK, of which there is already a lot of evidence, they can refer people to a more appropriate or faster access route in the meantime. Those actions are being taken.

She is quite right that orthopaedics is a large part of the waiting list. However, diagnostics, access to faster treatment and using the independent sector where appropriate will particularly target orthopaedic waiting lists as part of our elective reform plan.

[Dr Johnson]

I am not opposed to the principle of GPs seeking advice or guidance; the issue is the compulsory nature of that and GPs not being able to refer.

[Karin Smyth]

The shadow Minister is tempting me to divert away from addressing the main point, but I will take her point on board. I am glad that the Conservatives do not oppose the principle of advice and guidance, because evidence suggests that it is a good route to patients having care closer to home and getting faster treatment. She knows this because it has been clarified, but if there is any doubt: there is no compulsion on GPs to do that.

The hon. Member for Winchester talked about his expertise and blowing his own trumpet with regard to antimicrobial resistance. He jests slightly about that expertise, but he raises a really important point about AMR that I am sure we will talk about more when we discuss new clause 32. He is absolutely right that it is an important public health issue that crosses many divides, and I look forward to discussing that later.

[Dr Chambers]

I thank all Members for their contributions to the discussion. The hon. Member for Lichfield made the good point that a committee of 70 people may not be that efficient. He should come to the Lib Dem parliamentary party meetings, which are incredibly efficient. We have incredibly insightful discussions, which is what makes us such an effective force, so I would not knock a committee of 70 people.

I appreciate the Minister’s acknowledgment of the important of cross-party work for public health. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 15

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.”—(Dr Chambers.)

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.

Brought up, and read the First time.

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[Karin Smyth]

I am happy to talk about the impact of trade arrangements on NHS spending and how arrangements are scrutinised by Parliament. I am grateful to the Liberal Democrats for the new clauses.

Our relationship with industry, life sciences and the pharmaceutical sector, as my hon. Friend the Member for Bury St Edmunds and Stowmarket said, is crucial not only to our patients and constituents, but to growth in our country. Many hon. Members will have companies large and small in their constituencies—my hon. Friend the Member for Aylesbury has Lynam Pharma in hers. Important local companies are doing great work, innovating and bringing great people together to work on behalf of the life sciences sector and our country. They make us proud to be a leading country in this area, and I give credit to the Prime Minister for his leadership to put this country back in its rightful place on the international stage, addressing yet another part of our international reputation that was trashed by the Conservative party. [Interruption.] You started it.

On new clause 15, parliamentary scrutiny is crucial to ensure that trade deals negotiated by this Government are in the best interests of the UK. That is why the Government are committed to transparency and to enabling effective scrutiny of our trade agenda. Nowhere is scrutiny more important than in considering the potential impact of trade agreements on public services such as the NHS. The Government have a clear framework in place for scrutiny of the trade agreements that we have negotiated. This process strikes the right balance between ensuring that appropriate parliamentary accountability can take place and preserving our ability to negotiate agreements effectively. That is important to ensure that the UK can negotiate credibly with its partners and secure in trade deals positive outcomes for the public and British businesses, while upholding and protecting the role of Parliament.

[Helen Morgan]

The disquiet about the deal comes from the fact that the sums involved are huge—possibly £9 billion a year, or even more towards the back of the 10-year period—according to big companies in the sector. The Association of the British Pharmaceutical Industry was not involved in the negotiation of the deal; it was negotiated with the US. We fully support of the life sciences sector in this country, and there is a complex debate to be had about access to novel medicines for people with unusual and rare diseases, and about balancing that with everybody else’s access to volume services on the frontline, but that important discussion should be had by Parliament and the British people, not between a trade negotiator and Donald Trump’s White House. That is where our disquiet comes from, and it is why we tabled these new clauses.

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[Karin Smyth]

I understand the intent of the hon. Member for North Shropshire and her commitment to parliamentary scrutiny, as well as that of her hon. Friend the Member for Oxford West and Abingdon. I hope that some of my points will address that.

New clause 15 duplicates existing processes and creates responsibilities for the Secretary of State for Health that would cut across our important procedures for scrutiny. No trade agreement can, by itself, change UK domestic law or require new public expenditure without the usual domestic processes being followed. Any changes to legislation necessary to implement a trade agreement would be subject to parliamentary scrutiny in the usual way. It is right that the Government be held to account, to ensure that trade deals deliver for the country. However, those processes are already in place and are working.

[Joe Robertson]

To strip this back further, can the Minister confirm whether a deal has been done?

[Karin Smyth]

I am not party to the negotiations. That is above my pay grade, like the conversation yesterday that the hon. Gentleman alluded to. I will get back to him on any outstanding questions, as the Department will to the Select Committee with other details.

[Dave Robertson]

To quote the Precision Health Technologies Accelerator at the University of Birmingham, very close to my Lichfield constituency, its leadership has been supportive of the removal of tariffs from pharmaceuticals, saying that the introduction of the tariffs could lead to

“supply chains collapsing and patients suffering.”

That is an enormous growth opportunity for the West Midlands combined authority, for Birmingham and for the wider region. There have been a lot of discussions, but I wanted to make sure that the views of organisations that will benefit are on the record, because this will be so beneficial for my region.

[Karin Smyth]

My hon. Friend clearly highlights the advantages for his constituents and the importance, particularly for that university and universities across the country, of such outward-facing arrangements, which benefit constituencies in many ways, not only through employment, but through the pharmaceuticals and medical devices, and so on, that help all our constituents.

New clause 76 specifically references the trade arrangement between the United States and the United Kingdom. That landmark partnership with the United States Government on pharmaceuticals pricing and tariffs is in the best interest of UK patients, supporting the NHS and the economy. As a result of the changes to the UK’s medicines pricing, NHS patients will get improved access to lifesaving treatments. New medicines have already been recommended under the updated approach, including a brain cancer drug available to patients as young as 12 and a last-resort treatment for a rare, aggressive stomach cancer—something that I think the entire House and the Committee would support.

[Liz Twist]

I want to emphasise a point that has already been made, which is the positive impact of the agreement for people with rare and undiagnosed conditions. As the Minister will know, I have worked with a number of those organisations, and this is certainly an opportunity for innovative treatments to be funded, as they might not have been before. I thank the Minister for that.

[Karin Smyth]

Again, this is an area of work that my hon. Friend has led on for many years, as I have seen, often when many others have not been around to support it. With so many organisations and charities lobbying on behalf of so many people who are desperate for rare diseases in particular to be highlighted—those diseases that affect a small number of people, many of them children—that work is crucial. Her work in leading in this place is exemplary. That is exactly where we aim to get by working with our partners in difficult circumstances. Trade deals and negotiations are necessarily difficult—otherwise, they would be easy—but the hard work yields results for people. As I have said, this Government have taken an outward approach to working with our partners and with industry.

We have already taken steps towards achieving our commitments, most notably increasing the NICE cost-effectiveness threshold. The Government previously updated Parliament in two ministerial statements, and of course MPs quite rightly have the option to continue to table parliamentary questions. Officials should be able to produce confidential advice for Ministers, to inform trade or other negotiations, and we must maintain that confidentiality in this case, as the impact assessment contains commercially sensitive assumptions. It is scenario-based and remains linked to live policy development. On that basis, I ask the hon. Member for Winchester to withdraw the new clause.

[Dr Chambers]

I thank the Minister for her comments. It is good to hear cross-party recognition of how important the life sciences sector is in the UK, to universities and businesses as knowledge transfer partnerships. This is a huge opportunity not only to improve the health of the nation and the treatments available, but to boost the economy.

We will withdraw new clause 15, but I thought the hon. Member for Isle of Wight East spoke extremely well about his concerns relating to the trade deal.

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[Karin Smyth]

Like the hon. Member for Isle of Wight East, I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. All Members are committed to ensuring that carers receive the care and support they need. The Government recognise that unpaid carers play a vital role in sustaining the health and wellbeing of millions of people across our country. I pay tribute to them, and recognise all the work they have contributed to. I also note the work done by my hon. Friend the Member for Ashford on the APPG with Members from across the House.

The hon. Member for Winchester highlighted the shocking impact on the physical and mental health of people who are caring, which we heard about in the evidence session. That is an important issue, and it is good that we can now talk more about the mental health of carers. As he rightly said, many of us are carers. It is not an easy thing to do.

I pay tribute to the hon. Member for Isle of Wight East for his comments about the importance of wraparound care to people who do not want to leave the one they care for. I recognise that respite care is important.

I wish the hon. Member for Sleaford and North Hykeham good luck in her campaign in her constituency with the Reform council.

[Dr Johnson]

I thank the Minister for her good wishes. The council has not just proposed closing Swallow Lodge; it has also recently closed the memory support service. I listened to what my hon. Friend the Member for Isle of Wight East said about services for people with dementia, and this is another area where people will suffer because of the closure of vital services.

[Karin Smyth]

When the hon. Lady gets back to her constituency, I am sure she will be campaigning heavily on behalf of her constituents.

We acknowledge the need to support carers’ health and wellbeing, but we do not think new clause 16 is necessary, because the existing legal framework already requires the system to support them. The new clause duplicates existing duties and risks adding complexity, rather than improving support in practice. Carers are explicitly referenced in the NHS constitution, which establishes the principles and values of the NHS in England and sets out the aim of improving the health and wellbeing of the population. The Secretary of State for Health, all NHS bodies, private and voluntary sector providers supplying NHS services, and local authorities in the exercise of their public health functions are required by law to take account of the constitution in their decisions and actions. Local authorities and NHS bodies also have a duty of co-operation in respect of their functions relating to carers.

Finally, under the Bill, the Secretary of State will take on NHS England’s role in promoting the involvement of each patient in decisions relating to their illness, care or treatment. That duty includes the involvement of carers and representatives.

[Liz Twist]

As the Minister says, many people in this room have had experience of being a carer for a family member. She said that there is already a legal framework, but carers are clearly saying that they need a bit more. How will the Government ensure that we provide not just words and legal documents, but help on the ground?

[Karin Smyth]

I was just moving on to talk about some of the work beyond the legislative framework.

Beyond the legislative framework, our focus is on delivering practical improvements because, as my hon. Friend says, that is absolutely what people want. We are committed to ensuring that carers have the support they need. Through measures in the 10-year health plan, we are already equipping and supporting carers by making them more visible, empowering their voices in care planning, joining up services and streamlining their care tasks by introducing a new My Carer section on the NHS app. We are also working with Ministers from the Department for Work and Pensions, the Department for Business and Trade and the Department for Education to consider how best to recognise and support unpaid carers. The Government are preparing a cross-Government action plan for unpaid carers, to be published this year.

[Dr Prinsley]

Will the Minister acknowledge that the uplift in the carer’s earnings allowance is a very significant measure that this Government did introduce?

[Karin Smyth]

I thank my hon. Friend. That is indeed one of the ways in which, working through the DWP and across Government, we have sought to bring in, as my hon. Friend the Member for Blaydon and Consett said, practical measures to make carers visible and to support them. That is exactly the sort of thing we wanted to do and have done, and it does start to recognise the work that people do.

Let me turn to new clause 17 and new clause 89, which my hon. Friend the Member for Blaydon and Consett talked about and which was tabled by my hon. Friend the Member for Shipley, whose expertise and commitment in this area are well known across the House. The new clauses look at the identification of, and provision of information to, unpaid carers. I agree on the importance of ensuring that carers are properly recorded and identified in the system and provided with relevant information and advice so that they can be better supported and involved in care decisions.

However, we do not believe that explicit requirements to identify and record particular patient and carer groups are appropriate for legislation. We have made clear commitments in the NHS 10-year health plan and are taking practical steps to improve identification, support carers and involve them in care planning. If we need to mandate compliance, that is best done by including requirements in national NHS contracts or in statutory guidance or directions, where we can provide more detail and directly address barriers.

Information about unpaid carers will be captured systematically to ensure that their responsibilities are recognised and supported, and developments such as the single patient record, which we have discussed in Committee, will make that easier in the future. That is a really important step forward.

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.

We are also working to improve the quality of local authority data on unpaid carers. The Partners in Care and Health programme, launched with the Local Government Association, is working with local authorities to improve their data and address barriers to data sharing between local systems.

[Dr Prinsley]

Since I have been an MP, I have visited a number of schools in my constituency, and I have always been struck by the number of children who are carers. [Hon. Members: “Hear, hear.”] I think that is a very under-recognised group of people, whose lives are completely dominated by the fact that they are carers for their parents.

[Karin Smyth]

I thank my hon. Friend. I heard audible voices of approval for that point. I think that when any of us know or encounter children, whether it be in our own circle or when we visit schools in our constituency, we are very much struck by those who are at school and are themselves caring. I think most schools do a tremendous job where they recognise that. Often children, like adults, do not want to inform their school or local people that that is what they are doing—they are very proud—and perhaps the person they are caring for does not know how to do that. I have certainly seen in my constituency schools starting to recognise and support the needs of those children, in a way that is dignified and respecting of privacy.

I did allude to some of the work that we are doing across Government, including with the Department for Education, to recognise, and to find ways to support, those young people, many of whom want to support their loved ones. I think we have all seen great ways to support them. When we are addressing young children in classrooms, I am always conscious of the need to think about the circumstances in which we are talking to them. There are a lot of teenage carers as well. My hon. Friend the Member for Bury St Edmunds and Stowmarket is absolutely right to highlight that.

More broadly, apart from data sharing and addressing barriers, the My Carer section of the NHS app will allow people to securely prove that they are providing care. That will streamline the care responsibilities of carers significantly—again, that can be done without having to confront the situation in public, if that is what people want—while giving them a means to seek advice or reassurance directly from a range of professionals when they need it.

I am also not convinced that the challenge of providing effective support would be solved by an additional legal duty. The existing legal framework already requires the system to support carers, including through the provision of information and advice. As the Committee has discussed, practical steps are what is needed. Progress is being made locally through issuing practical toolkits to help hospitals implement their legal duties under the Health and Care Act 2022. This year, the Government will also commission the better care fund support programme, led by the Local Government Association, to work with the NHS and social care partners to strengthen their approach to involving unpaid carers in discharge planning.

New clause 18 would establish a national respite care scheme. The Government do not feel that that is necessary, as the legal framework already provides rights for carers to access support, including respite services. Under the Care Act 2014, where a carer appears to have support needs, whether those are current or in the future, local authorities are required to carry out a carer’s assessment. Where carers have eligible needs, local authorities have duties and powers to meet them. That establishes a framework where needs assessments and subsequent care planning focuses on the individual and their circumstances, rather than prescribing a particular service or solution. In other words, respite care is already one of the many forms of care and support that might be offered as part of the process, where it is appropriate to meet the needs of the individual carer.

Funding and mechanisms are in place to enable local areas to deliver support for carers. Under the better care fund framework, there is £9 billion for integrated care boards and local authorities to make joint plans and to pool budgets to deliver better, joined-up care. In developing their better care fund plans, ICBs and local authorities should consider how pooled funding can help the NHS and local authorities to meet duties on unpaid carers, including around short breaks and respite services.

The Government are also making available more than £4.6 billion of additional funding for adult social care in 2028-29, compared with 2025-26, to support the sector to make improvements. Local areas will determine how best to use the money to support carers, depending on local need and with reference to their statutory responsibilities.

For those reasons, I ask the hon. Member for Winchester to withdraw new clause 16, and hon. Members not to press new clauses 17, 18 and 89 to a vote.

[Dr Chambers]

I thank Committee members for their contributions. The hon. Member for Isle of Wight East spoke particularly well and emotively—I know that he worked for Dementia UK before entering Parliament. My mother was a carer for my father, who had dementia, and my sister and I gave her respite care, although probably not enough of it. I know that many Committee members will have been in a similar situation, as it is a common disease, and it is becoming increasingly common. I also thank the Minister for her comments and reassurance.

The hon. Member for Bury St Edmunds and Stowmarket made a point about children being carers. I sat on the Mental Health Bill Committee last year, and to give an example of how impactful such Committees can be, it is now a requirement, as a result of the Committee’s consideration, to identify whether mental health patients have children who are carers. That was not the case before, and we appreciated the Government engaging with us on that issue. It is often teenagers who care for adults with severe mental health issues, but they were not even identified before, so they could not be given the support they required. That has changed now, and it is fantastic to see that, through Committee scrutiny, we can make a tangible difference to people’s lives.

I will not press new clauses 16 and 17 to votes, but the Liberal Democrats do think that it would be sensible and impactful to establish a national respite care scheme, so I will press new clause 18 to a Division. On new clause 16, I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 18

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) a local authority carrying out a carer’s assessment under section 10 of the Care Act 2014 to be required to consider whether a 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’ has the meaning given by section 10 of the Care Act 2014 and includes a young carer within the meaning of section 96 of the Children and Families Act 2014.”—(Dr Chambers.)

This new clause would require the Secretary of State to establish a National Respite Care Scheme.

Brought up, and read the First time.

Question put, That the clause be read a Second time.

--- Later in debate ---

[Dr Johnson]

The hon. Member for Dewsbury and Batley (Iqbal Mohamed), who tabled new clause 25, asked me to speak to it, which I shall do briefly. This is a very serious issue. Critically ill children are infants, children and adolescents with life-threatening illness or injury, often requiring intensive, continuous care to survive conditions from leukaemia to meningococcal disease, traumatic brain injuries and major surgery such as spinal surgery. I should say that I am a consultant paediatrician, but I have worked in paediatric intensive care as a junior—now called a resident—doctor.

The new clause as drafted does not, I think, do what the hon. Member was aiming for. When I read it through, I think he is looking at cases such as the tragic one of little Charlie Gard, whom we all remember died of encephalomyopathic mitochondrial DNA depletion syndrome, known as MDDS. It is incredibly rare. That tragic case highlighted the potential for disputes between parents and doctors, which, thankfully, are unusual.

The new clause is headed, “Parents of critically ill children: communication and involvement in decision-making”. Of course parents should be involved in decision making about their children, but it is worth noting that the median time that children spend in ICU is two days and that, thankfully, most of them get better—very few do not. The new clause talks about teachers being involved, which in most cases is unnecessary and impractical; in many cases, a child may be admitted on a Friday and discharged from the ICU by the Monday. In the majority of cases, there is no practical reason for teachers to be involved.

I understand the desire for parents to be part of every meeting, but sometimes clinicians need to be able to talk frankly about cases. Sometimes they will have multidisciplinary meetings where they talk about a plethora of different cases, or they may compare one case with another in terms of what they have seen, the findings of scans and the like, so it is not possible to have parents in every single meeting, although it is of course desirable for them to be aware of the discussions.

Other parts of the new clause, including provision for parents to know about everything and to set out how communication and language needs may be met, seem reasonable. It mentions independent mediation where there is disagreement, which is a beneficial way to go about things, but we must not legislate so as to get in the way of urgent care, because most critically ill children in intensive care have urgent care needs that need dealing with now, not in a week’s time. Forming ethics committees to make decisions takes a long time, and that would get in the way of urgent care.

I think the hon. Member for Dewsbury and Batley is aiming for legislation that relates to chronically mechanically ventilated children with significant medical conditions, rather than children with an acute critical illness, but I said I would move the new clause and I have. I think he is trying to provide better care for some of the sickest children. That is a desirable aim and I know he cares deeply about it, but the new clause as drafted would not do what I think he aims for, and it could get in the way of paediatricians and others managing some of the sickest children in the country, so I will not press it to a vote.

[Karin Smyth]

I am grateful to the hon. Member for Dewsbury and Batley for tabling new clause 25, and grateful to the hon. Member for Sleaford and North Hykeham for her comments on it. It is a genuine pleasure to hear the expertise of clinicians such as her who work in the field of children’s health. She is obviously very passionate about that, and I thank her for bringing her expertise and commitment to looking after children, including critically ill children, to the Committee.

I recognise the profound impact that receiving a diagnosis of a life-threatening condition has on a child and their wider family. At such an overwhelming time in their lives, it is vital that families feel supported, informed and able to navigate the care and services available to them. We recognise that families can face huge variation in the support available and that they have to navigate complex systems at a particularly difficult time. I know that many hon. Members support many families in such circumstances in their constituencies. The Government are committed to ensuring that families have access to the support they need in the most straightforward way possible.

New clause 25 seeks to place a duty on the Secretary of State to issue guidance to integrated care boards on communications with parents of critically ill children and on parents’ involvement in decision making in respect of the treatment or care of their child. We heard from the Opposition spokesperson about some of the operational issues with some of its provisions, but there are no issues with its intent: of course parents should be involved and have good decision making at such a time.

Decisions about the care of a critically ill child can of course be distressing. We need to ensure that we get the process right from the beginning. That starts with good communication, sensitive handling and ensuring best practice across the system. Healthcare professionals should always act in the best interests of their patients; the views of parents are of course very important, but the child’s best interests are paramount, and we should not do anything that undermines that crucial principle. It is important that families and medical professionals communicate and, where possible, reach agreement on the care and treatment that is in the best interests of the child.

To support that, there are already many excellent examples of guidance and best practice across the health system. The Royal College of Paediatrics and Child Health is currently updating its framework for clinical practice on navigating decisions to provide, limit or withdraw treatment towards the end of a child’s life. That framework will include communication principles, legal and ethical principles, and clinical and practical considerations, including the role of clinical ethics services. It will also include guidance on navigating disagreements for professionals, children, young people and their families. An e-learning platform is available to staff working at all levels in children’s healthcare. The training programme provides professionals with a suite of resources to enhance knowledge, skills and confidence. It supports healthcare providers to recognise, manage and de-escalate conflict between families and healthcare providers where it occurs, and to signpost to both professional resources and resources for families. The actions I have outlined will continue to help and support the existing best practice.

[Dr Johnson]

The Minister is setting out the important guidance that can be provided to clinicians managing the care of children who are seriously unwell. I want to add for the record that I am a member of the Royal College of Paediatrics and Child Health, which is producing that guidance; I am grateful to her for setting out its importance. End-of-life-care decisions are very difficult. They need to be taken in conjunction with families but—the Minister is absolutely right—they must be made in the best interests of the child in all cases.

[Karin Smyth]

I am sure that the college will make best use of the hon. Member’s clinical expertise and her expertise as a legislator to get that guidance right. We work with royal colleges to ensure that we get the best clinical evidence into guidelines. I hope the actions I have outlined will continue to help and support the existing best practice, training and guidance on shared decision making and dispute resolution, so that it is embedded across the system.

There are a number of other important measures in this group that have not been mentioned. Let me just say that, alongside some of the things I have outlined, we want to progress system-wide reforms to improve the way children and young people, and their families, are supported across many conditions. We are working to bring forward a modern service framework for children and young people that will set out how we will improve quality for children and young people’s services in the longer term, as part of our 10-year health plan.

[Dr Johnson]

I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 28

Appeals against health and social care provision in EHC plans

“(1) The Special Educational Needs and Disability Regulations 2014 (S.I. 2014/1530) are amended in accordance with subsections (2) and (3).

(2) After regulation 42, insert—

‘42A Other matters relating to EHC plans against which appeals may be brought

(1) In addition to the matters set out in section 51(2) of the Act, a child’s parent or a young person may appeal to the First-tier Tribunal against the matters set out in paragraph (2), subject to section 55 of the Act (mediation).

The matters are—

(a) a decision of a local authority, following an EHC needs assessment, that it is not necessary for health care provision or social care provision to be made for the child or young person in accordance with an EHC plan;

(b) where an EHC plan is maintained for the child or young person—

(i) the child’s or young person’s health care or social care needs as specified in the plan;

(ii) the health care provision or social care provision specified in the plan.’

(3) In regulation 43 (appeals), after paragraph (2) insert—

‘(3) When determining an appeal on the matters set out in regulation 42A(2)(a), the First-tier Tribunal has the power to order that—

(a) health care needs, or health care needs of a particular kind, which relate to the child or young person's special educational needs are specified in the EHC plan in accordance with regulation 12(1)(c);

(b) social care needs, or social care needs of a particular kind, which relate to the child or young person's special educational needs or to a disability are specified in the EHC plan in accordance with regulation 12(1)(d).

(4) When determining an appeal on the matters set out in regulation 42A(2)(b), the First-tier Tribunal has the power to order that—

(a) the health care needs specified in the EHC plan in accordance with regulation 12(1)(c) are amended;

(b) the social care needs specified in the EHC plan in accordance with regulation 12(1)(d) are amended;

(c) health care needs, or health care needs of a particular kind, which relate to the child or young person's special educational needs are specified in the EHC plan in accordance with regulation 12(1)(c) where those needs have not been specified in the plan; and

(d) social care needs, or social care needs of a particular kind, which relate to the child or young person's special educational needs or to a disability are specified in the EHC plan in accordance with regulation 12(1)(d) where those needs have not been specified in the plan.

(5) When determining an appeal on the matters set out in regulation 42A(2)(a), the First-tier Tribunal has the power to order that—

(a) health care provision, or health care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(g);

(b) social care provision, or social care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(h).

(6) When determining an appeal on the matters set out in regulation 42A(2)(b), the First-tier Tribunal has the power to order that—

(a) the health care provision specified in the EHC plan in accordance with regulation 12(1)(g) is amended;

(b) the social care provision specified in the EHC plan in accordance with regulation 12(1)(h) is amended;

(c) health care provision, or health care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(g) where that provision has not been specified in the EHC plan; and

(d) social care provision, or social care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(h) where that provision has not been specified in the EHC plan.

(7) When the First-tier Tribunal makes an order in respect of health care needs or health care provision, it must send a copy of the order to the responsible commissioning body.

(8) When sending a copy of an order, the First-tier Tribunal may also send a copy of the decision which disposes of any appeal brought under section 51(1) of the Act or under regulation 42A to the responsible commissioning body.

(9) The responsible commissioning body must respond within 5 weeks beginning with the date of the order to—

(a) the child's parent or the young person, and

(b) the local authority that maintains the EHC plan.

(10) The time limit specified in paragraph (9) does not apply where the First-tier Tribunal directs that a different time limit is to apply for the responsible commissioning body's response.

(11) A response under paragraph (9) must—

(a) be in writing,

(b) state what steps, if any, the responsible commissioning body has decided to take following its consideration of the order, and

(c) give reasons for any decision not to follow the order, or any part of it.

(12) The local authority must send a copy of the response received from the responsible commissioning body under paragraph (9)(b) to the Secretary of State within 1 week beginning with the date it was received.

(13) When the First-tier Tribunal makes an order in respect of social care needs or social care provision, the local authority must issue the amended EHC plan to the child's parent or the young person within 5 weeks beginning with the date of the order.

(14) The time limit specified in paragraph (13) does not apply where the First-tier Tribunal directs that a different time limit is to apply.

(15) The local authority must send a copy of the amended EHC plan under paragraph (13) to the Secretary of State within 1 week beginning with the date on which this is issued to the child's parent or the young person.’

(4) The Special Educational Needs and Disability (First-tier Tribunal Recommendations Power) Regulations 2017 (S.I. 2017/1306) are revoked.

(5) In consequence of the revocation made by subsection (3), the following 15 provisions of the Special Educational Needs and Disability Regulations 2014 are also revoked—

(a) regulation 10(3)(e);

(b) regulation 14(2)(e);

(c) regulation 201(11)(e);

(d) regulation 21(10)(e);

(e) regulation 22(5)(e);

(f) regulation 25(2)(e); and

(g) regulation 31(3)(e).”—(Dr Chambers.)

This new clause extends the powers of the First-tier Tribunal so that when it is determining an appeal it may order that Education, Health and Care plans must include health and social care needs and provision, rather than just making recommendations on these matters.

Brought up, and read the First time.

--- Later in debate ---

There is a lot of merit in the new clause and, as my hon. Friend the Member for Sleaford and North Hykeham said, it will be interesting to hear the Minister’s thoughts on it. Obviously, this needs to be done in collaboration with the Department for Education, and it is right—the Select Committee acknowledged this—that other changes would also be needed to support it, including workforce increases and changes to commissioning, but that should not prevent us from seriously considering the new clause. I pay tribute to all the parents and carers in my constituency who are struggling with the EHCP process and doing their best for their children under really difficult circumstances.

[Karin Smyth]

May I add to the comments of the hon. Member for Farnham and Bordon by paying tribute to the families in my constituency of Bristol South who are also struggling? The care of a child is obviously one of the most difficult and important things that a person can do. When that child is in distress and not supported by the system, it is a very hard place for a parent to be. As I think all hon. Members have said, that is an issue that arises a lot in our inboxes, our emails and our constituency surgeries, and it has been difficult to address. I commend the Education Secretary and her team of Ministers for bringing this work forward and starting to tackle the issue.

[Dr Prinsley]

My wife is an educational psychologist, so I have lived this, in a vicarious fashion, for the last 30 years or more. I understand how the system for special educational needs has evolved, particularly the role of the psychological services and how children are supported. As a result of a series of reforms, in particular during the years of austerity, the services provided by local authorities to schools—particularly the schools’ psychological services—became much more focused on psychologists providing reports to inform the distribution of resources, and much less focused on educational psychologists actually being in schools supporting children. I would like to see a change, such that educational psychologists and their expertise are back in schools, in classrooms, supporting teachers. Time and again when I visit schools, they say, “Let’s get educational psychology support back into schools.” I think that is something my wife would support.

[Karin Smyth]

I thank my hon. Friend for that. I put on record my thanks—our thanks—to his wife for her work in this area and for making him so aware of the issues, because he is absolutely right. This is a long-in-gestation issue that some of us have watched sadly get worse in our constituencies over recent years. Children only get one chance to come through this system, which is why people feel so passionately about it.

[Sojan Joseph]

I pay tribute to all the parents and schoolteachers who engaged with me last summer, following the White Paper and the SEND consultation. It has been a huge problem in Kent. Kent county council has been under Conservative administration for the last 25 years. In recent years, it was in special measures because of its SEND provision. Parents really struggled. My inbox is filled with these issues. We know that 98% of SEND provision tribunals rule in the parents’ favour. There has been a long wait. Does the Minister agree that, whether we accept the new clause or not, we need to look into how the NHS and local authorities can work together to make it easier for children, families and schools to get proper provision in place?

[Karin Smyth]

I thank my hon. Friend for his description of what has happened in Kent, which has been under Conservative administration for so long. He is absolutely right about the White Paper. The hard work that my right hon. Friend the Secretary of State and the ministerial team have done across the country, regardless of the local political administration, is exemplary. I will come on to talk about the tribunals.

The Government’s SEND reforms aim to transform outcomes for children and young people with SEND and their families, ensuring that the right support is available at the right time and preventing needs from escalating or reaching crisis in the first place. That is why the reforms aim to build a system that parents can trust with collective responsibility in local areas and strong partnership working across education, health and care. That is what parents expect us to be doing.

[Liz Twist]

I recently held consultation meetings on the proposed SEND reforms in Blaydon and Consett. The message from parents was clear in both places: they wanted greater integration of health into EHCPs. I welcome the Government’s commitment to asking ICBs to work more closely with local authorities to develop SEND reform plans and tackle this issue. Does the Minister agree that it is important for ICBs to take that on board?

[Karin Smyth]

I thank my hon. Friend for going to hear directly from her constituents. She is right: that message is fairly consistent. Last year, my hon. Friend the Member for Bristol East (Kerry McCarthy), my right hon. Friend the Member for Bristol North West (Darren Jones) and I played a pivotal role in bringing our ICB and local authorities together as local Members of Parliament. That was a result of our experience with parents and constituents. Members of Parliament from across the House—this is not a party political point—can bring parents together to highlight this issue and use parliamentary power to bring together organisations that sometimes do not listen or know the best way to communicate. Our role in that has been pivotal. The Secretary of State for Education has taken that learning forward across the country.

That is why we are taking the steps to deliver the programme. ICBs have been asked to work with local authorities to develop local SEND reform plans. Those plans will lay the foundation for long-term reform, enabling ongoing monitoring of progress, and draw on knowledge, skills and lived experience held locally. That builds on work that is under way to improve accountability and set expectations of joint working, which is what parents and families expected to happen, but was not happening. Each ICB is expected to have an executive lead on SEND. The NHS medium-term planning framework for the next three years made it clear that ICBs and providers must meet their statutory duties and support delivery of the reforms.

Ofsted and the Care Quality Commission will continue to check how local services, including health, work together for children and young people and hold them accountable. We will also update the SEND code of practice and publish new guidance so that local SEND partnerships have clearer expectations to work to. That is why we have not proposed changes to health and social care appeals to the SEND tribunal or made the decisions binding. This reflects the need for ICBs and NHS providers to retain the flexibility to plan services across their wider populations and prioritise support according to clinical and population need. This aligns with our commitment in the 10-year health plan to create a new NHS operating model where ICBs are the strategic commissioners of local healthcare services. It is worth noting that while tribunal decisions on health and care are non-binding, local authorities and ICBs are expected to follow them, and in most cases do. If they do not follow recommendations, they must send a response setting out the next steps they have decided to take and why.

There is no doubt that health and social care have crucial roles in SEND reforms, with shared ambitions across education, health and care for earlier intervention and support. I reassure the Committee that we are exploring further opportunities to strengthen accountability, as stated in the SEND consultation document. We are considering responses to the consultation, which closed on 18 May, and will set out our next steps in due course. For those reasons, I ask the hon. Member for Winchester to withdraw the new clause.

[Dr Chambers]

I thank everyone for their comments. I thank the Minister for her reassurances on the seriousness of this issue. Given that we are waiting for the response to the report, I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

Ordered, That further consideration be now adjourned.—(Emma Foody.)

Health Bill (Fourteenth sitting)

Karin Smyth Excerpts

Committee stage
Thursday 9th July 2026 Public Bill Committees

[Dr Johnson]

I agree. I am sure that the purpose behind the new clause is to ensure that data is safe, but it removes democratic accountability from the process of developing the policy, which may reduce the public’s confidence in it. I agree with its underlying principles, but much of it is cumbersome and, as yet, undefined, so it is important that we get more detail and specificity.

[The Minister for Secondary Care (Karin Smyth)]

It is good to see you in the Chair, Dr Huq. I am grateful to the hon. Member for North Shropshire for tabling this new clause. I am sympathetic to its intentions: the security of data, the transparency of use and even realising the value of data. Its principles are in the interests of the public and the NHS, but we do not consider it necessary to achieve our aims. It would impose onerous operational requirements and could have a damaging impact on the ability of the NHS to function.

There is also a significant overlap with the role of the independent national guardian and potentially that of the information commissioner. Once the functions of NHS England have transferred to the Secretary of State, the Secretary of State must have regard to the need to respect and promote the privacy of recipients of health services and of adult social care in England, which is in addition to the requirements already set out in UK GDPR. The Secretary of State will be able to issue guidance to the health and care sector relating to the processing of information to which NHS bodies must have regard. The Secretary of State will be under a duty to have regard to guidance given by the Health Research Authority on the disclosure of confidential information.

The proposed trust functions would also encroach significantly on the operational role intended for the health data research service, and would place cumbersome constraints on vital data collecting and sharing within the NHS. The new clause would mean that all health data collections and data-sharing initiatives would have to be preceded by public consultation. That would capture any of the essential collections that NHS England undertakes, and indeed any collection by NHS organisations, not to mention the use of that data. The burden would be considerable, with very real consequences for the ability of the NHS to use that data to improve outcomes for patients.

Likewise, I cannot see how requiring all health data to be held anonymously and accessed only through a trusted, secure research environment would be compatible with delivering direct care to a patient or using confidential patient information for planning and commissioning services or research. It seems that the new clause would prevent such uses. For those reasons, I ask the hon. Member to withdraw the motion.

--- Later in debate ---

[Gregory Stafford]

It is very important that we consider these new clauses and amendments carefully, not least because, as my hon. Friend has just outlined, the hon. Member for Worthing West, who tabled them, has considerable expertise, being a public health consultant herself. I have the pleasure of sitting with the hon. Member on the Health and Social Care Committee and she brings her expertise to every single sitting. I am sure that the Minister has welcomed her questioning when she has appeared before that Committee.

It is really clear that, if we are going to make a success of the Bill, public health in all its guises needs to be at the forefront of our thinking about how we achieve better patient outcomes, better health and, more specifically, the Government’s stated aims in the 10-year plan to, first, shift care closer to home and, secondly, focus more on prevention rather than treatment. I am sure that across the House we agree with that ambition and therefore I can totally understand why the hon. Member for Worthing West has tabled these new clauses.

I suspect that the new clauses are also a reaction to something that we have already discussed in this Committee, which is the dislocation and now the separation of local authorities from ICBs, with the removal of their statutory functions on those boards, to be given to strategic mayoral authorities. Some of those strategic mayoral authorities exist but, as we have discussed at some length in the Committee, many of them do not exist and might never exist. I can see why the hon. Member for Worthing West is trying to ensure that the vital work of directors of public health in local authorities for their population areas is somehow safeguarded and included in the Bill.

That being said, I have some reservations about how these new clauses are currently drafted. My hon. Friend the Member for Sleaford and North Hykeham has already outlined many of them. Although strengthening public health leadership is an essential objective, new clause 24 defines the statutory role and legal status of directors of public health in this context without providing sufficient clarity about accountability or governance, or about how these new powers would interact with existing NHS and local authority structures. Potentially, there is a risk of creating overlapping responsibilities, blurred lines of accountability and additional bureaucracy at a time when integrated working should be simplified rather than made more complex.

Obviously, the hon. Member for Worthing West is not here to answer my questions. I ask the Minister this: if these new clauses are not pressed to a vote, or if they are but are not accepted by this Committee, how can she reassure me and the hon. Member for Worthing West that public health will still be at the forefront of the Bill, and that the removal of local authorities from ICBs will not have the impact that I think the hon. Member, who tabled these new clauses, is concerned about?

[Karin Smyth]

Further to that point, I absolutely want to assure my hon. Friend the Member for Worthing West, who is not a member of this Committee, and indeed the members of this Committee that the Government fully appreciate the important role of public health professionals. They bring critical expertise in population health intelligence, epidemiology and community co-design, and those capabilities are integral to the role of ICBs as strategic commissioners.

On new clause 11, there is already a statutory duty on ICBs to seek advice, and a statutory duty on local authorities to provide public health advice to ICBs. However, that does not mean that ICBs should be required to employ a director of public health directly. Local authorities already employ a director of public health and we expect ICBs to work collaboratively with their local authority partners and not to duplicate their work.

NHS England recently published the strategic commissioning framework and guidance for ICBs on strengthening the public health advice, both of which are clear that ICBs should work with local public health teams and stakeholders to draw upon their expertise to ensure a strong evidence base for commissioning decisions.

As the responsibilities of ICBs for commissioning NHS public health services grow, we expect them to continue to draw on the skills and expertise of local authority directors of public health, as well as other specialist public health expertise, including screening and immunisation leads, and the UK Health Security Agency. I absolutely agree that public health expertise is essential for ICBs to commission effectively and we have set out how they will access that; the basis for all this is of course the joint strategic needs assessment. However, I do not believe that it is necessary to require an ICB to appoint a lead director for public health in order to have access to such advice.

On new clause 24, as the Committee is aware, local authority directors of public health are advocates for the health of their population. They have a professional leadership role across the three domains of public health: health improvement, health protection and healthcare public health. Their work spans organisational boundaries. Although they are employed by local authorities and appointed jointly with the Secretary of State, their role is designed to bridge local government and the NHS. They are also required to provide objective, evidence-based advice, without political interference, and they are expected to be suitably qualified and regulated public health specialists who take a population-wide perspective to health outcomes and health inequalities.

At the heart of their role is their statutory responsibility to prepare an annual report on the health of their local population. That crucial document underpins the plans of health and wellbeing boards and, through them, the ICBs. Directors of public health are also required to be members of health and wellbeing boards, which will be the central mechanism for partnership working between local authorities and ICBs in the new neighbourhood health system. As such, directors of public health will be well placed to help to shape ICB system-wide plans and strategies on public health issues going forward, something that we discussed earlier in the Committee.

There is a statutory duty on ICBs to obtain appropriate and expert public health advice, and a legal duty on local authorities in turn, carried out by the director of public health and their team, to provide public health advice to ICBs. Beyond those requirements, the NHS, including ICBs, is of course free to employ its own senior public health professionals.

The proposed new clause risks creating some significant ambiguity around accountability and risk, constraining rather than enhancing the independence of directors of public health, which I am sure is not the intention of the hon. Member for Sleaford and North Hykeham or of the Committee. I hope I can offer reassurance to the hon. Member and indeed to the Committee that we are proud of our strong and coherent public health system, that this Bill does not alter its importance and that we will continue to champion the role of directors of public health and ensure clarity in the new architecture. I ask that the new clause be withdrawn.

[Dr Johnson]

I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 12

Corridor Care Accountability

“(1) Six months after the passage of this Act, and every 12 months thereafter, the Secretary of State must produce and lay before Parliament a report on the prevalence of corridor care in NHS hospitals.

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

(a) an analysis of data on the number of corridor incidents at the national, integrated care board, trust, and hospital level,

(b) the steps the Secretary of State has taken that year to reduce the number of corridor care incidents,

(c) the Secretary of State’s plans to reduce the number of corridor care incidents in the coming year, and

(d) information regarding the amount of funding directed toward reducing the number of corridor care incidents that year and funding allocated for such efforts in the future.

(3) Following the publication of a report under subsection (1) the Secretary of State must give evidence in front of a panel (to be called the “Corridor Care Tribunal”) including—

(a) patients,

(b) bereaved or affected families, and

(c) frontline NHS staff who have been impacted by corridor care.

(4) Panel members for a Corridor Care Tribunal under subsection (3) shall be identified by local Healthwatch organisations and NHS Royal Colleges.”

This new clause requires the Secretary of State to publish an annual report about corridor care and give evidence before a panel of affected patients and staff.—(Helen Morgan.)

Brought up, and read the First time.

--- Later in debate ---

[Gregory Stafford]

I will give way to the hon. Lady after I finish my sentence, if I may. The public want to know what the solutions are. I think we could look back through history at successive Governments since prehistory and say, “They got some things right, and they got some things wrong.” What the public want to know now is what the current Government will do. 

On the point about social care, I was not a member of the last Government, but I stood on an election manifesto commitment, as the Labour party certainly did and I think most political parties did, that essentially said that the Dilnot review had decided how we were going to deal with social care, and we were going to get on with it. It strikes me as very strange that the last Secretary of State, the right hon. Member for Ilford North (Wes Streeting), decided to have another review; he has said himself in interviews since he resigned that it looks like the stalling on social care means that we will not get any movement on it before another general election. I do not think the public should put up with that.

[Karin Smyth]

As the hon. Member was not here at the time, perhaps it eludes his memory, I remind him that it was a coalition Government agreement to move forward with Dilnot, which had cross-party support. As soon as the coalition finished in 2015 and the Conservative party had dumped their friends in the Liberal Democrats, almost immediately after that election, it also dumped all pretence around the Care Act 2014 provisions at the time. We are where we are. I just wanted to help his memory.

[The Chair]

Order. I think we are moving a little out of scope here. Could we bring it back to the contents of the Bill?

--- Later in debate ---

[Dr Johnson]

I am always happy to encourage the hon. Gentleman; I hope that in the impending reshuffle, he is given the opportunity to put his experience into practice. I have one word for him: pandemic. The pandemic made a huge difference to the numbers on waiting lists, and there is no current pandemic. It is possible to make arguments about whether the Government at the time—I was not in the Government at the time—were too harsh in their policies around elective care, whether patients would have come into hospitals for elective operations during covid or whether they would have preferred not to, and whether the waiting lists grew more than they may have done in other circumstances, but to try to say that the pandemic had no effect is going a stretch too far.

[Karin Smyth]

To correct the shadow Minister, I do not think my hon. Friend the Member for Bury St Edmunds and Stowmarket said that; he said the waiting lists have gone up. To be clear, in case her memory eludes her again, they were at 4 million before the pandemic and the Conservative party—her party, whose manifesto she stood on—did not meet a single target since before 2015. That is important for people to remember: 4 million people were on waiting lists before the pandemic started. The NHS went into crisis under the Conservatives’ leadership. Even if the hon. Member for Isle of Wight East thinks it is tedious to remind them of their record, no member of the public thinks it is tedious; they will never be forgiven for that record.

[Dr Johnson]

I think what members of the public want is the people who are in government now to do something to improve their lives. I am in danger of repeating myself, which could present an extra concern when so many people are questioning my memory, but there has been a 2.5% increase in the number of A&E attendances, but a 17.1% increase in the number of people waiting more than 12 hours after a decision to admit. That suggests that the Government are not going in the right direction. The public may enjoy a history lesson from time to time, but what they really want to know is what is happening now to make their lives better. I am sure the Minister will give us the answer to that in her summing up, but at the moment the Government are not bringing down the long waits in A&E.

Let me return to the new clauses. Corridor care needs a whole-pathway approach. In last night’s debate we talked about the importance of preventing admissions—I know that is one of the Government’s shifts—in order to increase hospital capacity. The hon. Gentleman for Bury St Edmunds and Stowmarket talked about capacity and the number of beds having reduced over a long period—another history lesson—but when my mum had me, a good few years ago, it was common for women to stay in hospital for quite a long time after having their child, and it was quite common for people to stay in bed for many days after having an operation. We now know that it is better for people to be up and about, and people leave hospital more quickly. That is a good thing. The reason for bed numbers coming down over successive Governments of different parties is clinical as well as managerial. I think that is worth saying.

Will the Minister answer a question that I asked in last night’s debate but, unless I missed it, she did not answer in her summing up? Does the NHS have more beds now than it did when Labour came to power in July 2024, or fewer? I believe the answer is fewer.

New Hospital Programme Annual Report

Karin Smyth Excerpts

Wednesday 8th July 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

Today the Department has published the first “New Hospital Programme annual report”, covering the 2025 to 2026 financial year.

This report marks the first full year of delivery following the programme reset and the publication of a costed, phased delivery plan through the NHP plan for implementation in January 2025. It represents an important transition from recovery and stabilisation to sustained delivery under a clearer and more realistic framework.

The report sets out the progress made by the NHP during the last financial year, at both programmatic and scheme level. Over the reporting period, the programme has strengthened its governance and assurance in response to scrutiny from the National Audit Office and Parliament.

It has made progress across hospital schemes in multiple waves, and new delivery approaches have been implemented such as the Hospital 2.0 standardised design model and the Hospital 2.0 Alliance commercial framework, aimed at improving efficiency, increasing market capacity, and enabling faster delivery at scale.

Each scheme within the NHP presents its own complex challenges. Market capacity at all tiers continues to pose potential delivery constraints. The launch of the Hospital 2.0 Alliance is an important step in creating a commercial environment that protects the supply chain and enables concurrent delivery of several large hospital schemes.

Looking ahead to the 2026-27 financial year, the NHP will continue to progress schemes in line with the plan for implementation. For wave 1 schemes, focus will remain on business case development and preparing sites for main construction. The seven RAAC replacement schemes, while having been deemed safe to remain open beyond 2030 with appropriate mitigations in place, remain a priority and will continue to be a key focus for the programme in the financial year 2026-27.

Wave 2 schemes will focus on early works to support scheme readiness and de-risk future delivery, and for schemes in wave 3 there is focus on early pre-construction work to de-risk the delivery of schemes where it is necessary to do so at this stage.

A copy of the report has been placed in the House of Commons Library and is available on www.gov.uk.

[HCWS201]

Health and Social Care 10-year Capital Plan

Karin Smyth Excerpts

Wednesday 8th July 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

Today the Government are publishing the 10-year capital plan for health and social care. Long-term capital under-investment has left the healthcare system starved of resources to function at its fullest, with large parts of the NHS and wider healthcare estate operating in outdated, inefficient and occasionally unsafe infrastructure. This was made clear in Lord Darzi’s report, which estimated a £37 billion shortfall of investment since 2010 compared with international peers.

The 10-year health plan set out the long-term vision for healthcare provision with the three shifts of hospital to community, analogue to digital and sickness to prevention as the core components of a new care model based on the NHS’s founding principles. This capital plan will bring together our commitments into a single coherent framework that is aligned with the 10-year health plan, and ensure infrastructure is the enabler for transforming the NHS over the decade ahead.

The Government are fully embracing this challenge and have already taken steps to address the root causes affecting healthcare delivery. At spending review 2025, the Chancellor provided the largest ever health capital budget, as well as multi-year allocations to 2030 for capital funding streams overall and extended certainty on NHS maintenance budgets to 2035. The priority is now to get on and deliver our priorities within this—making the most of both the budget and the certainty that enables the most strategic investment choices.

We will enable the first shift from hospital to community by reconfiguring the estate so that patients see the appropriate staff in the right place, and we have already invested £102 million in the primary care utilisation and modernisation fund, with a further £200 million over four years to 2030. In addition, we will support the development of neighbourhood health centres, as well as ensuring the secondary care estate can deliver the highest-quality healthcare for the most complex and specialist cases. Maintenance of the estate will extend beyond the current spending review via an investment of £6.75 billion over nine years to target the most critical building repairs through the estates safety fund.

The second shift from analogue to digital will be enabled through over £4.4 billion of capital investment over this spending review period, alongside over £6 billion of revenue funding into technological and digital programmes. This will enable seamless navigation between primary and secondary care such as through the NHS app and single patient record as part of an ambition to make the most digitally accessible healthcare system in the world.

The third shift from sickness to prevention will be achieved through continued investment into research and development as part of DHSC’s non-NHS capital allocation over the course of spending review 2025. This will enable earlier identification of illnesses, allowing for earlier intervention and strengthening system resilience to future threats. This is backed by notable investments including a new state-of-the-art health security campus in Harlow, Essex, that will create 1,600 extra jobs, and up to £1 billion for pandemic preparedness to replenish and expand stockpiles, in line with lessons learned from covid-19. We are also continuing our investment into genomics, pledging more than £650 million over the next five years.

This plan also supports the Government’s wider missions set out in the plan for change of driving economic growth and productivity, supporting the housing agenda, creating new healthy spaces to live and progressing towards net zero and clean energy. We will continue to commit to the NHS’s existing net zero targets and increase its climate resilience through continued setting of standards, showing climate leadership, and working across the system to break down barriers to financing and delivering net zero investments.

The increases in funding will be supported by our capital reforms, to reduce the layers of approval and reduce the time from initial proposal to get spades in the ground. We have already set the additional freedoms and flexibilities through devolving more control over capital budgets to the NHS frontline. Through this plan, we are also placing much greater focus on the outcomes of spend, and on taking steps to continually strengthen our approach to evidence, evaluation and benefits realisation.

The 10-year capital plan provides the clarity needed to do things differently and allow capital to become a true enabler of healthcare reform.

[HCWS202]

NHS Corridor Care

Karin Smyth Excerpts

Wednesday 8th July 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

The hon. Member for Sleaford and North Hykeham (Dr Johnson), the hon. Member for North Shropshire (Helen Morgan) and I are deep in the Health Bill Committee, and I have not seen them all day, so it is nice to have the opportunity to get back into the swing of our discussions. I am really grateful to my hon. Friend the Member for Tooting (Dr Allin-Khan) for securing this important debate. Her commitment, and her pride in St George’s hospital and all the staff who work there, is always so clear to see. She did a great job for them and the rest of the country again today. She has given us an opportunity to discuss something that matters so much to patients, their families, NHS staff, Members from across the House, and the staff who work here.

I recognise the important contribution of frontline clinicians, professional bodies and organisations such as the Royal College of Emergency Medicine and the Corridor Care Coalition. Their experience and expertise have helped shape our work to establish a consistent national definition of “corridor care” and strengthen national guidance. We share the same objective: to ensure that every patient receives safe, dignified care in an appropriate clinical setting. We will continue to work with these experts across NHS England and the Department of Health and Social Care.

Let me be absolutely clear: corridor care is not an acceptable standard of care, and it must not become normalised or, as the hon. Member for Mid Sussex (Alison Bennett) said, a habit. Wherever possible, patients should be assessed and treated in an appropriate clinical environment with dignity, privacy and the highest possible standards of care. Equally, NHS staff deserve to work in an environment that allows them to provide the compassionate care that they are trained to deliver. That is why tackling corridor care is a priority for this Government.

If we are to solve this problem, we have to be honest about why it occurs, and we have heard some of the reasons today. Corridor care is one of the clearest symptoms of pressure across the entire urgent and emergency care pathway—it is not simply an emergency department issue. As we heard from my hon. Friends the Members for Rushcliffe (James Naish) and for Worthing West (Dr Cooper), it also responds differently in different places, such as rural cities or coastal areas.

Historically, care in non-designated clinical areas was an exceptional escalation measure during periods of peak demand, but over time sustained increases in demand alongside capacity constraints across hospitals, community services and social care mean that what was once exceptional has become more routine in some places, and that is not acceptable. The hon. Member for Sleaford and North Hykeham might not remember exactly how and when that happened, but I know that when I worked in urgent and emergency care in Bristol, under the previous Labour Government, we eradicated such pressures in A&E, and they somehow crept back—not by magic, but by neglect—under the Conservatives’ stewardship.

We heard from my hon. Friend the Member for Salford (Rebecca Long Bailey) about her mother’s experience, and I do hope people are witnessing that. My hon. Friend the Member for Portsmouth North (Amanda Martin) talked about her father’s experience. My hon. Friend the Member for Bolton South and Walkden (Yasmin Qureshi) had a terrible experience of her own. My hon. Friend the Member for Ashford (Sojan Joseph)—again, he is on the Public Bill Committee and doing great work—went to observe his emergency department, as I know many hon. Members do. So we have direct experience of this in the House and have seen it for ourselves, and I have of course visited my local systems in Bristol.

Pressure in one part of the system affects other parts, and when patients who are medically fit cannot be discharged because appropriate support is unavailable, beds remain occupied, reducing hospitals’ ability to admit new patients from emergency departments, and the result is overcrowding, delayed patient flow and an increased risk of patients being cared for in temporary environments. We heard about that in detail from my hon. Friends the Members for Warrington South (Sarah Hall), for Stroud (Dr Opher) and for Truro and Falmouth (Jayne Kirkham), and that is why we are tackling it.

The first step was bringing in consistency and transparency about how corridor care is measured. For too long there has been no single national definition, making it really difficult to understand where the pressures were greatest or to compare performance across the NHS. We cannot improve what we do not measure, as was noted by my hon. Friend the Member for Gillingham and Rainham (Naushabah Khan). NHS England introduced a clear national definition of corridor care and began daily reporting in March 2026, and since June that data has been published, providing greater transparency and enabling targeted support for those organisations experiencing the greatest pressure.

Let me make it clear to the Liberal Democrat spokesperson, the hon. Member for North Shropshire, that part of getting the definition and the data right did mean that did not come out immediately. It is difficult to get this right, and we continue to work on doing so. I also make it really clear that, in overseeing this, I am not hiding the experience of things such as ambulance waits. We are absolutely monitoring those things as part of my overseeing of the wider system.

Alongside improved reporting, NHS England has strengthened the national guidance for trusts where temporary care environments cannot immediately be avoided. The guidance is clear that patients must continue to receive the same clinical standards of care wherever they are treated. They must be prioritised according to clinical urgency, supported by senior clinical oversight, named nursing responsibility and ongoing monitoring, with clear escalation arrangements, where required. I know that Members are rightly concerned by patient safety, and of course no patient should receive a lower standard of care because they are being treated in a temporary clinical environment, but the safest care is in the right clinical setting, and that is what we are aiming to do.

We have also ensured that, following the spending review, the Government allocated up to £1.9 billion of capital funding over the next four years to support improvements in urgent and emergency care to help restore the constitutional standards talked about by the hon. Member for Sleaford and North Hykeham. The Conservatives did not hit any constitutional standards for over 10 years, and we are determined to right that wrong.

Along with that investment, NHS England has published its model emergency department guidance, supporting faster clinical decision making, improved streaming of patients and stronger whole-system responsibility for performance. While there is much more to do, these reforms are already contributing to improvements, as we heard from my hon. Friend the Member for Stroud, including the shortest waiting times for four years and the fastest ambulance response times for about five years, despite continued and increasing high demand.

Targeted support is where we need to do the most work, and early national data shows that much corridor care is concentrated in some key places. The specialist “Getting it right first time” teams are therefore working directly with those trusts to help improve patient flows, strengthen the discharge process, make better use of data and share learning from organisations that have already made progress.

I commend my hon. Friend the Member for Bury St Edmunds and Stowmarket (Dr Prinsley), who highlighted the improvements at West Suffolk hospital, and my hon. Friend the Member for Rossendale and Darwen (Andy MacNae) for the great work happening at Blackburn and the work he is doing with other east Lancs MPs. My hon. Friend the Member for Watford (Matt Turmaine) talked about the improvements happening there. We heard about North Herefordshire and I am going to hold them to the autumn deadline raised by the hon. Member for North Herefordshire (Dr Chowns). There is nothing like putting it on the record for them, is there? Great work. As colleagues have said, we want to take the best to the rest and some people are doing amazing work in difficult circumstances.

Ultimately, as Members have said, eliminating corridor care means improving flow across the whole system. That requires: faster discharge; stronger community and neighbourhood services, as highlighted by my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh); improved social care; and more people receiving care closer to home, so that hospitals can focus on those who need in-patient care. That ambition sits at the heart of our urgent and emergency care plan and our 10-year health plan, which of course includes more prevention, as mentioned by my hon. Friend the Member for Worthing West. The shift from hospital to community care will improve patient experience, reduce avoidable hospital attendance and create the capacity needed to restore urgent emergency care standards. This is about lasting reform, not a temporary response to seasonal pressures, whether they be the current heat or winter.

Before I conclude, I want to acknowledge the extraordinary professionalism of NHS staff: doctors, nurses, paramedics, health care assistants, porters, pharmacists and so many other people who continue to provide outstanding care under immense pressure. No member of staff comes to work expecting to treat patients in corridors, and many have spoken openly, rightly, about the moral distress it causes. They deserve not only our gratitude, but practical action to improve the conditions under which they work. Part of what we are doing—introducing the national definition, being transparent about the data, strengthening patient safety guidance, investing additional urgent care capacity, providing targeted support to the most challenged trusts and addressing the wider pressures that drive corridor care—is the start of doing just that.

Every patient deserves care delivered with dignity, compassion and respect. Every member of staff deserves a system that enables them to provide that care safely. Corridor care is not inevitable. It is the consequence of pressures that have built up across the health and care system, and it is a challenge that this Government are determined to overcome. By improving patient flow, increasing capacity, supporting frontline services and delivering long-term reform, we will restore urgent emergency care standards and end the routine use of corridor care before the end of this Parliament. That is our commitment to patients, NHS staff and this House.

Health Bill (Thirteenth sitting)

Karin Smyth Excerpts

Committee stage
Tuesday 7th July 2026 Public Bill Committees

[Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

It is a pleasure to serve under your chairship, Ms Lewell.

The question is what will make patients more safe. Does incorporating the department that looks at safety into the organisation that inspects the services help? It might. Safety is not an add-on; safety must be at the heart of absolutely everything that we do. Safety is not a separate matter; it depends on those who work in our NHS and all of us all the time. That must be the culture. Let us not rely so much on inspections and litigations. At a time when we are unable to find jobs for newly qualified midwives, we spend more on obstetric litigation and compensation than we spend on obstetrics. I applaud what our Government are trying to do and their intention to improve things.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms Lewell. This morning, we had really good and detailed exchanges about patient safety and learning the role of HSSIB.

Often politics is confrontational and divisive, but I want to be clear that I take at face value that every single Member who has spoken and who I have met with, including people who do not want to see this change, have the best of intentions. They want to understand patient safety—in the long term we can talk about safety and quality of service, but let us focus on the safety aspects here—and they are trying to navigate something. They are seeing a change, which is always difficult, and we need to ensure we get that right. It is absolutely right that we do that in Committee, on Report and in the House of Lords. We will continue to take note of all the points made and seek to address them. I fortunately had the lunch break to reflect and do that a bit more carefully.

For people here and those reading our deliberations, what is difficult about the Bill—we understand this as legislators—is that we are abolishing an organisation and moving functions. That stands within a wider framework of changes to the safety and quality landscape that the Government are seeking. When one focuses on things that are being abolished, it is very binary. I will try and locate some of that without veering too far from the matter in front of us.

Among all the discussions, there are a couple of key questions that I want to address, including why I do this. Through the passage of the Bill, many people in the wider landscape have said to me, “Why are you bothering having a row about this?” I find that quite shocking as a riposte, because the answer is simple in the context. It is too important to not attempt to get this right and make changes to something that clearly is not working. I do not think I have heard anybody say that the current system is working.

As the right hon. Member for Melton and Syston noted, I said during the passage of the Health and Care Act 2022 that the functions of HSSIB are really important and must be built to the highest standard. I absolutely stand by that. It is not working; that is why we are changing it, but also why we are preserving the function within a new system, which we will seek to improve.

[Joe Robertson]

Will the Minister give way?

[Karin Smyth]

I am going to try to go through these points because I have listened carefully to everybody’s contributions. If there is something outstanding, I will be happy to come back to it.

To answer some of the direct questions that were put to me about the Dash review, I do not recall anybody particularly disagreeing with its findings when it was published or when we put it forward in our 10-year plan last year. I do not expect everyone to agree with every single recommendation or point made in that review. To an earlier point that was made by the Opposition, it was informed by a broad range of evidence and perspectives from across the health and social care system, including engagement with commissioners, providers, patients, families, and people harmed by poor-quality care, as well as charities, academics and national organisations. It looked really closely at what has not worked and why. I encourage hon. Members to go back to the work that Penny Dash was asked to do and the wider report.

The hon. Member for Farnham and Bordon and the right hon. Member for Melton and Syston asked why the review covered only six organisations. The then Secretary of State authorised the Dash review to look at six organisations in this space that were directly overseen by the Department. Many other organisations in this space are not directly overseen by the Department, so they were not in scope of that review as they had their own regulatory landscape ecologies and so on. That is why those six organisations, which we oversee, were looked at.

Last night at the Dispatch Box, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Birmingham Edgbaston (Preet Kaur Gill), made it clear that the rationale for this change is not based on cost. It is not based on the recommendations being too expensive. Rather, as I am sure colleagues will agree, we have seen far too many recommendations regarding patient safety but too little action. Inaction is not helping to improve the patient landscape.

Opposition Members referenced the view from the longest-serving Health Secretary, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), that the NHS will not change or adopt the recommendations. That is a profoundly depressing prospect. We cannot predicate our laws and the health landscape on the basis that the culture in the NHS cannot and will not change. This is not a party-political point, but because of what has happened in the last decade, we must move from a defensive culture into a culture of learning while keeping a safe space in which people can speak up. We have heard a lot about “perception” today. I accept that there is a perception of negativity that is damaging to patient safety and people speaking up, but that is what our wider reforms are seeking to address.

[Dr Prinsley]

I listened carefully to what the Minister said about a change of culture. A change of culture can certainly happen. In the surgical world, we used to bring patients into the operating theatre, check that the patient was on the operating table and do the operation. Sometimes, we operated on the wrong patient and on the wrong part of the body. We then introduced the World Health Organisation checklist, which checked absolutely everything before we started. It was a complete change of culture in the operating department. We made sure that we had the right prosthesis, the right patient and that we were operating on the right part of the patient. Now, the WHO checklist is a universally adopted process. I am absolutely sure that the culture in the health service can change.

[Karin Smyth]

I thank my hon. Friend for that. He and others on both sides of the House with clinical experience, including the hon. Member for Sleaford and North Hykeham, have shared live examples that can shock the layperson. It is important that those practices are changed clinically, and it is up to Government to make sure that the overarching legislative framework enables that.

[Dr Johnson]

Will the Minister give way?

[Karin Smyth]

I want to make some points first. I will pick up any outstanding points I do not cover.

The abolition of HSSIB and the transfer of its functions to CQC is being done to strengthen the link between patient safety investigations and the action being taken on the frontline to simplify the patient safety landscape. We want to align the recommendations with action.

Hon. Members quoted evidence that Dr Dash gave to the Committee. Let me remind the Committee of something else she told us, about how HSSIB’s functions can be better aligned as part of the CQC. She said:

“by bringing HSSIB into the CQC, you can align the work of the two.

For example, if the CQC is going round the country and spotting a particular problem with the way in which anaesthesia is being given or with managing patients post-surgery, the CQC could then say to HSSIB—that team of people with specific expertise—‘Can you go in and take a look at this? Can you do a detailed focus review of this particular area of care that we are spotting through our visits and which seem to be a particular challenge?’ It is that bit about enabling the CQC to identify a problem and then asking HSSIB to review it in detail, and HSSIB bringing its expertise in investigations into the CQC to enable the CQC to go deeper and then come back to the NHS”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.]

to enable best action. These organisations can learn better from each other.

Transferring investigation powers to the Care Quality Commission is an opportunity to strengthen the CQC. We have to move away from a defensive culture to a culture of shared learning if we are to improve patient care. The CQC can learn and improve from HSSIB best practice and take a more holistic approach to patient safety. Those executing the regulatory and investigatory functions can learn from each other and exchange skills, which would strengthen the links between learning, oversight and improvement, leading to real and sustained change across the system, driven by the CQC.

--- Later in debate ---

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

On that point, will the Minister briefly give way?

[Karin Smyth]

No.

There will be no barrier to investigating whether CQC inspections are causing unintended harm. If they are, and the investigator feels that a recommendation for change should be made, they will make it. The insight gained from investigations will continue to inform recommendations concerning the CQC’s regulatory functions, and the Bill allows for the investigation function to make recommendations to the CQC in its report. The CQC would be legally required to respond to such recommendations. There will be no need for litigation through the courts. That is an important point. Again, I am addressing the points made by Opposition Members. We will continue to set this out more clearly for Members. I am happy to find different ways to do that.

I now turn to the wider point about whether both an investigatory and a regulatory function can reside in the same body. Many organisations have different functions and responsibilities that they have to discharge simultaneously; we have also heard a lot about the safety body, which of course is part of the Department for Transport. It happens across a lot of bodies. I totally accept that it would be helpful for the debate if we were clearer on what some of those bodies are, and we will come forward with more information on that.

[Joe Robertson]

Will the Minister give way?

[Karin Smyth]

I am going to persist on some of these arguments. I think I have addressed all the points made by the Opposition. It is the job of effective leadership to manage those interests and responsibilities, and that is what we expect of the CQC’s leadership.

I will now turn to the amendments on this topic, which I thank the hon. Members for Sleaford and North Hykeham and for North Shropshire for tabling. Amendment 55 would make provision for the Secretary of State to disapply investigation powers in certain circumstances. I recognise the importance of ensuring that investigatory powers are not exercised in relation to sensitive Crown or Government premises where there is a national security interest. I want to be clear: the Bill already provides for that.

The Bill already amends section 96 of the Health and Social Care Act 2008 so that it applies to the new CQC investigatory function. Section 96 makes provision for the application of CQC legislation to the Crown, which means that the mechanism that the amendment is seeking to introduce is already in place within the existing legislative framework. Additionally, the Bill already provides for a power which enables the Secretary of State to disapply these investigatory powers in relation to Crown premises when it is in the interest of national security. The amendment would therefore duplicate an existing provision and would add unnecessary complexity to the legislation without delivering any additional benefit.

Amendment 56 would allow the Care Quality Commission to recover charges that are higher than the actual costs it incurs when providing assistance to anyone other than an NHS body or the Secretary of State. I understand the intention behind the amendment—to give the commission greater financial flexibility—but the Government do not think that it is necessary. The charging framework in the Bill is based on the clear principle of cost recovery. Removing subsection (9) of proposed new section 51R of the Health and Social Care Act 2008 would mean that the commission could charge more than it actually costs to provide a service, shifting away from recovering costs and towards allowing the commission to make a surplus through its charging powers.

[Dr Johnson]

My understanding is that, in the past, HSSIB has provided services to not only British health services but overseas health services, which were, in some cases, charged for that service, as it is a world-leading organisation. Why would the Minister not want that to continue?

[Karin Smyth]

I am happy to get back to the hon. Lady on that specific point, if that is the case. The charging framework is about recovering costs, not making a surplus, which is what the amendment would result in. If that is not the case, I will make sure that she receives a proper correction.

The Government do not think that there is a good case for the amendment, because, as I have said, the aim of the provision is to provide for fair and transparent cost recovery, not to raise extra income beyond cost. I am not sure whether the hon. Lady is suggesting that it might be good for the commission to create additional funding, but if that is not clear, I am happy to get back to her on it. The provision makes the recovery of costs more predictable and consistent for those who have to pay them. That is usual for public bodies.

New clause 42 relates to funding provisions for the CQC’s new investigation function. The Department already provides grant in aid to the CQC to provide adequate funding for investigations and special reviews; similarly, HSSIB’s budget is provided through grant in aid and is set each year. When the CQC takes on HSSIB’s functions, the funding streams will remain distinct, and the CQC will have to assure the Department that the amount allocated to the new investigation function is being used for that purpose.

Funding decisions for the investigation function will continue to be captured in wider departmental budget-planning processes and considered centrally. That provides assurance that business and strategic priorities for the investigation functions can be met. Robust financial oversight will require the CQC to demonstrate that grant in aid is used appropriately, and solely to support the investigation function, without the need to prescribe funding arrangements in legislation.

As there is already an operational mechanism for the Secretary of State to provide adequate funding and resources for investigations, the new clause is not needed. It would also be inappropriate to prescribe the form or level of funding in legislation. The new clause would reduce the Department’s ability to manage funding through the established spending review and estimates process; introduce unnecessary rigidity as the merged function evolves; and risk creating binding funding expectations that may not align with future fiscal constraints. A non-legislative approach ensures flexibility, scale and adaptive function while maintaining robust oversight.

I agree with the intention behind amendment 5, tabled by the hon. Member for North Shropshire, which is, as I understand it, to ensure that the Health Services Safety Investigations Body functions that are transferred to the CQC retain a high level of operational independence and continue to command the confidence—the Committee heard that word a lot this morning; I completely agree on its importance—of patients and their families, healthcare professionals and the wider public. Similarly, I understand that the objective of the amendment is to maximise the perception—again, that is a word I am coming back to; I tried to address the issue earlier—of independence in the CQC.

The Government have protected safe spaces in legislation, and we agree that operational independence of the investigation function is required, but our plans support and enable that. For that reason, we cannot support the amendment, which would impose a highly prescriptive governance structure on the CQC by requiring the creation of a separate statutory committee and setting out in primary legislation detailed requirements for its purpose, membership appointments and operational arrangements. While the Government fully agree that effective safety investigations must be conducted independently and objectively, we do not consider it necessary to put such detailed organisational arrangements in the Bill.

The Bill already provides a clear legislative framework for the transfer of those functions and enables the CQC to discharge them appropriately, within its broader statutory responsibilities. Furthermore, the CQC already operates within a robust statutory framework and is capable of establishing governance arrangements that support the effective delivery of its functions, including appropriate safeguards to protect investigative independence and the handling of safe-space material.

The amendment would reduce organisational flexibility by mandating a specific committee structure, and would constrain the CQC’s ability to adapt its governance arrangements over time in response to operational experience, changes in circumstances or future improvements in best practice. Under the amendment, governance arrangements would be fixed in statute, rather than having the capability to evolve as the organisation learns and develops.

Those additional administrative and governance requirements would increase bureaucracy and complexity, which the Government are looking to reduce. I re-emphasise that, in addition, a statutory committee would weaken the important links between learning and the action that the transfer of this organisation is intended to support. One of the key benefits of bringing these functions into the CQC is the opportunity to strengthen strategic oversight and ensure that learning from investigations can more readily inform improvement activity across the system.

[Dr Johnson]

The Minister seems to be saying that her reasoning for moving HSSIB into the CQC is to ensure that actions take place in response to the recommendations. But if HSSIB outwith the CQC makes recommendations that are delivered by the provider organisations, commissioned by the ICBs and overseen by Ministers, and then the CQC checks that as part of the regulation, why does HSSIB need to be within the CQC for that to happen?

[Karin Smyth]

We are probably not going to agree on this point. I have made the point several times—and we made it in the Dash review—about bringing these organisations together. As I said again in my opening comments, it is about the opportunity to get this right and share that learning and experience. It is not about the cost but about aligning the recommendations and the actions that follow through from them. That learning, and the opportunity to push that through, is something we should grasp.

Coming back to amendment 5, creating a separate statutory committee risks introducing additional layers of separation that could slow the flow of intelligence and impede timely action in response to emerging patient safety concerns. We believe the integration of investigatory functions can be secured through clear statutory functions and appropriate safeguards, rather than through organisational structures set out in primary legislation that are too rigid. Establishing detailed governance requirements in statute may also make future improvements more difficult to implement without legislative change.

I understand and respect the concerns that underpin the amendment, but the Government believe that the Bill already provides the necessary framework for the safe and effective delivery of health services’ safety investigations following their transfer to the CQC. We will of course work closely with both the CQC and HSSIB on their transition arrangements through a transition board, whether on the issues of ensuring operation independence of the investigation function and the ways in which that learning is shared, or, further to the Opposition spokesperson’s point, how we make sure that learning is shared and creates an impact, and where that is felt most clearly. For those reasons, I ask hon. Members not to press their amendments, and I commend clauses 59, 60 and 61 to the Committee.

Question put, That the clause stand part of the Bill.

--- Later in debate ---

Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

Clause 62 underscores the importance that we place on special reviews and investigations, and it will maintain the Care Quality Commission’s ability to conduct them by ensuring that the CQC’s investigatory role remains properly aligned with its original statutory purpose. The CQC is the independent regulator of health and care providers, and in the case of commissioners, it has the powers to undertake a special review or investigation when requested to by the Secretary of State.

On 30 January 2024, the then Secretary of State, the right hon. Member for Louth and Horncastle (Victoria Atkins), commissioned a section 48 review into mental health services in Nottinghamshire following the tragic events of June 2023. As we know, that revealed serious and systemic failings and led to strengthened oversight and a clear improvement plan. With NHS England being abolished and its functions being transferred to the Department and across the wider system, this clause will remove NHSE from the scope of section 48 and allow Ministers to set out, through regulations, the future scope of section 48.

NHS England’s commissioning functions will mostly transfer to the integrated care boards but, as we discussed previously, NHSE’s most specialised commissioning functions will transfer to the Secretary of State. In future, regulations will set out the specific commissioning functions that the Secretary of State will be responsible for and that the CQC may review or investigate. The scope of the special reviews and investigations will continue to apply only to commissioning functions under the National Health Service Act 2006 or section 117 of the Mental Health Act 1983, which is the CQC’s existing remit.

This approach will ensure that the CQC’s investigatory powers will not be automatically extended to departmental functions, which would fundamentally change the relationship between an arm’s length body and a Government Department and would not align with the original intention of section 48 reviews. For that reason, the Bill will provide for scrutiny through secondary legislation. That will set out a transparent and accountable way to specify which commissioning functions are in scope, enabling parliamentary scrutiny and CQC oversight where it is genuinely relevant to patient safety and care quality.

This approach will also provide important flexibility: as commissioning arrangements change, the right function can be brought into scope without unnecessary delays. Taken together, this clause will protect the CQC’s independence, maintain accountability and provide a sensible framework for scrutiny where it adds real value for patient safety and care quality. I commend the clause to the Committee.

[Dr Johnson]

I have just a couple of questions. Clause 62 will update the CQC’s power to conduct special reviews of NHS commissioning to cover ICBs and the Secretary of State’s commissioning functions, and the requirement for ministerial approval before the CQC can investigate will be retained. How will that apply when HSSIB is moved into the CQC? Is it the Minister’s intention that HSSIB will need the Secretary of State’s approval to complete investigations?

[Karin Smyth]

My understanding is that the clause will not change that particular power, but I will get back to the hon. Lady if I am wrong.

Question put and agreed to.

Clause 62 accordingly ordered to stand part of the Bill.

Clause 63

Time limit for bringing proceedings

Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

The 10-year health plan reaffirms the Government’s commitment to families affected by bereavement or serious harm, ensuring that lessons are learned from their experience and that more cases are fully reviewed and acted on. Families seek closure following serious harm to or the death of a loved one by wanting to understand what went wrong and what could be done to stop other families experiencing similar trauma, and by wanting to hold someone to account. Families often turn to the Care Quality Commission for help.

Clause 63 will extend the CQC’s power to bring proceedings against a health and social care provider for a serious breach of regulations from the existing limitation of three years from the date of the offence to five years. Let me be clear: extending the three-year limitation from the time of the offence will not alter the first requirement that the CQC should act within 12 months of sufficient evidence of a serious breach of regulations becoming available. That 12-month window for action once the regulator is aware of the offence will remain unchanged. Extending the limitation period to five years from the date of the offence will mean that fewer events that should be considered by the regulator will effectively time out and go beyond the reach of the regulator’s action.

The CQC is not the only body with an interest in investigating serious breaches of regulations that result in unnatural death; there are other investigatory bodies, such as the police, with equal interest and powers to investigate deaths for the purpose of pursuing criminal prosecution. The coronial process serves a different purpose. A coroner’s role is to establish facts surrounding an unnatural death rather than to find fault. In a complex case, a police investigation or a coroner’s inquest—sometimes both—can take time to conclude. Those independent processes are a useful source of information for the CQC to form a full picture of a breach of regulation.

A culture of learning from investigations, inquiries, errors and poor care should be the norm in the NHS. It is therefore expected that a service provider may also commission its own internal investigation to learn from an unnatural death. Furthermore, there are cases where the CQC is approached late with information after an offence may have been committed. For example, the CQC may only receive information about an offence two and half years after it was committed, leaving little time in the remaining six-month period to investigate. Extending the period to five years would help mitigate such circumstances, and that is why we are extending the statutory limitation period. This will ensure that the CQC has the ability in far more cases to address the serious regulatory failings that it should and must address, without risking falling foul of a time limitation. I therefore commend the clause to the Committee.

[Dr Johnson]

As the Minister said, clause 63 amends section 90(2) of the Health and Social Care Act 2008 to extend the limit on proceedings relating to the registration of offences under part 1 from three to five years. The impact assessment talks a little about the time it takes to investigate these cases, but as the Minister said, the time to investigate is 12 months from the CQC being given enough evidence to consider whether the case is prosecutable. Why has she chosen not to change that too? Does she think people will have enough time to investigate? She is looking puzzled.

[Karin Smyth]

Apologies—I missed the exact question as to what needed to be changed. Could the hon. Lady repeat that?

[Dr Johnson]

The Minister talked about changing the time period in which proceedings can be effected from three to five years, but once the CQC is aware that an investigation could be brought and there is evidence that needs to be looked at, it will still get only 12 months. That has not been changed. I wonder what the rationale is for that. I am not criticising it; I am just asking the question.

The other issue is that clause 63 is prospective, so if an offence were committed immediately after the Act was passed, for the first three years things would effectively be as they are now; the change from three years to five would be relevant only after three years. Clause 71(2) on commencement provides that clause 63 will not come into force until two months after the Act is passed. I just wonder in practical terms why, given that it will take three years to come into effect in any case, it will not come into force on the day the Act receives Royal Assent.

The impact assessment talks about the CQC prosecuting two or three additional cases a year, and a cost of £4.3 million over 10 years with fines of £2.7 million over 10 years. Will the regulator keep the fines, or will they go back into the Treasury? Can the Minister guarantee that the additional funds that are estimated to be required for the additional cases under this new regulation will be provided so that the CQC can do the investigations that she is giving it the opportunity to do?

[Karin Smyth]

Put simply, the answer to the hon. Lady’s questions is that we are not seeking to change other aspects. The CQC wants to get to points as soon as possible, so the 12-month period has not been changed. The function of clause 63 is merely to recognise the issues around the three years and to change that to five years. We are not seeking to alter anything else in that regard. On her point about the commencement date, that is merely recognising what is considered to be parliamentary convention.

Question put and agreed to.

Clause 63 accordingly ordered to stand part of the Bill.

Clause 64

Abolition of Healthwatch England

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to discuss the following:

Schedule 9.

New Clause 74—Report on the abolition of Healthwatch England—

“(1) Within 12 months of the passage of this Act, the Secretary of State must lay a report before both Houses of Parliament on the impact of the abolition of Healthwatch England and transfer of Healthwatch England's functions to ICBs.

(2) The report must consider—

(a) the effectiveness of escalation routes for complaints,

(b) the ability to receive responses to complaints from the relevant ICB officer,

(c) accountability of ICB CEOs for delivering new functions arising from the abolition of Healthwatch;

(d) independence in the delivery of patient surveys, and

(e) ability to investigate organisations from which the ICB commissions services.

(3) The report must make recommendations about how any issues identified under subsection (2) may be mitigated.”

This new clause would require the Secretary of State to publish a report within 12 months of the passage of this Act on the impact of the abolition of Healthwatch England and transfer of Healthwatch England's functions to ICBs.

New clause 78—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.

[The Chair]

I call the Minister.

[Karin Smyth]

This is a popular clause, Ms Lewell—and rightly so. I recognise that this provision has elicited a lot of interest among our constituents and the wider public. I look forward to hearing Members’ contributions.

--- Later in debate ---

[Joe Robertson]

It is a pleasure to serve with you in the Chair, Ms Lewell. This is another example of the Government seeking to abolish an independent voice and merge its functions into an organisation that, frankly, will probably benefit to some extent from not having that independent scrutiny, but it is not for the betterment of patients or indeed the system. Healthwatch England is effective specifically because it is an independent voice for patients. We have not heard any compelling arguments for why, just because the system is not perfect, this change is better than leaving it alone.

The argument has been advanced that this brings patient voice closer to decision making, but I would hope that the directly elected Ministers who represent people are what bring the voice of the people closer to decision making in the Department of Health. They should be the ones bringing patient voice to the heart of decision making—I am sure that they do, of course—and there are other means by which the Department formulates policies and decisions; it does not need to remove an independent patient voice through Healthwatch England, which serves a different purpose, to enhance that.

That different purpose is this: some of the things that Healthwatch England advocates for and shines a light on are uncomfortable truths for decision makers and the Department of Health. It looks far too cosy to now bring that function into the decision-making process. Some of these issues need the light shedding on them that comes with an independent organisation providing patient voice. We have heard how the Select Committee and MPs, in their free-ranging Back-Bench function, benefit from hearing that voice through an independent organisation such as Healthwatch England, because it allows them to fulfil their scrutiny function. This is not just about decision making; it is also about scrutiny of decisions once they have been made. What will the Select Committee, MPs and journalists do when they no longer have the light shed by that independent voice?

As my hon. Friend the Member for Farnham and Bordon has pointed out, representatives who are employees in the Department of Health and Social Care rightly have other overriding primary duties to the employer—the Department itself. Let us ensure that patient voice is articulated by those who do not have a primary obligation to their employer, but have an obligation to an independent organisation with functions that serve solely to amplify and project the voice of patients.

There are a number of issues with the abolition of local healthwatches, but I will save that for the next discussion. I want to make the wider point that there is a centralisation issue here too. Whether the Government like it or not, this measure will centralise powers into the Department; it will take outside powers from Healthwatch England and bring them in-house. That is nothing short of a centralising measure. The Minister needs to address the justification for that, because the more negatives there are to this decision, the more we need to understand the positives. So far, they are light indeed, or she has failed to articulate them. I think that there is a reason she has failed to articulate the positives: they simply do not exist.

I look forward to the Minister’s response. I urge her to take some more interventions, because the arguments she has given to the Committee in her speeches at the end of each discussion have tended to raise more questions than they have answered. We can only deal with that by intervening on what she says.

[Karin Smyth]

I think that the record will show that I have taken several interventions in recent days, and I will continue to do so. I have been very clear that we have some fundamental disagreements on philosophy and approach. I will desperately try not to veer into the next groups, but it may be tricky. I am sure that you will steer me through, Ms Lewell.

I want to pick up on some good, helpful points that have been made. I pay particular tribute to my hon. Friend the Member for Lichfield for the comments he made. I appreciate that certain areas, particularly Mid Staffs, have elicited a lot of debate and concern. I commend him for following that through on behalf of his constituency. I know that other Members in Staffordshire want to understand how the Government’s future plans will address their very real concerns. That is also true of other areas that have experienced shocking scandals, as we call them. I take that very seriously.

I will pick up on the question of independence that we veered into before, which was mentioned by the hon. Member for Sleaford and North Hykeham. She highlighted her concerns and the issues raised by my right hon. Friend the Member for Makerfield, and I heard what she said. Independence was also raised by the hon. Member for Winchester and my hon. Friend the Member for Lichfield. We therefore return to that point about independence and, as my hon. Friend said, about being in the room, making those decisions and changing the entire culture of the organisation to do something different.

The question is then whether bringing the functions of Healthwatch to the national level is the right method. Again, I commend work on that and the individuals involved in it. Hon. Members mentioned Jacob Lant of National Voices and the King’s Fund, which have worked with us very well to challenge us and try to make this legislation better. I really appreciate their work, and we will continue to talk with them.

The hon. Member for Farnham and Bordon mentioned GIRFT. I cannot help but respond to his point, because he suggested that being inside NHS England has somehow made it less effective, and I could not disagree with him more. It is not because he has left and is here; his presence is obviously missed at GIRFT and welcomed here. To be serious, every meeting I have with NHS England and everything we are attempting to do in reforming outcomes for patients on the ground involves GIRFT. It is now at the very heart of what NHS England does. By coming inside the organisation, it has done exactly some of the things we want to do: drive cultural difference and change inside the organisation, rather than being outside of it. As I said before, this is a slightly philosophical argument and political argument. I appreciate that there are views on either side, but that is absolutely our intention.

On the patient experience directorate, we recognise that public trust will be crucial. We need to ensure that there is system learning across the piece. The patient experience directorate has to earn the trust of the public and parliamentarians, so we will design it to operate transparently and sit at the centre of decision making rather than at its margins. Ministers will be accountable for and answerable to Parliament on the work of the patient experience directorate. It has to focus on the voices that are too often overlooked. The central priority of the directorate will be to reach under-represented and seldom heard groups and to ensure that engagement is accessible, inclusive and proactive, so that the experiences of vulnerable people help inform and shape the decisions that affect their lives.

[Liz Twist (Blaydon and Consett) (Lab)]

I was flattered to hear my comments on Second Reading quoted by the hon. Member for Sleaford and North Hykeham, but I think she has misunderstood me. My question to the Minister was and still is about how we maintain within the new arrangements the ability to speak up on behalf of others. Could the Minister comment on that?

[Karin Smyth]

I thank my hon. Friend for making the intention of her comments clear to the Committee. It is right that we need to build trust in patient voice and experience. We will pick up on that in our debate on local healthwatch branches, because that is perhaps where Members of Parliament are particularly important.

At a national level, there are many voices and organisations continuing to review the issue and challenge the Government, including through reports, meetings with Ministers and in Parliament, highlighting the good work that they do and numerous Committees. Health Ministers appear before the Public Accounts Committee, the Health and Social Care Committee and Lords Committees; I have appeared before the Science, Innovation and Technology Committee. That is an important way of ensuring that the Department and the new experience directorate will be accountable.

I recognise the important contribution that Healthwatch has made in capturing patient insight and informing the design and delivery of services, but we do not believe that new clause 78 is necessary. It is inconsistent with the purpose of the Bill. I am aware of the views of the hon. Member for North Shropshire, but the Government’s policy is to abolish Healthwatch and ensure that patient and public voice is more directly connected to decision making. It would therefore not be appropriate or consistent to legislate for a specific funding level for organisations that would no longer exist, or to constrain how funding is deployed to support the new arrangements.

[Helen Morgan]

For the record, I tabled amendments to delete those clauses, so there was consistency of intention.

[Karin Smyth]

I am just computing that in my brain. Can I seek clarification on that?

[Helen Morgan]

I tabled amendments to delete the clauses that will remove Healthwatch, but they have not been chosen for debate, because we can just vote against those clauses standing part. New clause 78, which would ensure that Healthwatch is funded properly, was tabled alongside amendments to ensure that Healthwatch is retained.

[Karin Smyth]

I understand. I am grateful to the hon. Member for that clarification, but her new clause represents an incomplete picture of Government funding for Healthwatch. A £14.15 million grant has been provided to local authorities for local healthwatches, and that is only part of the overall funding; a larger proportion is rolled into the wider local government financial settlement, and because that is not visible as a distinct line, headline figures often understate the total funding available. All of this funding is not ringfenced.

--- Later in debate ---

[The Chair]

With this it will be convenient to discuss schedule 10.

[Karin Smyth]

Clause 65 and schedule 10 will abolish the current local healthwatch arrangements and place responsibility for gathering the views of local people firmly with the bodies with the clearest levers to act: integrated care boards and local authorities.

At present, many organisations are gathering views, running engagement exercises and raising issues, often with the best of intentions, but the result can be duplication, variable coverage and uncertainty about who is accountable for responding. We can end up with lots of feedback but too little clarity on the action that follows. By placing those duties on integrated care boards and local authorities, we are ensuring that insight from patients, service users and communities feeds directly into where commissioning and service planning decisions are made for both health and care. As my hon. Friend the Member for Lichfield said, the people are in the room. It makes it easier to connect lived experience to priorities, quality improvement and the tackling of inequalities, rather than leaving intelligence at arm’s length from decision makers.

This is about strengthening impact, not silencing criticism. Integrated care boards and local authorities will have a statutory duty to demonstrate how they have engaged with all people in their area, including seldom heard groups, and will be expected to have clear routes for people to raise concerns. We expect transparency about what people have told the system, what the system has done in response and how learning is shared across partners.

As I said in my evidence, many constituents in my Bristol South constituency are said to be hard to reach. They are not hard to reach, in my view. We know exactly where they live, who they are, how old they are and what sex they are. We know largely what diseases they have. We know their level of income. We know their levels of education and attainment, and how they impact their health outcomes. They are not hard to reach; the system is not set up to listen to them. That is what we are determined to change.

Dr Penny Dash’s review of patient safety described a cluttered landscape, with overlaps in how user experience and advocacy are organised. It described the burden that that can place on the frontline, producing multiple, poorly co-ordinated asks with limited impact. Bringing the patient and community voice closer to the organisations responsible for improvement—it is actually their job as commissioners—will help to make feedback more actionable, reduce confusion and support better services. I commend the clause to the Committee.

[Dr Johnson]

As I understand it, the objectives of the Bill are to replace the local healthwatch with a less independent, internalised gatherer of patient experience feedback. The objectives appear to be featuring feedback more centrally in strategic decision making, getting people into the room and simplifying the patient landscape.

There are things that I do not understand about that. If the problem is that those who commission or deliver the services are not listening adequately to the people who gather the patient experience information, why not invite the independent individual who has gathered that information into the room? Why ask someone in the room to gather the information and risk the independence? Why not compel more listening?

The Minister talked about who is accountable for action. My understanding is that it is the healthwatches’ job to gather the patient experience and present it to Healthwatch England and the decision makers. It is not their job, as I understand it, to make decisions on how care is delivered or to deliver that care differently. Does the Minister intend that to change?

The Minister also talked about strengthening the impact of Healthwatch, but I do not understand how this change will do that. We have heard how its independence allows Healthwatch to go on telly, talk to Members of Parliament, Select Committees, radio stations and others, and publicise its findings. If it is within the Department, will it be able to do so as freely? I suggest that it will not.

The other thing that I do not really understand—perhaps the Minister can help us with this—is the organisation. At the moment, it is done in local authority areas. It will now become the job of the local authority and the ICB to commission feedback, but we have already heard how the 50% cuts to ICB budgets have led to ICBs merging into larger conglomerates. Those do not necessarily overlap with the strategic mayoral authorities in the way the Minister eventually wants. What geography does the Minister want the feedback to be gathered over? How does she see that working? Will it require further restructuring? The hon. Member for Lichfield talked about the importance of localism and how different areas of his constituency have different health needs. How does the Minister think that that will work under her new plans?

The Minister said that one benefit of the new process is reaching vulnerable individuals, but what is to stop Healthwatch doing that? Ultimately, if we have Healthwatch doing things now that are independent and respected across the House—I am sure your local healthwatch is also excellent, Ms Lewell; Lincolnshire’s certainly is—why not strengthen that voice? Why not say to those who are providing that service, “We’re going to give you more resources,” or “We’re going to ask you to deliver it in a slightly different way,” or “We’re going to ask you to focus on particular populations,” or even, “We’re going to invite you into the room with the ICBs so that they can hear you and listen carefully”?

Why not compel those making the decisions and delivering the services to listen to Healthwatch, rather than replacing it? It was not Healthwatch’s job to listen to them, but to gather the information and present it, and that is what it has done. Can the Minister explain how removing its independence is going to help? I simply do not understand it.

--- Later in debate ---

I am using my own patch as an example, and it is fairly unique, but there are many areas across the country, particularly coastal and rural ones, with their own unique challenges. At the moment, those are well-represented through small, independent local healthwatches. That uniqueness will be lost, not only because of the lack of independence of the patient voice that will result from merging healthwatches with ICBs, but because the patient voice will be merged with others, since ICBs cover far wider areas. Given the values that Labour says it stands by and gets elected on—patient choice, patient voice, improving healthcare outcomes—it surprises me that a Labour Government want to abolish that independent patient voice. No matter how much they want to make space for that voice within an ICB, they cannot argue that that voice is independent once it becomes part and parcel of the ICB.

[Karin Smyth]

Again, we have had an important discussion, particularly around the issue of independence; I accept that it is difficult and that there are arguments on both sides. We have heard a lot about Professor Croisdale-Appleby’s evidence on behalf of Healthwatch. I made this argument on Second Reading: we have had this arrangement for 52 years, and I think we can all agree that the situation is not good. It has not worked. As I said earlier, 20,000 reports add a lot of work. There is a lot of work in this landscape—well-intentioned work by good people. We can argue about whether Healthwatch was set up appropriately to do the job it has been asked to do.

I was pleased to hear the three examples from the Lib Dems and other individual examples of where light has been shone upon a closure, for example. It is good that that has been valued by local Members of Parliament. I would argue that nobody should be closing services without fully engaging with the local population and setting out clearly why that is being done. That is a failure of those local organisations, and we need to address the cause of that failure.

I am struck by the oral evidence to the Committee on those 20,000 reports in 52 years. It was suggested that it takes six months, as I think the hon. Member for Farnham and Bordon said when quoting the evidence, for somebody to “go out”—that is the phrase that is used: “Let’s go out and talk to people in these far-flung communities. What do they think? What is their experience? Who are they?” It constantly surprises me, as it did when I worked inside the system. These are not remote people. We know who they are and what is wrong with them. We know how remote they are from the system. That goes to the heart of why the taxpayer is so alienated in this country from public services and their poor functioning. That is what the Government want to change.

It is not a matter of ICBs adding a new function; the Opposition have fundamentally misunderstood that. It is about rewiring these organisations to do something very different. Their function as strategic commissioners is to understand and to use all the data and evidence, including direct voice. We can argue about how that direct voice is taken in, but that is fundamentally what a commissioner is—I say that, having been a commissioner. It is not being done well, and that is why we are changing the legislation. Under previous legislation, ICBs had multiple functions. We are changing that to force them to be commissioners, but it is not an add-on; it is fundamental to the commissioning process. It is a complete rewiring of the organisation to listen to patient voice, patient experience and the reality of health inequalities.

In my constituency, I am afraid have not seen examples of the independent voice really speaking on behalf of the people I serve—some of whom have the worst health inequalities in the country, largely as a result of the tobacco industry and its legacy—whereas their experiences and their health outcomes are very well known and should drive the necessary changes. That is why we are driving all the changes in the 10-year health plan: to meet the needs of communities. We will continue to have this debate, but I wanted to make that absolutely clear.

We assume that the independent voice is always clear, but it is not. We have heard that it is variable and fragmented. That is not the fault of anyone trying to provide it, but that is where it is. The system is supposed to listen and improve services, and it does not. Things need to be changed in order to achieve that, and that is what we intend to do. The changes will be supported by scrutiny, transparency and oversight arrangements. The alternative, which is maintaining a separate structure with limited levers to drive change, has not delivered, and it cannot continue to try.

We are not removing patient and user voice; we are embedding it at the heart of the new system. ICBs will be expected to carry out proactive, inclusive engagement, particularly with so-called seldom-heard groups, including carers, those who do not have access to digital platforms, those less proficient with technology and people for whom English is a second language. Crucially, ICBs will be accountable for demonstrating reach and impact, not simply how many reports or engagement exercises they have done. Impact is what we will be looking at.

As I have said, this is about moving from a model where voices can be collected but overlooked to one where they must be heard and acted upon. The new patient experience director in the Department will work closely with local systems to identify national themes and significant concerns, ensuring that patient experience informs policy and improvement at the national level. To answer a previous question, the Secretary of State will have the power to issue directions to ICBs and local authorities if they are failing to exercise that function.

As I have said in debates on previous groups, I understand that it is difficult when we are debating the abolition of something outwith the wider framework of the 10-year health plan, the Dash review, the patient experience directorate in the Department and changes to the national quality board. It is incumbent on the Government to make that architecture clear and to build confidence and trust. That is what we intend to do, and that is how this body will be taken forward.

All comments have been noted. There is a fundamental difference of approach. We are making those bodies fundamentally different and rewiring them to do something different. I understand the bumpy road—I have been part of that, with community health councils and links to Healthwatch, and it has been a long one. I think we will keep returning to this theme. Those organisations have not been changed to do what they are supposed to do, and that is the ambition of this Government.

Question put, That the clause stand part of the Bill.

--- Later in debate ---

Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

As the UK resilience action plan sets out, we are living through a period of profound change. Ensuring that our institutions are clear in what they must do to prepare for, respond to and recover from emergencies is essential. With that mind, the clause is necessary. It clarifies the existing duties on NHS trusts under the Civil Contingencies Act 2004—the legislation that sets out how the UK prepares for, co-ordinates and responds to serious emergencies. Since the Civil Contingencies Act came into force, NHS trusts have been included as category 1 responders. That means that they have had specific legal duties to assess risks, plan for emergencies, maintain business continuity, warn and inform the public, and work together to co-ordinate an effective local response.

Due to changing policies by the previous Government, references to NHS trusts were removed from the Civil Contingencies Act, yet under transitionary powers in other legislation, they remain category 1 responders. This has meant that their role has seemed unclear for some other responders and the public. I want to be clear that the clause does not change the position of NHS trusts, nor their duties or functions under the Civil Contingencies Act; instead, it simply clarifies the legislation, making their place and role clear. That is vital so that NHS trusts and other responders know exactly what is required of them during and after an emergency. I commend the clause to the Committee.

Question put and agreed to.

Clause 66 accordingly ordered to stand part of the Bill.

Clause 67

Minor and consequential amendments

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to discuss the following:

Government amendments 20 to 24 and 83.

Schedule 11.

[Karin Smyth]

These are minor and technical amendments. Government amendments 20 to 22 make changes to the Armed Forces Act 2006 to remove references to NHS England, reflecting that NHS England will be abolished. Those amendments are consequential to the Armed Forces Bill 2026. Government amendment 83 makes changes to the Children’s Wellbeing and Schools Act 2026 to remove reference to NHS England and update a reference to NHS trusts to take account of the new conversion procedure created by clause 35 of the Bill. Government amendments 23 and 24 both amend the NHS Act 2006 by removing unnecessary consequential amendments to that Act.

Clause 67 inserts schedule 11, which makes minor and consequential amendments that are required as a consequence of the provision made in other clauses of the Bill. They mostly result from the abolition of NHS England, the conferral of NHS England’s functions on others—primarily the Secretary of State and integrated care boards—and the changes made to the NHS provider landscape. Those minor and consequential changes are made to a large number of enactments, but notably a significant number of such consequential changes are made to: the Mental Health Act 1983, the NHS Act 2006, the Health and Social Care Act 2008, the Health and Social Care Act 2012 and the Medicines and Medical Devices Act 2021. The changes are necessary to ensure the proper operation of the statute book and reflect the substantive changes being made elsewhere in the Bill. I commend clause 67 to the Committee.

Question put and agreed to.

Clause 67 accordingly ordered to stand part of the Bill.

Schedule 11

Minor and consequential amendments

Amendments made: 20, in schedule 11, page 140, line 16, at end insert—

“91A The Armed Forces Act 2006 is amended as follows.”

This amendment and amendments 21 and 22 remove a reference to NHS England from section 343AZB of the Armed Forces Act 2006 (to be inserted by the Armed Forces Bill).

Amendment 21, in schedule 11, page 140, line 17, leave out

“of the Armed Forces Act 2006”.

See explanatory statement for amendment 20.

Amendment 22, in schedule 11, page 140, line 18, at end insert—

“92A In section 343AZB (inserted by the Armed Forces Act 2026), in subsection (5)(a) omit sub-paragraph (i).”

See explanatory statement for amendment 20.

Amendment 23, in schedule 11, page 144, line 5, leave out paragraph 118.

This removes an unnecessary consequential amendment to section 12E of the NHS Act 2006 (that section is replaced in its entirety by clause 10 of the Bill).

Amendment 24, in schedule 11, page 148, line 9, leave out paragraph 139.

This removes an unnecessary consequential amendment to a heading that is replaced by clause 11.

Amendment 83, in schedule 11, page 191, line 35, at end insert—

“Children’s Wellbeing and Schools Act 2026

400 In Schedule 1 to the Children’s Wellbeing and Schools Act 2026 (relevant authorities)—

(a) omit paragraph 9;

(b) in paragraph 12, omit ‘section 25 of’.”—(Karin Smyth.)

This is a consequential amendment to Schedule 1 to the Children’s Wellbeing and Schools Act 2026, which would remove a reference to NHS England and update a reference to NHS trusts to take account of the new conversion procedure created by clause 35 of the Bill.

Schedule 11, as amended, agreed to.

New Clause 20

Arrangements between NHS bodies and local authorities

“(1) Section 75 of the National Health Service Act 2006 (arrangements between NHS bodies and local authorities) is amended as follows.

(2) In subsection (6), for the words from ‘consultation’ to the end substitute ‘the making of arrangements by virtue of this section’.

(3) Omit subsections (7A) to (7L).

(4) In subsection (8), at the appropriate place insert—

‘“local authority” includes—

(a) a combined authority,

(b) a combined county authority, and

(c) the Greater London Authority;’.”—(Karin Smyth.)

This enables combined authorities, combined county authorities and the Greater London Authority to enter into arrangements with NHS bodies under section 75 of the NHS Act 2006 in relation to any of their functions, replacing the current different and more limited provision about combined authorities and combined county authorities.

Brought up, read the First and Second time, and added to the Bill.

New Clause 21

Dispensing medical practitioners etc

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

(2) In section 132 (persons authorised to provide pharmaceutical services)—

(a) for subsection (1) substitute—

‘(1) Except as may be provided for by or under regulations, no arrangements may be made by an integrated care board with a person providing primary medical services under Part 4 to provide pharmaceutical services.’;

(b) in subsection (3), for ‘medical practitioners’ substitute ‘persons providing primary medical services under Part 4’;

(c) in subsection (4)—

(i) for paragraph (a) substitute—

‘(a) as to grounds on which an integrated care board may, or must, refuse to grant an application for inclusion in a list referred to in subsection (3),’;

(ii) in paragraph (aa) omit ‘of medical practitioners’;

(iii) in paragraph (b), for ‘NHS England by a medical practitioner’ substitute ‘an integrated care board by a person’;

(iv) omit paragraph (c).

(3) In section 134 (pilot schemes), in subsection (8) omit ‘by a medical practitioner or dental practitioner to a patient of his’.

(4) In Schedule 12 (LPS schemes), in paragraph 1(8) omit ‘by a medical practitioner or dental practitioner to a patient of his’.”—(Karin Smyth.)

This updates the legislation about the provision of pharmaceutical services by medical practitioners to conform with current law and practice whereby commissioning arrangements are generally made with the practice rather than individual doctors. It also removes a reference to dental practitioners that is not needed.

Brought up, read the First and Second time, and added to the Bill.

New Clause 22

Inadequate provision of pharmaceutical services

“(1) Section 133 of the National Health Service Act 2006 (inadequate provision of pharmaceutical services) is amended as follows.

(2) For subsection (1) substitute—

‘(1) Subsection (2) applies if the Secretary of State is satisfied that a situation or event has caused or is likely to cause a disruption resulting in the inadequate provision of pharmaceutical services in England or in an area within England.’

(3) In subsection (2)—

(a) after ‘Secretary of State’ insert ‘may by direction’;

(b) for paragraph (a) (but not the ‘and’ at the end) substitute—

‘(a) require an integrated care board to make other arrangements,’;

(c) in paragraph (b) omit ‘may’.

(4) After subsection (2) insert—

‘(3) A direction under subsection (2) must specify the period for which it has effect.

(4) The period must not be more than 6 months.

(5) But the Secretary of State may by further direction extend the period for which a direction under subsection (2) has effect by up to 6 months at a time.

(6) The Secretary of State must publish any directions under this section.’”—(Karin Smyth.)

The amendments made by this clause (among other things) relax the legal test for making alternative provision to address the inadequate provision of pharmaceutical services owing to a disruption of services.

Brought up, read the First and Second time, and added to the Bill.

New Clause 23

Pharmaceutical services: appeals etc

“Schedule (Pharmaceutical services: appeals etc) makes provision about the destination of appeals, and jurisdiction to determine certain matters, currently governed by Part 7 of the National Health Service Act 2006 (pharmaceutical services and local pharmaceutical services).”—(Karin Smyth.)

The clause introduces a Schedule which amends provisions about certain appeals etc to the First-tier Tribunal. Those appeals will be transferred to an NHS body determined by regulations. It is expected that initially this will be NHS Resolution.

Brought up, read the First and Second time, and added to the Bill.

New Clause 91

Regulations: reference to agreements and standards

“(1) The Medicines and Medical Devices Act 2021 is amended as follows.

(2) In section 2 (power to make regulations about human medicines), after subsection (4) insert—

‘(4A) Regulations under subsection (1) making provision in reliance on section 3, 4, 5 or 7 may refer to international agreements or standards relating to human medicines, including agreements or standards as they have effect from time to time.’

(3) In section 16 (manufacture, marketing and supply), after subsection (2) insert—

‘(3) Provision made in reliance on subsection (1)(a) may refer to United Kingdom standards that—

(a) relate to the marketing, putting into service or other supply of medical devices, and

(b) are specified in a list published by the Secretary of State from time to time.

(4) Regulations made under section 15(1) that contain provision made in reliance on subsection (1)(a) about relevant requirements (or exceptions from them) may include provision in relation to a medical device where—

(a) the device complies with regulatory requirements applicable somewhere outside the United Kingdom which is specified in regulations, and

(b) a description of the device and the regulatory requirements applicable to it are contained in a list published by the Secretary of State from time to time.

(5) In this section “United Kingdom standard” means a standard that is—

(a) set by the British Standards Institution, or

(b) primarily developed for use in the United Kingdom, or part of the United Kingdom.’”—(Karin Smyth.)

This new clause would amend the Medicines and Medical Devices Act 2021 to (a) enable regulations to refer to both international agreements and standards and standards developed in the United Kingdom and (b) enable the Secretary of State to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom.

Brought up, and read the First time.

[Karin Smyth]

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

[The Chair]

With this it will be convenient to discuss the following:

Government new clause 92—Medical Devices Regulations 2002: mutual recognition agreements.

Government new clause 93—Consultation about medicines and medical devices regulations.

Government new clause 94—Medicines and medical devices regulations: parliamentary procedure.

Government new clause 95—Medical devices etc: parliamentary procedure for certain fees regulations.

Government amendments 80 to 82.

New clause 67—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 68—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) and Innovative Licensing and Access Pathway (ILAP),

(b) the effectiveness of the early access outside of the Early Access to Medicines Scheme (EAMS) and Innovative Licensing and Access Pathway (ILAP), 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 House of Parliament.”

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

[Karin Smyth]

I will begin with Government new clauses 91 to 95. Many hon. Members will know that the current regulatory framework for medicines and medical devices is seen as overly complicated and difficult to navigate. It is also slow and burdensome to amend, limiting our ability to ensure that it keeps pace with developments. Maintaining the safeguards to public health is central to every decision we make. However, the regulatory framework currently slows down innovation and delays patient access to healthcare products. From a market growth perspective, it also places barriers to the UK market, particularly for small and medium-sized enterprises.

These new clauses will deliver a more streamlined regime for making and updating secondary legislation. The ability to make faster and more responsive updates to secondary legislation will enable the Department and the Medicines and Healthcare Products Regulatory Agency to address the current barriers that I have highlighted in the regulation more quickly.

New clauses 91 and 92 provide for changes with regard to powers to make “ambulatory references”, which are references in legislation to external documents such as technical standards and lists, which can be updated from time to time. These changes will ensure that the legislation continues to capture updated versions of those documents without the need for further regulations. International and domestic standards are crucial in the highly technical areas targeted by the change. It is important that the regulatory regime remains aligned with the technical, scientific and international framework that is designed to evolve over time.

Currently, there are limited powers for medical devices regulations to refer to external international agreements or standards that change over time, and there are no such powers at all for medicines. Without the ability to make ambulatory references to those documents, legislation is needed each time the standards are updated. That is disproportionate and risks unintentional regulatory divergence that creates uncertainty for industry.

The new clauses introduce a power for human medicines regulations to refer to external international agreements or standards that are updated over time. For medical devices, the provisions also extend the current ambulatory reference power to make reference to lists of countries subject to mutual recognition agreements, lists of devices or categories of device that are eligible for an international reliance pathway, and lists of British technical standards. Amendment 80 sets out that the extent of new clause 92 will cover England, Scotland and Wales.

The provisions of new clause 93 enable a more flexible approach to consultations on regulatory changes related to medicines and medical devices, rather than the current one-size-fits-all requirement. Under the amended powers, the MHRA and the Department will still retain a legal duty to consult relevant stakeholders, and significant regulatory changes will continue to be subject to public consultation. The measure is designed to enable consultations that are proportionate to the scale of the change in hand. That will ensure that regulations can be updated more efficiently and in line with the needs of the health service.

New clause 94 will enable certain technical updates to medicines and medical devices regulations to be made using the negative rather than the affirmative procedure. Specifically, it relates to changes that routinely arise as clinical practice evolves—for example, updating detailed lists of medicines or making limited adjustments to the professional groups who may prescribe, supply, sell or administer particular medicines. At present, even minor or time-sensitive changes of this sort can require a debate under the affirmative procedure, which is not always the best use of parliamentary time.

New clause 95 is the final measure in the regulatory framework package for the MHRA. It is designed to streamline the process for routine fee updates made using powers under the European Union (Withdrawal) Act 2018 by allowing the use of the negative parliamentary procedure for routine fee uplifts. That will bring the powers in line with those relating to fees in the Medicines and Medical Devices Act 2021, where uplifts to existing fees can be made with the negative procedure. That will also reduce delays in making and communicating such adjustments, while maintaining appropriate safeguards, including the requirement to set out the cost basis for any new uplifts with any legislation—whether it is made under the negative or affirmative procedure. The draft affirmative procedure will be retained for any substantive changes, such as the introduction of a new chargeable function.

Finally, there are a number of consequential provisions related to those I have just discussed. Government amendments 80 to 82 primarily relate to the commencement period in which they come into force.

In conclusion, the amendments will enable a faster and more responsible reform of the existing legislative framework, while preserving proportionate safeguards and necessary scrutiny. I commend the new clauses to the Committee.

[Dr Johnson]

New clause 91 would amend the Medicines and Medical Devices Act to enable regulations

“to refer to both international agreements and standards and standards developed in the United Kingdom”

and enable the Secretary of State

“to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom.”

New clause 92 would amend the definition of “mutual recognition agreement” so that

“agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.”

New clause 93

“amends the duty to consult in relation to regulations about human medicines and medical devices.”

That means that instead of a public consultation, it

“gives the option of consulting such persons as the relevant authority considers appropriate”.

I would be grateful if the Minister clarified whether that could be nobody, or whether it has to at least be somebody.

New clause 94

“changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure.”

That relates to regulations about medicines and medical devices. I want to ask about scrutiny, because we have had a number of statutory instruments over the last few years that, under the new regulations, would now be put under the negative procedure. When we have looked at them, there have been questions and potential changes.

Why does the Minister want a lower level of scrutiny? In general, scrutiny is a good thing. I understand that this could smooth out procedure and make it a bit quicker in some cases, but we had an example where a Minister brought forward fee increases. I then raised the issue of national insurance and that Minister was not aware of whether it was paid at that time. The civil service pay estimate was significantly lower than expected and lower than what was given. Therefore, six months later we were back in Committee with a different Minister asking for more money. There is a scrutiny issue with new clause 94. That also relates to the fees and terms in new clause 95, which was one of the examples I gave.

[Karin Smyth]

I thank the hon. Lady for her comments. The purpose of the new clauses is to support our life sciences and medicine sector, in order to make that more streamlined. She will be aware of the proposals about the negative and affirmative procedure. If there were particular issues of scrutiny, normal parliamentary rules and processes would apply if Members wanted to raise any particular issue.

Question put and agreed to.

New clause 91 accordingly read a Second time, and added to the Bill.

New Clause 92

Medical Devices Regulations 2002: mutual recognition agreements

“(1) The Medical Devices Regulations 2002 (S.I. 2002/618) are amended as follows.

(2) For regulation 1A (Schedules) substitute—

‘1A Schedule

Schedule 2A has effect.’

(3) In regulation 2 (interpretation), in paragraph (1)—

(a) in the definition of ‘mutual recognition agreement’, in paragraph (a), for ‘country listed in Schedule 2’ substitute ‘country specified in a list published by the Secretary of State from time to time’;

(b) in the definition of ‘third country conformity assessment body’, for ‘established in a country which is listed in Schedule 2 and designated in accordance with a relevant’ substitute ‘designated in accordance with a’.

(4) Omit Schedule 2 (mutual recognition agreements).”—(Karin Smyth.)

This new clause would amend the definition of “mutual recognition agreement” in the Medical Devices Regulations 2002 (as it has effect in England and Wales, and Scotland) so that agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.

Brought up, read the First and Second time, and added to the Bill.

New Clause 93

Consultation about medicines and medical devices regulations

‘(1) Section 45 of the Medicines and Medical Devices Act 2021 (consultation) is amended as follows.

(2) In subsection (1), for “a provision of Part 1, 2, 3 or 4” substitute “Part 1 or 3”.

(3) After subsection (1) insert—

“(1ZA) Before making regulations under Part 2 or 4 the relevant authority must—

(a) carry out a public consultation, or

(b) consult such persons as it considers appropriate.”

(4) In subsection (3), at the beginning insert “Where a public consultation is carried out”.

(5) In subsection (4), in the words before paragraph (a), for “subsection (1)” substitute “subsection (1ZA)”.’—(Karin Smyth.)

This amends the duty to consult in relation to regulations about human medicines and medical devices. It gives the option of consulting such persons as the relevant authority considers appropriate instead of a public consultation.

Brought up, read the First and Second time, and added to the Bill.

New Clause 94

Medicines and medical devices regulations: parliamentary procedure

‘In section 47 of the Medicines and Medical Devices Act 2021 (regulations: procedure), for subsection (3) substitute—

“(3) Regulations under Part 1 are subject to the draft affirmative procedure.

(3A) Regulations under Part 2—

(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—

(i) provision made in reliance on section 6(1)(a) (fees);

(ii) provision amending the meaning of ‘appropriate practitioner’ or ‘approved country health professional’ for the purposes of Part 12 of the Human Medicines Regulations 2012 (see regulation 214 of those regulations);

(iii) provision amending any of the following provisions of the Human Medicines Regulations 2012—

• regulations 217C(3) or 217CA(3) (original pack dispensing for products containing relevant substances: definition of ‘relevant substance’),

• Schedule 13 (prescription only medicines for which community practitioner nurse prescribers are appropriate practitioners),

• Schedule 15 (requirements for specific products subject to general sale),

• Schedule 16 (patient group directions and vaccine group directions),

• Schedule 17 (exemption for sale, supply or administration by certain persons),

• Schedule 18 (substances that may not be sold or supplied by a pharmacist without a prescription in reliance on emergency provisions),

• Schedule 19 (medicinal products for parenteral administration in an emergency), or

• Schedule 21 (medicinal products at high dilutions);

(iv) provision amending regulation 250 of the Human Medicines Regulations 2012 (restrictions on persons to be supplied with medicinal products: exceptions) for the purpose of changing the products to which any exception from time to time provided for by that regulation applies;

(v) provision that is consequential on provision of a description mentioned in any of sub-paragraphs (ii) to (iv);

(b) are subject to the made affirmative procedure if they—

(i) contain only provision that is made in reliance on section 7 (emergencies),

(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health, and

(iii) are not within paragraph (a);

(c) are subject to the draft affirmative procedure if they are not within sub-paragraphs (a) or (b).

(3B) Regulations under Part 3—

(a) are subject to the negative procedure if they contain only provision made in reliance on section 12(1)(a) (fees), and

(b) are subject to the draft affirmative procedure if they are not within paragraph (a).

(3C) Regulations under Part 4—

(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—

(i) provision made in reliance on—

• section 17(1)(a) (fees), or

• paragraph 9 of Schedule 2 (supplementary provision about civil sanctions);

(ii) provision amending or revoking regulation 1ZA of the Medical Devices Regulations 2002 (expiry of certain provisions) or consequential on such provision;

(b) are subject to the made affirmative procedure if they—

(i) contain only provision made in reliance on section 18 (emergencies), and

(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health;

(c) are subject to the draft affirmative procedure if they are not within paragraph (a) or (b).”’—(Karin Smyth.)

This changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure. The changes all relate to regulations about medicines and medical devices (although the procedural provisions relating to certain other matters are restated in the amendment).

Brought up, read the First and Second time, and added to the Bill.

New Clause 95

Medical devices etc: parliamentary procedure for certain fees regulations

‘In Schedule 7 to the European Union (Withdrawal) Act 2018 (regulations), in paragraph 12—

(a) in sub-paragraph (1) for “relate to altering the amount of a fee or charge to reflect changes in the value of money” substitute “fall within sub-paragraph (1A)”.

(b) after sub-paragraph (1) insert—

“(1A) Provision falls within this sub-paragraph if it relates to—

(a) altering the amount of a fee or charge to reflect changes in the value of money,

(b) altering the amount of a fee or charge to be charged in connection with the exercise of a function which a public authority has by virtue of provision made under section 8C in connection with the EU medical devices Regulations, or

(c) altering the amount of a fee or charge to be charged under the Blood Safety and Quality Regulations 2005 (S.I. 2005/50).

(1B) In sub-paragraph (1A)(b) ‘the EU medical devices Regulations’ means—

(a) Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC, or

(b) Regulation (EU) 2017/746 of the European Parliament and of the Council of 5 April 2017 on in vitro diagnostic medical devices and repealing Directive 98/79/EC and Commission Decision 2010/227/EU,

as they have effect from time to time by virtue of Article 5(4) of the Windsor Framework.”’—(Karin Smyth.)

This allows regulations altering certain fees in relation to medical devices etc to be made subject to the negative resolution procedure. At the moment those regulations are subject to the affirmative resolution procedure.

Brought up, read the First and Second time, and added to the Bill.

New Clause 1

National Maternity Commissioner

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

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

(a) oversee NHS maternity services;

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

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

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

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

(3) The person appointed as Commissioner must—

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

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

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

This new clause would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise of maternity services, and not a political appointment.

Brought up, and read the First time.

[Helen Morgan]

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

--- Later in debate ---

[Dr Johnson]

As the hon. Lady said, new clause 1 seems somewhat redundant, because the Government appear to have decided to appoint a maternity commissioner.

New clause 13 asks for a report. Before I go any further, I should say that I am a member of the Royal College of Paediatrics and Child Health and have attended the delivery of many babies as a paediatrician at different levels of seniority. I should also say that I am a member of the British Medical Association, that I continue to work as an NHS consultant paediatrician and that I worked at Nottingham University hospitals NHS trust in late 2012, early 2013.

I have great sympathy with the reasoning behind what the hon. Member for North Shropshire is proposing. We have all been shocked by the many reports we have read, the circumstances we have heard about, the tragedies that have occurred over many years and the challenges that are faced by maternity care. I am not sure that writing more reports is going to help; I think we need more action rather than words.

The hon. Lady mentioned the taskforce. I was disappointed that it took the Government so many months to establish it, that it took so long for it to meet and that it has met only a few times. As we have talked about things such as Healthwatch and the HSSIB, the Minister has shown her enthusiasm to get on with things and ensure that the recommendations made in the varying reports are implemented. I would therefore be interested to understand how that will occur in maternity.

My understanding is that the Government are going to produce a plan on how to deliver the recommendations in the recent report, and that is going to be available by Christmas. However, that means that we will then be in a situation where the Government came into power in mid-2024 and then spent a year writing a plan—the 10-year “Fit for the Future” plan. Around the time that they published that, they decided that they needed an urgent maternity report; that was going to take a few months, but it ended up taking another year in of itself. Now we are going to take another six or seven months writing another plan on how to implement the plan we have written, based on the plan we wrote before, based on the plan we did not have at the general election.

I am interested to understand how the Government are going to convert the good intentions I am sure they have into action. In particular, their manifesto promised that thousands more additional midwives would be trained. I would be interested to know what progress they have made on that.

[Karin Smyth]

I am grateful to the hon. Member for North Shropshire for bringing this discussion before the Committee. I put on record our thanks for the work she has done in this area and for her engagement with me, and indeed with officials at the Department, to help us understand it more clearly, particularly in the light of the new clause.

Hon. Members across the Committee are committed, as are the Government, to ensuring that women, families and babies receive the care and support they need. We know that the vast majority of births are safe and that there are outstanding examples of care in the NHS. However, where things do go wrong, it can have a devastating impact on women and their families.

That is why the Government launched the national investigation into NHS maternity and neonatal care, chaired by the noble Lady Baroness Amos. Baroness Amos brought the findings from past reviews, local rapid reviews and new evidence from families and staff together into one clear national set of recommendations, which as we heard was published last week. The Government also launched the maternity and neonatal taskforce, chaired personally by the Secretary of State, which will translate Baroness Amos’s recommendations into action.

As we heard, Baroness Amos recommended the appointment of a statutory maternity and neonatal commissioner. We have accepted that recommendation, and I know there is support for it across the House. To be clear, the Secretary of State stated last week that we are committed to putting the role on a “statutory basis” as soon as possible.

I am afraid I cannot give the hon. Member for North Shropshire a more detailed timetable at the moment, because we are currently looking at options to legislate at pace, including potentially through this Bill, subject to discussions through the usual channels, while also—this is crucial—giving the taskforce the opportunity to shape the scope of the role. That was one of Baroness Amos’s urgent actions, and we accept it as a crucial first step in overseeing systemic improvements to care and outcomes and earning back the trust of women and families.

The maternity and neonatal commissioner will champion the voices of families and drive forward that necessary change. The Secretary of State will remain accountable to Parliament for maternity services. The role will be discussed urgently with the taskforce and will have a relentless focus on driving those improvements, which will include co-chairing the taskforce.

As the Committee knows, these are complex matters. The Government, having accepted the Baroness Amos’s recommendation, intend to legislate as soon as practicable. Our immediate priority is to work quickly through the taskforce to define the scope and responsibilities of the role. I know that the hon. Member for North Shropshire will not press the new clause, but I commit to keeping in touch with her and other hon. Members as this work progresses.

[Dr Johnson]

We talked about clause 1—on the abolition of NHS England—at the beginning of the Bill. The Minister was keen at that time to take unelected individuals out of the picture and create accountability by returning things to democratic control through the abolition of NHS England and putting them back in the Secretary of State’s hands. However, this proposal essentially does the reverse with maternity care, taking it out of the hands of Ministers and the Secretary of State and putting it into the hands of a commissioner. Could the Minister explain that?

[Karin Smyth]

I am sorry, but I did not get the end of that sentence. However, I think the hon. Lady was saying that the Bill essentially abolishes NHS England. Again, as I have said repeatedly, nobody is opposing that. As is well known, the recommendations on the maternity commissioner have come through a separate process. Given the need for public assurance and to earn back the trust of women and families, as well as—I think the hon. Lady said this herself—the shocking revelations that have come through some of this work, Baroness Amos recommended a maternity and neonatal commissioner to drive through these changes and give confidence to the system. That is why we are going to accept her recommendation. Accountability for maternity services obviously remains with the Secretary of State, who will be co-chairing the taskforce. I hope that addresses the comments the hon. Lady made.

On new clause 13, we know that the vast majority of births are safe, but the devastating trauma experienced by many through failures in care must be brought to an end. The CQC has an important role in assessing whether patients are receiving safe, effective and high-quality care, and it is essential that it can do that objectively and independent of Government. It is therefore not appropriate to impose a duty on the Secretary of State to ensure particular ratings.

--- Later in debate ---

[Edward Argar]

My questions will be very brief. I am conscious that, given that these are mostly Liberal Democrat new clauses, for once I will be asking the hon. Member for Winchester for a response, not the Minister.

New clause 4 would require that contracts be laid before Parliament. I would be grateful if the hon. Gentleman can tell the Committee how many such contracts he thinks would end up being laid before the House in any given year, based on historical data, and therefore how much parliamentary time that would take up. Does he envisage that being handled by an affirmative or negative statutory instrument? What will the process be?

I can see what the hon. Gentleman is trying to do, but I have a certain wariness, along the lines of that expressed by the hon. Member for Bury St Edmunds and Stowmarket. Although it is important that we have appropriate protections and scrutiny, when we are procuring services and technology for the NHS we should be looking for the most effective and best tools that have those safeguards but can do the job that eminent surgeons and clinicians need them to do in order to do their work for patients.

[Karin Smyth]

I am grateful to hon. Members for tabling these new clauses. I recognise the concerns behind them. Contracts involving NHS data, digital services and technology must be subject to proper scrutiny. Patients expect their medical information to be protected, and NHS staff expect the systems that they use to be safe and reliable. The Government agree that Parliament should be entitled to test how those protections work.

I also want to be clear that the Government want British businesses to win more public contracts and build stronger UK capability in digital and technology. The Government are already using procurement to support British businesses, jobs, skills and national security. More than 90% of UK public contracts are currently awarded to UK suppliers, and the Government have set out reforms to make procurement do more to support British industry and supply chain resilience.

I do not think that new clause 3 is the right way to achieve proper scrutiny. It would require the Secretary of State, within six months, to conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside the United Kingdom. That would include contracts regardless of the value—we heard a little about that from the Opposition—and of the services being provided, the type of data and whether there is evidence of any sort of concern. Risk is driven by the nature of the data involved, not just where the supplier is located. That is why the Government’s approach is based on targeted assessment and proportionate control.

We already have the tools we need in the Procurement Act 2023, which gives contracting authorities the powers to exclude suppliers and terminate contracts where the legal tests are met, including on national security grounds. They may also refer suppliers for a debarment investigation. The National Security Unit for Procurement supports Ministers in assessing suppliers on national security grounds, working closely with Departments and the intelligence community. In health and digital contracts, those procurement powers sit alongside data protection legislation and data protection impact assessments, in line with the digital, data and technology playbook. That is not an argument for complacency; we should continue to identify risks before procurement begins.

A broad duty of the kind in new clause 3 would risk becoming a reporting exercise and would not necessarily make the highest-risk contracts safer. It could, however, draw time and resource away from the assurance activities that matter most. The right approach is to strengthen the targeted controls, not to create a single statutory risk assessment covering every non-UK supplier.

Similarly, on new clause 4, a blanket “buy British” rule would not be the right test for NHS data contracts, although I hope that I have assured the hon. Member for Winchester that home-grown domestic products are absolutely what we are trying to focus on. The UK must treat suppliers from countries with reciprocal procurement access fairly. Our international obligations matter and are an important driver of the UK economy, including the World Trade Organisation agreement on Government procurement, which gives British businesses guaranteed access to £1.3 trillion in public procurement opportunities overseas annually.

As the hon. Member will understand, new clause 5 would require the Government to commit to a new programme of work to develop domestic capability, to reduce reliance on overseas suppliers of IT services and technology. The strategy would also require us to set out an approach to managing the risk associated with our current use of technology provided by overseas suppliers. I welcome the notion of encouraging domestic innovation to ensure the security and resilience of our IT infrastructure. However, ensuring the security of our data and the resilience of our systems is already embedded in everything we do. The new clause is therefore simply not necessary.

Hon. Members will accept that we want to see continued growth of digital and tech industries in this country; it is one of our real success stories. However, it will not be achieved by cutting across procurement law and not seeking the solutions that provide the best value for our money and the right service for the NHS. Our approach to securing the best IT and tech solutions should always be to seek the best on offer in a diverse, global market, not to prioritise based on location. Prioritising domestic providers means making a decision on grounds other than the quality, integrity or value for money of a solution.

I understand the concern behind new clause 43, which the hon. Member for Sleaford and North Hykeham spoke to. However, where public money is used to provide NHS services, there should be proper transparency about the contract, the service being delivered and the use of public funds. Patients and the public are entitled to expect that information is not placed beyond reach simply because a service is delivered through a contract. I do not think the new clause necessary, and I am concerned that it could create confusion about the operation of the Freedom of Information Act 2000. The Act already deals with information held by another person on behalf of the public authority. The key issue is not where the information physically sits. It does not matter whether it is held by the authority or by one of its commercial partners; what matters is whether it is held for the public authority’s purpose.

The Government agree with the principle of transparency, but new clause 5 would not improve the existing framework. It would risk duplicating duties that already exist, cutting across standard contract terms and creating uncertainty about patient information, which is rightly protected. For all those reasons, I ask hon. Members not to press the new clauses.

Finally, I say to the hon. Member for Winchester that we have already debated the single patient record. Public trust is key, and there will be multiple suppliers. We are bringing patients and the public with us and will continue to do so. The hon. Member asked about the FDP roll-out. I do not think it was about the supplier. I think it was about the money. It was about inertia in rolling out some good technology that provides good efficiency. It was also about capacity, capability and an attitude to productivity, which we absolutely need to drive more of.

[Dr Chambers]

I appreciate the Minister’s response and the comments of other Members, which were insightful as usual.

When we discussed whether carers could access parts of the single patient record, Members made very good points about privacy and historical health issues that a patient might not want a carer to know about. Those are very sensible concerns, but someone watching these proceedings or looking back over the record would think that there had been a lot more agonising over whether someone caring for a patient could access relevant information than over the potential systemic misuse of health information facilitated by private companies. A lot of people are worried about that when it comes to procurement, trust and sovereignty.

I thank the Minister for her comments on new clause 3. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 4

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.’”—(Dr Chambers.)

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.

Brought up, and read the First time.

Question put, That the clause be read a Second time.

Health Bill (Thirteenth sitting)

Karin Smyth Excerpts

Tuesday 7th July 2026 Public Bill Committees

[Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

It is a pleasure to serve under your chairship, Ms Lewell.

The question is what will make patients more safe. Does incorporating the department that looks at safety into the organisation that inspects the services help? It might. Safety is not an add-on; safety must be at the heart of absolutely everything that we do. Safety is not a separate matter; it depends on those who work in our NHS and all of us all the time. That must be the culture. Let us not rely so much on inspections and litigations. At a time when we are unable to find jobs for newly qualified midwives, we spend more on obstetric litigation and compensation than we spend on obstetrics. I applaud what our Government are trying to do and their intention to improve things.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms Lewell. This morning, we had really good and detailed exchanges about patient safety and learning the role of HSSIB.

Often politics is confrontational and divisive, but I want to be clear that I take at face value that every single Member who has spoken and who I have met with, including people who do not want to see this change, have the best of intentions. They want to understand patient safety—in the long term we can talk about safety and quality of service, but let us focus on the safety aspects here—and they are trying to navigate something. They are seeing a change, which is always difficult, and we need to ensure we get that right. It is absolutely right that we do that in Committee, on Report and in the House of Lords. We will continue to take note of all the points made and seek to address them. I fortunately had the lunch break to reflect and do that a bit more carefully.

For people here and those reading our deliberations, what is difficult about the Bill—we understand this as legislators—is that we are abolishing an organisation and moving functions. That stands within a wider framework of changes to the safety and quality landscape that the Government are seeking. When one focuses on things that are being abolished, it is very binary. I will try and locate some of that without veering too far from the matter in front of us.

Among all the discussions, there are a couple of key questions that I want to address, including why I do this. Through the passage of the Bill, many people in the wider landscape have said to me, “Why are you bothering having a row about this?” I find that quite shocking as a riposte, because the answer is simple in the context. It is too important to not attempt to get this right and make changes to something that clearly is not working. I do not think I have heard anybody say that the current system is working.

As the right hon. Member for Melton and Syston noted, I said during the passage of the Health and Care Act 2022 that the functions of HSSIB are really important and must be built to the highest standard. I absolutely stand by that. It is not working; that is why we are changing it, but also why we are preserving the function within a new system, which we will seek to improve.

[Joe Robertson]

Will the Minister give way?

[Karin Smyth]

I am going to try to go through these points because I have listened carefully to everybody’s contributions. If there is something outstanding, I will be happy to come back to it.

To answer some of the direct questions that were put to me about the Dash review, I do not recall anybody particularly disagreeing with its findings when it was published or when we put it forward in our 10-year plan last year. I do not expect everyone to agree with every single recommendation or point made in that review. To an earlier point that was made by the Opposition, it was informed by a broad range of evidence and perspectives from across the health and social care system, including engagement with commissioners, providers, patients, families, and people harmed by poor-quality care, as well as charities, academics and national organisations. It looked really closely at what has not worked and why. I encourage hon. Members to go back to the work that Penny Dash was asked to do and the wider report.

The hon. Member for Farnham and Bordon and the right hon. Member for Melton and Syston asked why the review covered only six organisations. The then Secretary of State authorised the Dash review to look at six organisations in this space that were directly overseen by the Department. Many other organisations in this space are not directly overseen by the Department, so they were not in scope of that review as they had their own regulatory landscape ecologies and so on. That is why those six organisations, which we oversee, were looked at.

Last night at the Dispatch Box, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Birmingham Edgbaston (Preet Kaur Gill), made it clear that the rationale for this change is not based on cost. It is not based on the recommendations being too expensive. Rather, as I am sure colleagues will agree, we have seen far too many recommendations regarding patient safety but too little action. Inaction is not helping to improve the patient landscape.

Opposition Members referenced the view from the longest-serving Health Secretary, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), that the NHS will not change or adopt the recommendations. That is a profoundly depressing prospect. We cannot predicate our laws and the health landscape on the basis that the culture in the NHS cannot and will not change. This is not a party-political point, but because of what has happened in the last decade, we must move from a defensive culture into a culture of learning while keeping a safe space in which people can speak up. We have heard a lot about “perception” today. I accept that there is a perception of negativity that is damaging to patient safety and people speaking up, but that is what our wider reforms are seeking to address.

[Dr Prinsley]

I listened carefully to what the Minister said about a change of culture. A change of culture can certainly happen. In the surgical world, we used to bring patients into the operating theatre, check that the patient was on the operating table and do the operation. Sometimes, we operated on the wrong patient and on the wrong part of the body. We then introduced the World Health Organisation checklist, which checked absolutely everything before we started. It was a complete change of culture in the operating department. We made sure that we had the right prosthesis, the right patient and that we were operating on the right part of the patient. Now, the WHO checklist is a universally adopted process. I am absolutely sure that the culture in the health service can change.

[Karin Smyth]

I thank my hon. Friend for that. He and others on both sides of the House with clinical experience, including the hon. Member for Sleaford and North Hykeham, have shared live examples that can shock the layperson. It is important that those practices are changed clinically, and it is up to Government to make sure that the overarching legislative framework enables that.

[Dr Johnson]

Will the Minister give way?

[Karin Smyth]

I want to make some points first. I will pick up any outstanding points I do not cover.

The abolition of HSSIB and the transfer of its functions to CQC is being done to strengthen the link between patient safety investigations and the action being taken on the frontline to simplify the patient safety landscape. We want to align the recommendations with action.

Hon. Members quoted evidence that Dr Dash gave to the Committee. Let me remind the Committee of something else she told us, about how HSSIB’s functions can be better aligned as part of the CQC. She said:

“by bringing HSSIB into the CQC, you can align the work of the two.

For example, if the CQC is going round the country and spotting a particular problem with the way in which anaesthesia is being given or with managing patients post-surgery, the CQC could then say to HSSIB—that team of people with specific expertise—‘Can you go in and take a look at this? Can you do a detailed focus review of this particular area of care that we are spotting through our visits and which seem to be a particular challenge?’ It is that bit about enabling the CQC to identify a problem and then asking HSSIB to review it in detail, and HSSIB bringing its expertise in investigations into the CQC to enable the CQC to go deeper and then come back to the NHS”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.]

to enable best action. These organisations can learn better from each other.

Transferring investigation powers to the Care Quality Commission is an opportunity to strengthen the CQC. We have to move away from a defensive culture to a culture of shared learning if we are to improve patient care. The CQC can learn and improve from HSSIB best practice and take a more holistic approach to patient safety. Those executing the regulatory and investigatory functions can learn from each other and exchange skills, which would strengthen the links between learning, oversight and improvement, leading to real and sustained change across the system, driven by the CQC.

--- Later in debate ---

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

On that point, will the Minister briefly give way?

[Karin Smyth]

No.

There will be no barrier to investigating whether CQC inspections are causing unintended harm. If they are, and the investigator feels that a recommendation for change should be made, they will make it. The insight gained from investigations will continue to inform recommendations concerning the CQC’s regulatory functions, and the Bill allows for the investigation function to make recommendations to the CQC in its report. The CQC would be legally required to respond to such recommendations. There will be no need for litigation through the courts. That is an important point. Again, I am addressing the points made by Opposition Members. We will continue to set this out more clearly for Members. I am happy to find different ways to do that.

I now turn to the wider point about whether both an investigatory and a regulatory function can reside in the same body. Many organisations have different functions and responsibilities that they have to discharge simultaneously; we have also heard a lot about the safety body, which of course is part of the Department for Transport. It happens across a lot of bodies. I totally accept that it would be helpful for the debate if we were clearer on what some of those bodies are, and we will come forward with more information on that.

[Joe Robertson]

Will the Minister give way?

[Karin Smyth]

I am going to persist on some of these arguments. I think I have addressed all the points made by the Opposition. It is the job of effective leadership to manage those interests and responsibilities, and that is what we expect of the CQC’s leadership.

I will now turn to the amendments on this topic, which I thank the hon. Members for Sleaford and North Hykeham and for North Shropshire for tabling. Amendment 55 would make provision for the Secretary of State to disapply investigation powers in certain circumstances. I recognise the importance of ensuring that investigatory powers are not exercised in relation to sensitive Crown or Government premises where there is a national security interest. I want to be clear: the Bill already provides for that.

The Bill already amends section 96 of the Health and Social Care Act 2008 so that it applies to the new CQC investigatory function. Section 96 makes provision for the application of CQC legislation to the Crown, which means that the mechanism that the amendment is seeking to introduce is already in place within the existing legislative framework. Additionally, the Bill already provides for a power which enables the Secretary of State to disapply these investigatory powers in relation to Crown premises when it is in the interest of national security. The amendment would therefore duplicate an existing provision and would add unnecessary complexity to the legislation without delivering any additional benefit.

Amendment 56 would allow the Care Quality Commission to recover charges that are higher than the actual costs it incurs when providing assistance to anyone other than an NHS body or the Secretary of State. I understand the intention behind the amendment—to give the commission greater financial flexibility—but the Government do not think that it is necessary. The charging framework in the Bill is based on the clear principle of cost recovery. Removing subsection (9) of proposed new section 51R of the Health and Social Care Act 2008 would mean that the commission could charge more than it actually costs to provide a service, shifting away from recovering costs and towards allowing the commission to make a surplus through its charging powers.

[Dr Johnson]

My understanding is that, in the past, HSSIB has provided services to not only British health services but overseas health services, which were, in some cases, charged for that service, as it is a world-leading organisation. Why would the Minister not want that to continue?

[Karin Smyth]

I am happy to get back to the hon. Lady on that specific point, if that is the case. The charging framework is about recovering costs, not making a surplus, which is what the amendment would result in. If that is not the case, I will make sure that she receives a proper correction.

The Government do not think that there is a good case for the amendment, because, as I have said, the aim of the provision is to provide for fair and transparent cost recovery, not to raise extra income beyond cost. I am not sure whether the hon. Lady is suggesting that it might be good for the commission to create additional funding, but if that is not clear, I am happy to get back to her on it. The provision makes the recovery of costs more predictable and consistent for those who have to pay them. That is usual for public bodies.

New clause 42 relates to funding provisions for the CQC’s new investigation function. The Department already provides grant in aid to the CQC to provide adequate funding for investigations and special reviews; similarly, HSSIB’s budget is provided through grant in aid and is set each year. When the CQC takes on HSSIB’s functions, the funding streams will remain distinct, and the CQC will have to assure the Department that the amount allocated to the new investigation function is being used for that purpose.

Funding decisions for the investigation function will continue to be captured in wider departmental budget-planning processes and considered centrally. That provides assurance that business and strategic priorities for the investigation functions can be met. Robust financial oversight will require the CQC to demonstrate that grant in aid is used appropriately, and solely to support the investigation function, without the need to prescribe funding arrangements in legislation.

As there is already an operational mechanism for the Secretary of State to provide adequate funding and resources for investigations, the new clause is not needed. It would also be inappropriate to prescribe the form or level of funding in legislation. The new clause would reduce the Department’s ability to manage funding through the established spending review and estimates process; introduce unnecessary rigidity as the merged function evolves; and risk creating binding funding expectations that may not align with future fiscal constraints. A non-legislative approach ensures flexibility, scale and adaptive function while maintaining robust oversight.

I agree with the intention behind amendment 5, tabled by the hon. Member for North Shropshire, which is, as I understand it, to ensure that the Health Services Safety Investigations Body functions that are transferred to the CQC retain a high level of operational independence and continue to command the confidence—the Committee heard that word a lot this morning; I completely agree on its importance—of patients and their families, healthcare professionals and the wider public. Similarly, I understand that the objective of the amendment is to maximise the perception—again, that is a word I am coming back to; I tried to address the issue earlier—of independence in the CQC.

The Government have protected safe spaces in legislation, and we agree that operational independence of the investigation function is required, but our plans support and enable that. For that reason, we cannot support the amendment, which would impose a highly prescriptive governance structure on the CQC by requiring the creation of a separate statutory committee and setting out in primary legislation detailed requirements for its purpose, membership appointments and operational arrangements. While the Government fully agree that effective safety investigations must be conducted independently and objectively, we do not consider it necessary to put such detailed organisational arrangements in the Bill.

The Bill already provides a clear legislative framework for the transfer of those functions and enables the CQC to discharge them appropriately, within its broader statutory responsibilities. Furthermore, the CQC already operates within a robust statutory framework and is capable of establishing governance arrangements that support the effective delivery of its functions, including appropriate safeguards to protect investigative independence and the handling of safe-space material.

The amendment would reduce organisational flexibility by mandating a specific committee structure, and would constrain the CQC’s ability to adapt its governance arrangements over time in response to operational experience, changes in circumstances or future improvements in best practice. Under the amendment, governance arrangements would be fixed in statute, rather than having the capability to evolve as the organisation learns and develops.

Those additional administrative and governance requirements would increase bureaucracy and complexity, which the Government are looking to reduce. I re-emphasise that, in addition, a statutory committee would weaken the important links between learning and the action that the transfer of this organisation is intended to support. One of the key benefits of bringing these functions into the CQC is the opportunity to strengthen strategic oversight and ensure that learning from investigations can more readily inform improvement activity across the system.

[Dr Johnson]

The Minister seems to be saying that her reasoning for moving HSSIB into the CQC is to ensure that actions take place in response to the recommendations. But if HSSIB outwith the CQC makes recommendations that are delivered by the provider organisations, commissioned by the ICBs and overseen by Ministers, and then the CQC checks that as part of the regulation, why does HSSIB need to be within the CQC for that to happen?

[Karin Smyth]

We are probably not going to agree on this point. I have made the point several times—and we made it in the Dash review—about bringing these organisations together. As I said again in my opening comments, it is about the opportunity to get this right and share that learning and experience. It is not about the cost but about aligning the recommendations and the actions that follow through from them. That learning, and the opportunity to push that through, is something we should grasp.

Coming back to amendment 5, creating a separate statutory committee risks introducing additional layers of separation that could slow the flow of intelligence and impede timely action in response to emerging patient safety concerns. We believe the integration of investigatory functions can be secured through clear statutory functions and appropriate safeguards, rather than through organisational structures set out in primary legislation that are too rigid. Establishing detailed governance requirements in statute may also make future improvements more difficult to implement without legislative change.

I understand and respect the concerns that underpin the amendment, but the Government believe that the Bill already provides the necessary framework for the safe and effective delivery of health services’ safety investigations following their transfer to the CQC. We will of course work closely with both the CQC and HSSIB on their transition arrangements through a transition board, whether on the issues of ensuring operation independence of the investigation function and the ways in which that learning is shared, or, further to the Opposition spokesperson’s point, how we make sure that learning is shared and creates an impact, and where that is felt most clearly. For those reasons, I ask hon. Members not to press their amendments, and I commend clauses 59, 60 and 61 to the Committee.

Question put, That the clause stand part of the Bill.

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Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

Clause 62 underscores the importance that we place on special reviews and investigations, and it will maintain the Care Quality Commission’s ability to conduct them by ensuring that the CQC’s investigatory role remains properly aligned with its original statutory purpose. The CQC is the independent regulator of health and care providers, and in the case of commissioners, it has the powers to undertake a special review or investigation when requested to by the Secretary of State.

On 30 January 2024, the then Secretary of State, the right hon. Member for Louth and Horncastle (Victoria Atkins), commissioned a section 48 review into mental health services in Nottinghamshire following the tragic events of June 2023. As we know, that revealed serious and systemic failings and led to strengthened oversight and a clear improvement plan. With NHS England being abolished and its functions being transferred to the Department and across the wider system, this clause will remove NHSE from the scope of section 48 and allow Ministers to set out, through regulations, the future scope of section 48.

NHS England’s commissioning functions will mostly transfer to the integrated care boards but, as we discussed previously, NHSE’s most specialised commissioning functions will transfer to the Secretary of State. In future, regulations will set out the specific commissioning functions that the Secretary of State will be responsible for and that the CQC may review or investigate. The scope of the special reviews and investigations will continue to apply only to commissioning functions under the National Health Service Act 2006 or section 117 of the Mental Health Act 1983, which is the CQC’s existing remit.

This approach will ensure that the CQC’s investigatory powers will not be automatically extended to departmental functions, which would fundamentally change the relationship between an arm’s length body and a Government Department and would not align with the original intention of section 48 reviews. For that reason, the Bill will provide for scrutiny through secondary legislation. That will set out a transparent and accountable way to specify which commissioning functions are in scope, enabling parliamentary scrutiny and CQC oversight where it is genuinely relevant to patient safety and care quality.

This approach will also provide important flexibility: as commissioning arrangements change, the right function can be brought into scope without unnecessary delays. Taken together, this clause will protect the CQC’s independence, maintain accountability and provide a sensible framework for scrutiny where it adds real value for patient safety and care quality. I commend the clause to the Committee.

[Dr Johnson]

I have just a couple of questions. Clause 62 will update the CQC’s power to conduct special reviews of NHS commissioning to cover ICBs and the Secretary of State’s commissioning functions, and the requirement for ministerial approval before the CQC can investigate will be retained. How will that apply when HSSIB is moved into the CQC? Is it the Minister’s intention that HSSIB will need the Secretary of State’s approval to complete investigations?

[Karin Smyth]

My understanding is that the clause will not change that particular power, but I will get back to the hon. Lady if I am wrong.

Question put and agreed to.

Clause 62 accordingly ordered to stand part of the Bill.

Clause 63

Time limit for bringing proceedings

Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

The 10-year health plan reaffirms the Government’s commitment to families affected by bereavement or serious harm, ensuring that lessons are learned from their experience and that more cases are fully reviewed and acted on. Families seek closure following serious harm to or the death of a loved one by wanting to understand what went wrong and what could be done to stop other families experiencing similar trauma, and by wanting to hold someone to account. Families often turn to the Care Quality Commission for help.

Clause 63 will extend the CQC’s power to bring proceedings against a health and social care provider for a serious breach of regulations from the existing limitation of three years from the date of the offence to five years. Let me be clear: extending the three-year limitation from the time of the offence will not alter the first requirement that the CQC should act within 12 months of sufficient evidence of a serious breach of regulations becoming available. That 12-month window for action once the regulator is aware of the offence will remain unchanged. Extending the limitation period to five years from the date of the offence will mean that fewer events that should be considered by the regulator will effectively time out and go beyond the reach of the regulator’s action.

The CQC is not the only body with an interest in investigating serious breaches of regulations that result in unnatural death; there are other investigatory bodies, such as the police, with equal interest and powers to investigate deaths for the purpose of pursuing criminal prosecution. The coronial process serves a different purpose. A coroner’s role is to establish facts surrounding an unnatural death rather than to find fault. In a complex case, a police investigation or a coroner’s inquest—sometimes both—can take time to conclude. Those independent processes are a useful source of information for the CQC to form a full picture of a breach of regulation.

A culture of learning from investigations, inquiries, errors and poor care should be the norm in the NHS. It is therefore expected that a service provider may also commission its own internal investigation to learn from an unnatural death. Furthermore, there are cases where the CQC is approached late with information after an offence may have been committed. For example, the CQC may only receive information about an offence two and half years after it was committed, leaving little time in the remaining six-month period to investigate. Extending the period to five years would help mitigate such circumstances, and that is why we are extending the statutory limitation period. This will ensure that the CQC has the ability in far more cases to address the serious regulatory failings that it should and must address, without risking falling foul of a time limitation. I therefore commend the clause to the Committee.

[Dr Johnson]

As the Minister said, clause 63 amends section 90(2) of the Health and Social Care Act 2008 to extend the limit on proceedings relating to the registration of offences under part 1 from three to five years. The impact assessment talks a little about the time it takes to investigate these cases, but as the Minister said, the time to investigate is 12 months from the CQC being given enough evidence to consider whether the case is prosecutable. Why has she chosen not to change that too? Does she think people will have enough time to investigate? She is looking puzzled.

[Karin Smyth]

Apologies—I missed the exact question as to what needed to be changed. Could the hon. Lady repeat that?

[Dr Johnson]

The Minister talked about changing the time period in which proceedings can be effected from three to five years, but once the CQC is aware that an investigation could be brought and there is evidence that needs to be looked at, it will still get only 12 months. That has not been changed. I wonder what the rationale is for that. I am not criticising it; I am just asking the question.

The other issue is that clause 63 is prospective, so if an offence were committed immediately after the Act was passed, for the first three years things would effectively be as they are now; the change from three years to five would be relevant only after three years. Clause 71(2) on commencement provides that clause 63 will not come into force until two months after the Act is passed. I just wonder in practical terms why, given that it will take three years to come into effect in any case, it will not come into force on the day the Act receives Royal Assent.

The impact assessment talks about the CQC prosecuting two or three additional cases a year, and a cost of £4.3 million over 10 years with fines of £2.7 million over 10 years. Will the regulator keep the fines, or will they go back into the Treasury? Can the Minister guarantee that the additional funds that are estimated to be required for the additional cases under this new regulation will be provided so that the CQC can do the investigations that she is giving it the opportunity to do?

[Karin Smyth]

Put simply, the answer to the hon. Lady’s questions is that we are not seeking to change other aspects. The CQC wants to get to points as soon as possible, so the 12-month period has not been changed. The function of clause 63 is merely to recognise the issues around the three years and to change that to five years. We are not seeking to alter anything else in that regard. On her point about the commencement date, that is merely recognising what is considered to be parliamentary convention.

Question put and agreed to.

Clause 63 accordingly ordered to stand part of the Bill.

Clause 64

Abolition of Healthwatch England

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to discuss the following:

Schedule 9.

New Clause 74—Report on the abolition of Healthwatch England—

“(1) Within 12 months of the passage of this Act, the Secretary of State must lay a report before both Houses of Parliament on the impact of the abolition of Healthwatch England and transfer of Healthwatch England's functions to ICBs.

(2) The report must consider—

(a) the effectiveness of escalation routes for complaints,

(b) the ability to receive responses to complaints from the relevant ICB officer,

(c) accountability of ICB CEOs for delivering new functions arising from the abolition of Healthwatch;

(d) independence in the delivery of patient surveys, and

(e) ability to investigate organisations from which the ICB commissions services.

(3) The report must make recommendations about how any issues identified under subsection (2) may be mitigated.”

This new clause would require the Secretary of State to publish a report within 12 months of the passage of this Act on the impact of the abolition of Healthwatch England and transfer of Healthwatch England's functions to ICBs.

New clause 78—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.

[The Chair]

I call the Minister.

[Karin Smyth]

This is a popular clause, Ms Lewell—and rightly so. I recognise that this provision has elicited a lot of interest among our constituents and the wider public. I look forward to hearing Members’ contributions.

--- Later in debate ---

[Joe Robertson]

It is a pleasure to serve with you in the Chair, Ms Lewell. This is another example of the Government seeking to abolish an independent voice and merge its functions into an organisation that, frankly, will probably benefit to some extent from not having that independent scrutiny, but it is not for the betterment of patients or indeed the system. Healthwatch England is effective specifically because it is an independent voice for patients. We have not heard any compelling arguments for why, just because the system is not perfect, this change is better than leaving it alone.

The argument has been advanced that this brings patient voice closer to decision making, but I would hope that the directly elected Ministers who represent people are what bring the voice of the people closer to decision making in the Department of Health. They should be the ones bringing patient voice to the heart of decision making—I am sure that they do, of course—and there are other means by which the Department formulates policies and decisions; it does not need to remove an independent patient voice through Healthwatch England, which serves a different purpose, to enhance that.

That different purpose is this: some of the things that Healthwatch England advocates for and shines a light on are uncomfortable truths for decision makers and the Department of Health. It looks far too cosy to now bring that function into the decision-making process. Some of these issues need the light shedding on them that comes with an independent organisation providing patient voice. We have heard how the Select Committee and MPs, in their free-ranging Back-Bench function, benefit from hearing that voice through an independent organisation such as Healthwatch England, because it allows them to fulfil their scrutiny function. This is not just about decision making; it is also about scrutiny of decisions once they have been made. What will the Select Committee, MPs and journalists do when they no longer have the light shed by that independent voice?

As my hon. Friend the Member for Farnham and Bordon has pointed out, representatives who are employees in the Department of Health and Social Care rightly have other overriding primary duties to the employer—the Department itself. Let us ensure that patient voice is articulated by those who do not have a primary obligation to their employer, but have an obligation to an independent organisation with functions that serve solely to amplify and project the voice of patients.

There are a number of issues with the abolition of local healthwatches, but I will save that for the next discussion. I want to make the wider point that there is a centralisation issue here too. Whether the Government like it or not, this measure will centralise powers into the Department; it will take outside powers from Healthwatch England and bring them in-house. That is nothing short of a centralising measure. The Minister needs to address the justification for that, because the more negatives there are to this decision, the more we need to understand the positives. So far, they are light indeed, or she has failed to articulate them. I think that there is a reason she has failed to articulate the positives: they simply do not exist.

I look forward to the Minister’s response. I urge her to take some more interventions, because the arguments she has given to the Committee in her speeches at the end of each discussion have tended to raise more questions than they have answered. We can only deal with that by intervening on what she says.

[Karin Smyth]

I think that the record will show that I have taken several interventions in recent days, and I will continue to do so. I have been very clear that we have some fundamental disagreements on philosophy and approach. I will desperately try not to veer into the next groups, but it may be tricky. I am sure that you will steer me through, Ms Lewell.

I want to pick up on some good, helpful points that have been made. I pay particular tribute to my hon. Friend the Member for Lichfield for the comments he made. I appreciate that certain areas, particularly Mid Staffs, have elicited a lot of debate and concern. I commend him for following that through on behalf of his constituency. I know that other Members in Staffordshire want to understand how the Government’s future plans will address their very real concerns. That is also true of other areas that have experienced shocking scandals, as we call them. I take that very seriously.

I will pick up on the question of independence that we veered into before, which was mentioned by the hon. Member for Sleaford and North Hykeham. She highlighted her concerns and the issues raised by my right hon. Friend the Member for Makerfield, and I heard what she said. Independence was also raised by the hon. Member for Winchester and my hon. Friend the Member for Lichfield. We therefore return to that point about independence and, as my hon. Friend said, about being in the room, making those decisions and changing the entire culture of the organisation to do something different.

The question is then whether bringing the functions of Healthwatch to the national level is the right method. Again, I commend work on that and the individuals involved in it. Hon. Members mentioned Jacob Lant of National Voices and the King’s Fund, which have worked with us very well to challenge us and try to make this legislation better. I really appreciate their work, and we will continue to talk with them.

The hon. Member for Farnham and Bordon mentioned GIRFT. I cannot help but respond to his point, because he suggested that being inside NHS England has somehow made it less effective, and I could not disagree with him more. It is not because he has left and is here; his presence is obviously missed at GIRFT and welcomed here. To be serious, every meeting I have with NHS England and everything we are attempting to do in reforming outcomes for patients on the ground involves GIRFT. It is now at the very heart of what NHS England does. By coming inside the organisation, it has done exactly some of the things we want to do: drive cultural difference and change inside the organisation, rather than being outside of it. As I said before, this is a slightly philosophical argument and political argument. I appreciate that there are views on either side, but that is absolutely our intention.

On the patient experience directorate, we recognise that public trust will be crucial. We need to ensure that there is system learning across the piece. The patient experience directorate has to earn the trust of the public and parliamentarians, so we will design it to operate transparently and sit at the centre of decision making rather than at its margins. Ministers will be accountable for and answerable to Parliament on the work of the patient experience directorate. It has to focus on the voices that are too often overlooked. The central priority of the directorate will be to reach under-represented and seldom heard groups and to ensure that engagement is accessible, inclusive and proactive, so that the experiences of vulnerable people help inform and shape the decisions that affect their lives.

[Liz Twist (Blaydon and Consett) (Lab)]

I was flattered to hear my comments on Second Reading quoted by the hon. Member for Sleaford and North Hykeham, but I think she has misunderstood me. My question to the Minister was and still is about how we maintain within the new arrangements the ability to speak up on behalf of others. Could the Minister comment on that?

[Karin Smyth]

I thank my hon. Friend for making the intention of her comments clear to the Committee. It is right that we need to build trust in patient voice and experience. We will pick up on that in our debate on local healthwatch branches, because that is perhaps where Members of Parliament are particularly important.

At a national level, there are many voices and organisations continuing to review the issue and challenge the Government, including through reports, meetings with Ministers and in Parliament, highlighting the good work that they do and numerous Committees. Health Ministers appear before the Public Accounts Committee, the Health and Social Care Committee and Lords Committees; I have appeared before the Science, Innovation and Technology Committee. That is an important way of ensuring that the Department and the new experience directorate will be accountable.

I recognise the important contribution that Healthwatch has made in capturing patient insight and informing the design and delivery of services, but we do not believe that new clause 78 is necessary. It is inconsistent with the purpose of the Bill. I am aware of the views of the hon. Member for North Shropshire, but the Government’s policy is to abolish Healthwatch and ensure that patient and public voice is more directly connected to decision making. It would therefore not be appropriate or consistent to legislate for a specific funding level for organisations that would no longer exist, or to constrain how funding is deployed to support the new arrangements.

[Helen Morgan]

For the record, I tabled amendments to delete those clauses, so there was consistency of intention.

[Karin Smyth]

I am just computing that in my brain. Can I seek clarification on that?

[Helen Morgan]

I tabled amendments to delete the clauses that will remove Healthwatch, but they have not been chosen for debate, because we can just vote against those clauses standing part. New clause 78, which would ensure that Healthwatch is funded properly, was tabled alongside amendments to ensure that Healthwatch is retained.

[Karin Smyth]

I understand. I am grateful to the hon. Member for that clarification, but her new clause represents an incomplete picture of Government funding for Healthwatch. A £14.15 million grant has been provided to local authorities for local healthwatches, and that is only part of the overall funding; a larger proportion is rolled into the wider local government financial settlement, and because that is not visible as a distinct line, headline figures often understate the total funding available. All of this funding is not ringfenced.

--- Later in debate ---

[The Chair]

With this it will be convenient to discuss schedule 10.

[Karin Smyth]

Clause 65 and schedule 10 will abolish the current local healthwatch arrangements and place responsibility for gathering the views of local people firmly with the bodies with the clearest levers to act: integrated care boards and local authorities.

At present, many organisations are gathering views, running engagement exercises and raising issues, often with the best of intentions, but the result can be duplication, variable coverage and uncertainty about who is accountable for responding. We can end up with lots of feedback but too little clarity on the action that follows. By placing those duties on integrated care boards and local authorities, we are ensuring that insight from patients, service users and communities feeds directly into where commissioning and service planning decisions are made for both health and care. As my hon. Friend the Member for Lichfield said, the people are in the room. It makes it easier to connect lived experience to priorities, quality improvement and the tackling of inequalities, rather than leaving intelligence at arm’s length from decision makers.

This is about strengthening impact, not silencing criticism. Integrated care boards and local authorities will have a statutory duty to demonstrate how they have engaged with all people in their area, including seldom heard groups, and will be expected to have clear routes for people to raise concerns. We expect transparency about what people have told the system, what the system has done in response and how learning is shared across partners.

As I said in my evidence, many constituents in my Bristol South constituency are said to be hard to reach. They are not hard to reach, in my view. We know exactly where they live, who they are, how old they are and what sex they are. We know largely what diseases they have. We know their level of income. We know their levels of education and attainment, and how they impact their health outcomes. They are not hard to reach; the system is not set up to listen to them. That is what we are determined to change.

Dr Penny Dash’s review of patient safety described a cluttered landscape, with overlaps in how user experience and advocacy are organised. It described the burden that that can place on the frontline, producing multiple, poorly co-ordinated asks with limited impact. Bringing the patient and community voice closer to the organisations responsible for improvement—it is actually their job as commissioners—will help to make feedback more actionable, reduce confusion and support better services. I commend the clause to the Committee.

[Dr Johnson]

As I understand it, the objectives of the Bill are to replace the local healthwatch with a less independent, internalised gatherer of patient experience feedback. The objectives appear to be featuring feedback more centrally in strategic decision making, getting people into the room and simplifying the patient landscape.

There are things that I do not understand about that. If the problem is that those who commission or deliver the services are not listening adequately to the people who gather the patient experience information, why not invite the independent individual who has gathered that information into the room? Why ask someone in the room to gather the information and risk the independence? Why not compel more listening?

The Minister talked about who is accountable for action. My understanding is that it is the healthwatches’ job to gather the patient experience and present it to Healthwatch England and the decision makers. It is not their job, as I understand it, to make decisions on how care is delivered or to deliver that care differently. Does the Minister intend that to change?

The Minister also talked about strengthening the impact of Healthwatch, but I do not understand how this change will do that. We have heard how its independence allows Healthwatch to go on telly, talk to Members of Parliament, Select Committees, radio stations and others, and publicise its findings. If it is within the Department, will it be able to do so as freely? I suggest that it will not.

The other thing that I do not really understand—perhaps the Minister can help us with this—is the organisation. At the moment, it is done in local authority areas. It will now become the job of the local authority and the ICB to commission feedback, but we have already heard how the 50% cuts to ICB budgets have led to ICBs merging into larger conglomerates. Those do not necessarily overlap with the strategic mayoral authorities in the way the Minister eventually wants. What geography does the Minister want the feedback to be gathered over? How does she see that working? Will it require further restructuring? The hon. Member for Lichfield talked about the importance of localism and how different areas of his constituency have different health needs. How does the Minister think that that will work under her new plans?

The Minister said that one benefit of the new process is reaching vulnerable individuals, but what is to stop Healthwatch doing that? Ultimately, if we have Healthwatch doing things now that are independent and respected across the House—I am sure your local healthwatch is also excellent, Ms Lewell; Lincolnshire’s certainly is—why not strengthen that voice? Why not say to those who are providing that service, “We’re going to give you more resources,” or “We’re going to ask you to deliver it in a slightly different way,” or “We’re going to ask you to focus on particular populations,” or even, “We’re going to invite you into the room with the ICBs so that they can hear you and listen carefully”?

Why not compel those making the decisions and delivering the services to listen to Healthwatch, rather than replacing it? It was not Healthwatch’s job to listen to them, but to gather the information and present it, and that is what it has done. Can the Minister explain how removing its independence is going to help? I simply do not understand it.

--- Later in debate ---

I am using my own patch as an example, and it is fairly unique, but there are many areas across the country, particularly coastal and rural ones, with their own unique challenges. At the moment, those are well-represented through small, independent local healthwatches. That uniqueness will be lost, not only because of the lack of independence of the patient voice that will result from merging healthwatches with ICBs, but because the patient voice will be merged with others, since ICBs cover far wider areas. Given the values that Labour says it stands by and gets elected on—patient choice, patient voice, improving healthcare outcomes—it surprises me that a Labour Government want to abolish that independent patient voice. No matter how much they want to make space for that voice within an ICB, they cannot argue that that voice is independent once it becomes part and parcel of the ICB.

[Karin Smyth]

Again, we have had an important discussion, particularly around the issue of independence; I accept that it is difficult and that there are arguments on both sides. We have heard a lot about Professor Croisdale-Appleby’s evidence on behalf of Healthwatch. I made this argument on Second Reading: we have had this arrangement for 52 years, and I think we can all agree that the situation is not good. It has not worked. As I said earlier, 20,000 reports add a lot of work. There is a lot of work in this landscape—well-intentioned work by good people. We can argue about whether Healthwatch was set up appropriately to do the job it has been asked to do.

I was pleased to hear the three examples from the Lib Dems and other individual examples of where light has been shone upon a closure, for example. It is good that that has been valued by local Members of Parliament. I would argue that nobody should be closing services without fully engaging with the local population and setting out clearly why that is being done. That is a failure of those local organisations, and we need to address the cause of that failure.

I am struck by the oral evidence to the Committee on those 20,000 reports in 52 years. It was suggested that it takes six months, as I think the hon. Member for Farnham and Bordon said when quoting the evidence, for somebody to “go out”—that is the phrase that is used: “Let’s go out and talk to people in these far-flung communities. What do they think? What is their experience? Who are they?” It constantly surprises me, as it did when I worked inside the system. These are not remote people. We know who they are and what is wrong with them. We know how remote they are from the system. That goes to the heart of why the taxpayer is so alienated in this country from public services and their poor functioning. That is what the Government want to change.

It is not a matter of ICBs adding a new function; the Opposition have fundamentally misunderstood that. It is about rewiring these organisations to do something very different. Their function as strategic commissioners is to understand and to use all the data and evidence, including direct voice. We can argue about how that direct voice is taken in, but that is fundamentally what a commissioner is—I say that, having been a commissioner. It is not being done well, and that is why we are changing the legislation. Under previous legislation, ICBs had multiple functions. We are changing that to force them to be commissioners, but it is not an add-on; it is fundamental to the commissioning process. It is a complete rewiring of the organisation to listen to patient voice, patient experience and the reality of health inequalities.

In my constituency, I am afraid have not seen examples of the independent voice really speaking on behalf of the people I serve—some of whom have the worst health inequalities in the country, largely as a result of the tobacco industry and its legacy—whereas their experiences and their health outcomes are very well known and should drive the necessary changes. That is why we are driving all the changes in the 10-year health plan: to meet the needs of communities. We will continue to have this debate, but I wanted to make that absolutely clear.

We assume that the independent voice is always clear, but it is not. We have heard that it is variable and fragmented. That is not the fault of anyone trying to provide it, but that is where it is. The system is supposed to listen and improve services, and it does not. Things need to be changed in order to achieve that, and that is what we intend to do. The changes will be supported by scrutiny, transparency and oversight arrangements. The alternative, which is maintaining a separate structure with limited levers to drive change, has not delivered, and it cannot continue to try.

We are not removing patient and user voice; we are embedding it at the heart of the new system. ICBs will be expected to carry out proactive, inclusive engagement, particularly with so-called seldom-heard groups, including carers, those who do not have access to digital platforms, those less proficient with technology and people for whom English is a second language. Crucially, ICBs will be accountable for demonstrating reach and impact, not simply how many reports or engagement exercises they have done. Impact is what we will be looking at.

As I have said, this is about moving from a model where voices can be collected but overlooked to one where they must be heard and acted upon. The new patient experience director in the Department will work closely with local systems to identify national themes and significant concerns, ensuring that patient experience informs policy and improvement at the national level. To answer a previous question, the Secretary of State will have the power to issue directions to ICBs and local authorities if they are failing to exercise that function.

As I have said in debates on previous groups, I understand that it is difficult when we are debating the abolition of something outwith the wider framework of the 10-year health plan, the Dash review, the patient experience directorate in the Department and changes to the national quality board. It is incumbent on the Government to make that architecture clear and to build confidence and trust. That is what we intend to do, and that is how this body will be taken forward.

All comments have been noted. There is a fundamental difference of approach. We are making those bodies fundamentally different and rewiring them to do something different. I understand the bumpy road—I have been part of that, with community health councils and links to Healthwatch, and it has been a long one. I think we will keep returning to this theme. Those organisations have not been changed to do what they are supposed to do, and that is the ambition of this Government.

Question put, That the clause stand part of the Bill.

--- Later in debate ---

Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

As the UK resilience action plan sets out, we are living through a period of profound change. Ensuring that our institutions are clear in what they must do to prepare for, respond to and recover from emergencies is essential. With that mind, the clause is necessary. It clarifies the existing duties on NHS trusts under the Civil Contingencies Act 2004—the legislation that sets out how the UK prepares for, co-ordinates and responds to serious emergencies. Since the Civil Contingencies Act came into force, NHS trusts have been included as category 1 responders. That means that they have had specific legal duties to assess risks, plan for emergencies, maintain business continuity, warn and inform the public, and work together to co-ordinate an effective local response.

Due to changing policies by the previous Government, references to NHS trusts were removed from the Civil Contingencies Act, yet under transitionary powers in other legislation, they remain category 1 responders. This has meant that their role has seemed unclear for some other responders and the public. I want to be clear that the clause does not change the position of NHS trusts, nor their duties or functions under the Civil Contingencies Act; instead, it simply clarifies the legislation, making their place and role clear. That is vital so that NHS trusts and other responders know exactly what is required of them during and after an emergency. I commend the clause to the Committee.

Question put and agreed to.

Clause 66 accordingly ordered to stand part of the Bill.

Clause 67

Minor and consequential amendments

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to discuss the following:

Government amendments 20 to 24 and 83.

Schedule 11.

[Karin Smyth]

These are minor and technical amendments. Government amendments 20 to 22 make changes to the Armed Forces Act 2006 to remove references to NHS England, reflecting that NHS England will be abolished. Those amendments are consequential to the Armed Forces Bill 2026. Government amendment 83 makes changes to the Children’s Wellbeing and Schools Act 2026 to remove reference to NHS England and update a reference to NHS trusts to take account of the new conversion procedure created by clause 35 of the Bill. Government amendments 23 and 24 both amend the NHS Act 2006 by removing unnecessary consequential amendments to that Act.

Clause 67 inserts schedule 11, which makes minor and consequential amendments that are required as a consequence of the provision made in other clauses of the Bill. They mostly result from the abolition of NHS England, the conferral of NHS England’s functions on others—primarily the Secretary of State and integrated care boards—and the changes made to the NHS provider landscape. Those minor and consequential changes are made to a large number of enactments, but notably a significant number of such consequential changes are made to: the Mental Health Act 1983, the NHS Act 2006, the Health and Social Care Act 2008, the Health and Social Care Act 2012 and the Medicines and Medical Devices Act 2021. The changes are necessary to ensure the proper operation of the statute book and reflect the substantive changes being made elsewhere in the Bill. I commend clause 67 to the Committee.

Question put and agreed to.

Clause 67 accordingly ordered to stand part of the Bill.

Schedule 11

Minor and consequential amendments

Amendments made: 20, in schedule 11, page 140, line 16, at end insert—

“91A The Armed Forces Act 2006 is amended as follows.”

This amendment and amendments 21 and 22 remove a reference to NHS England from section 343AZB of the Armed Forces Act 2006 (to be inserted by the Armed Forces Bill).

Amendment 21, in schedule 11, page 140, line 17, leave out

“of the Armed Forces Act 2006”.

See explanatory statement for amendment 20.

Amendment 22, in schedule 11, page 140, line 18, at end insert—

“92A In section 343AZB (inserted by the Armed Forces Act 2026), in subsection (5)(a) omit sub-paragraph (i).”

See explanatory statement for amendment 20.

Amendment 23, in schedule 11, page 144, line 5, leave out paragraph 118.

This removes an unnecessary consequential amendment to section 12E of the NHS Act 2006 (that section is replaced in its entirety by clause 10 of the Bill).

Amendment 24, in schedule 11, page 148, line 9, leave out paragraph 139.

This removes an unnecessary consequential amendment to a heading that is replaced by clause 11.

Amendment 83, in schedule 11, page 191, line 35, at end insert—

“Children’s Wellbeing and Schools Act 2026

400 In Schedule 1 to the Children’s Wellbeing and Schools Act 2026 (relevant authorities)—

(a) omit paragraph 9;

(b) in paragraph 12, omit ‘section 25 of’.”—(Karin Smyth.)

This is a consequential amendment to Schedule 1 to the Children’s Wellbeing and Schools Act 2026, which would remove a reference to NHS England and update a reference to NHS trusts to take account of the new conversion procedure created by clause 35 of the Bill.

Schedule 11, as amended, agreed to.

New Clause 20

Arrangements between NHS bodies and local authorities

“(1) Section 75 of the National Health Service Act 2006 (arrangements between NHS bodies and local authorities) is amended as follows.

(2) In subsection (6), for the words from ‘consultation’ to the end substitute ‘the making of arrangements by virtue of this section’.

(3) Omit subsections (7A) to (7L).

(4) In subsection (8), at the appropriate place insert—

‘“local authority” includes—

(a) a combined authority,

(b) a combined county authority, and

(c) the Greater London Authority;’.”—(Karin Smyth.)

This enables combined authorities, combined county authorities and the Greater London Authority to enter into arrangements with NHS bodies under section 75 of the NHS Act 2006 in relation to any of their functions, replacing the current different and more limited provision about combined authorities and combined county authorities.

Brought up, read the First and Second time, and added to the Bill.

New Clause 21

Dispensing medical practitioners etc

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

(2) In section 132 (persons authorised to provide pharmaceutical services)—

(a) for subsection (1) substitute—

‘(1) Except as may be provided for by or under regulations, no arrangements may be made by an integrated care board with a person providing primary medical services under Part 4 to provide pharmaceutical services.’;

(b) in subsection (3), for ‘medical practitioners’ substitute ‘persons providing primary medical services under Part 4’;

(c) in subsection (4)—

(i) for paragraph (a) substitute—

‘(a) as to grounds on which an integrated care board may, or must, refuse to grant an application for inclusion in a list referred to in subsection (3),’;

(ii) in paragraph (aa) omit ‘of medical practitioners’;

(iii) in paragraph (b), for ‘NHS England by a medical practitioner’ substitute ‘an integrated care board by a person’;

(iv) omit paragraph (c).

(3) In section 134 (pilot schemes), in subsection (8) omit ‘by a medical practitioner or dental practitioner to a patient of his’.

(4) In Schedule 12 (LPS schemes), in paragraph 1(8) omit ‘by a medical practitioner or dental practitioner to a patient of his’.”—(Karin Smyth.)

This updates the legislation about the provision of pharmaceutical services by medical practitioners to conform with current law and practice whereby commissioning arrangements are generally made with the practice rather than individual doctors. It also removes a reference to dental practitioners that is not needed.

Brought up, read the First and Second time, and added to the Bill.

New Clause 22

Inadequate provision of pharmaceutical services

“(1) Section 133 of the National Health Service Act 2006 (inadequate provision of pharmaceutical services) is amended as follows.

(2) For subsection (1) substitute—

‘(1) Subsection (2) applies if the Secretary of State is satisfied that a situation or event has caused or is likely to cause a disruption resulting in the inadequate provision of pharmaceutical services in England or in an area within England.’

(3) In subsection (2)—

(a) after ‘Secretary of State’ insert ‘may by direction’;

(b) for paragraph (a) (but not the ‘and’ at the end) substitute—

‘(a) require an integrated care board to make other arrangements,’;

(c) in paragraph (b) omit ‘may’.

(4) After subsection (2) insert—

‘(3) A direction under subsection (2) must specify the period for which it has effect.

(4) The period must not be more than 6 months.

(5) But the Secretary of State may by further direction extend the period for which a direction under subsection (2) has effect by up to 6 months at a time.

(6) The Secretary of State must publish any directions under this section.’”—(Karin Smyth.)

The amendments made by this clause (among other things) relax the legal test for making alternative provision to address the inadequate provision of pharmaceutical services owing to a disruption of services.

Brought up, read the First and Second time, and added to the Bill.

New Clause 23

Pharmaceutical services: appeals etc

“Schedule (Pharmaceutical services: appeals etc) makes provision about the destination of appeals, and jurisdiction to determine certain matters, currently governed by Part 7 of the National Health Service Act 2006 (pharmaceutical services and local pharmaceutical services).”—(Karin Smyth.)

The clause introduces a Schedule which amends provisions about certain appeals etc to the First-tier Tribunal. Those appeals will be transferred to an NHS body determined by regulations. It is expected that initially this will be NHS Resolution.

Brought up, read the First and Second time, and added to the Bill.

New Clause 91

Regulations: reference to agreements and standards

“(1) The Medicines and Medical Devices Act 2021 is amended as follows.

(2) In section 2 (power to make regulations about human medicines), after subsection (4) insert—

‘(4A) Regulations under subsection (1) making provision in reliance on section 3, 4, 5 or 7 may refer to international agreements or standards relating to human medicines, including agreements or standards as they have effect from time to time.’

(3) In section 16 (manufacture, marketing and supply), after subsection (2) insert—

‘(3) Provision made in reliance on subsection (1)(a) may refer to United Kingdom standards that—

(a) relate to the marketing, putting into service or other supply of medical devices, and

(b) are specified in a list published by the Secretary of State from time to time.

(4) Regulations made under section 15(1) that contain provision made in reliance on subsection (1)(a) about relevant requirements (or exceptions from them) may include provision in relation to a medical device where—

(a) the device complies with regulatory requirements applicable somewhere outside the United Kingdom which is specified in regulations, and

(b) a description of the device and the regulatory requirements applicable to it are contained in a list published by the Secretary of State from time to time.

(5) In this section “United Kingdom standard” means a standard that is—

(a) set by the British Standards Institution, or

(b) primarily developed for use in the United Kingdom, or part of the United Kingdom.’”—(Karin Smyth.)

This new clause would amend the Medicines and Medical Devices Act 2021 to (a) enable regulations to refer to both international agreements and standards and standards developed in the United Kingdom and (b) enable the Secretary of State to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom.

Brought up, and read the First time.

[Karin Smyth]

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

[The Chair]

With this it will be convenient to discuss the following:

Government new clause 92—Medical Devices Regulations 2002: mutual recognition agreements.

Government new clause 93—Consultation about medicines and medical devices regulations.

Government new clause 94—Medicines and medical devices regulations: parliamentary procedure.

Government new clause 95—Medical devices etc: parliamentary procedure for certain fees regulations.

Government amendments 80 to 82.

New clause 67—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 68—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) and Innovative Licensing and Access Pathway (ILAP),

(b) the effectiveness of the early access outside of the Early Access to Medicines Scheme (EAMS) and Innovative Licensing and Access Pathway (ILAP), 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 House of Parliament.”

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

[Karin Smyth]

I will begin with Government new clauses 91 to 95. Many hon. Members will know that the current regulatory framework for medicines and medical devices is seen as overly complicated and difficult to navigate. It is also slow and burdensome to amend, limiting our ability to ensure that it keeps pace with developments. Maintaining the safeguards to public health is central to every decision we make. However, the regulatory framework currently slows down innovation and delays patient access to healthcare products. From a market growth perspective, it also places barriers to the UK market, particularly for small and medium-sized enterprises.

These new clauses will deliver a more streamlined regime for making and updating secondary legislation. The ability to make faster and more responsive updates to secondary legislation will enable the Department and the Medicines and Healthcare Products Regulatory Agency to address the current barriers that I have highlighted in the regulation more quickly.

New clauses 91 and 92 provide for changes with regard to powers to make “ambulatory references”, which are references in legislation to external documents such as technical standards and lists, which can be updated from time to time. These changes will ensure that the legislation continues to capture updated versions of those documents without the need for further regulations. International and domestic standards are crucial in the highly technical areas targeted by the change. It is important that the regulatory regime remains aligned with the technical, scientific and international framework that is designed to evolve over time.

Currently, there are limited powers for medical devices regulations to refer to external international agreements or standards that change over time, and there are no such powers at all for medicines. Without the ability to make ambulatory references to those documents, legislation is needed each time the standards are updated. That is disproportionate and risks unintentional regulatory divergence that creates uncertainty for industry.

The new clauses introduce a power for human medicines regulations to refer to external international agreements or standards that are updated over time. For medical devices, the provisions also extend the current ambulatory reference power to make reference to lists of countries subject to mutual recognition agreements, lists of devices or categories of device that are eligible for an international reliance pathway, and lists of British technical standards. Amendment 80 sets out that the extent of new clause 92 will cover England, Scotland and Wales.

The provisions of new clause 93 enable a more flexible approach to consultations on regulatory changes related to medicines and medical devices, rather than the current one-size-fits-all requirement. Under the amended powers, the MHRA and the Department will still retain a legal duty to consult relevant stakeholders, and significant regulatory changes will continue to be subject to public consultation. The measure is designed to enable consultations that are proportionate to the scale of the change in hand. That will ensure that regulations can be updated more efficiently and in line with the needs of the health service.

New clause 94 will enable certain technical updates to medicines and medical devices regulations to be made using the negative rather than the affirmative procedure. Specifically, it relates to changes that routinely arise as clinical practice evolves—for example, updating detailed lists of medicines or making limited adjustments to the professional groups who may prescribe, supply, sell or administer particular medicines. At present, even minor or time-sensitive changes of this sort can require a debate under the affirmative procedure, which is not always the best use of parliamentary time.

New clause 95 is the final measure in the regulatory framework package for the MHRA. It is designed to streamline the process for routine fee updates made using powers under the European Union (Withdrawal) Act 2018 by allowing the use of the negative parliamentary procedure for routine fee uplifts. That will bring the powers in line with those relating to fees in the Medicines and Medical Devices Act 2021, where uplifts to existing fees can be made with the negative procedure. That will also reduce delays in making and communicating such adjustments, while maintaining appropriate safeguards, including the requirement to set out the cost basis for any new uplifts with any legislation—whether it is made under the negative or affirmative procedure. The draft affirmative procedure will be retained for any substantive changes, such as the introduction of a new chargeable function.

Finally, there are a number of consequential provisions related to those I have just discussed. Government amendments 80 to 82 primarily relate to the commencement period in which they come into force.

In conclusion, the amendments will enable a faster and more responsible reform of the existing legislative framework, while preserving proportionate safeguards and necessary scrutiny. I commend the new clauses to the Committee.

[Dr Johnson]

New clause 91 would amend the Medicines and Medical Devices Act to enable regulations

“to refer to both international agreements and standards and standards developed in the United Kingdom”

and enable the Secretary of State

“to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom.”

New clause 92 would amend the definition of “mutual recognition agreement” so that

“agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.”

New clause 93

“amends the duty to consult in relation to regulations about human medicines and medical devices.”

That means that instead of a public consultation, it

“gives the option of consulting such persons as the relevant authority considers appropriate”.

I would be grateful if the Minister clarified whether that could be nobody, or whether it has to at least be somebody.

New clause 94

“changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure.”

That relates to regulations about medicines and medical devices. I want to ask about scrutiny, because we have had a number of statutory instruments over the last few years that, under the new regulations, would now be put under the negative procedure. When we have looked at them, there have been questions and potential changes.

Why does the Minister want a lower level of scrutiny? In general, scrutiny is a good thing. I understand that this could smooth out procedure and make it a bit quicker in some cases, but we had an example where a Minister brought forward fee increases. I then raised the issue of national insurance and that Minister was not aware of whether it was paid at that time. The civil service pay estimate was significantly lower than expected and lower than what was given. Therefore, six months later we were back in Committee with a different Minister asking for more money. There is a scrutiny issue with new clause 94. That also relates to the fees and terms in new clause 95, which was one of the examples I gave.

[Karin Smyth]

I thank the hon. Lady for her comments. The purpose of the new clauses is to support our life sciences and medicine sector, in order to make that more streamlined. She will be aware of the proposals about the negative and affirmative procedure. If there were particular issues of scrutiny, normal parliamentary rules and processes would apply if Members wanted to raise any particular issue.

Question put and agreed to.

New clause 91 accordingly read a Second time, and added to the Bill.

New Clause 92

Medical Devices Regulations 2002: mutual recognition agreements

“(1) The Medical Devices Regulations 2002 (S.I. 2002/618) are amended as follows.

(2) For regulation 1A (Schedules) substitute—

‘1A Schedule

Schedule 2A has effect.’

(3) In regulation 2 (interpretation), in paragraph (1)—

(a) in the definition of ‘mutual recognition agreement’, in paragraph (a), for ‘country listed in Schedule 2’ substitute ‘country specified in a list published by the Secretary of State from time to time’;

(b) in the definition of ‘third country conformity assessment body’, for ‘established in a country which is listed in Schedule 2 and designated in accordance with a relevant’ substitute ‘designated in accordance with a’.

(4) Omit Schedule 2 (mutual recognition agreements).”—(Karin Smyth.)

This new clause would amend the definition of “mutual recognition agreement” in the Medical Devices Regulations 2002 (as it has effect in England and Wales, and Scotland) so that agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.

Brought up, read the First and Second time, and added to the Bill.

New Clause 93

Consultation about medicines and medical devices regulations

‘(1) Section 45 of the Medicines and Medical Devices Act 2021 (consultation) is amended as follows.

(2) In subsection (1), for “a provision of Part 1, 2, 3 or 4” substitute “Part 1 or 3”.

(3) After subsection (1) insert—

“(1ZA) Before making regulations under Part 2 or 4 the relevant authority must—

(a) carry out a public consultation, or

(b) consult such persons as it considers appropriate.”

(4) In subsection (3), at the beginning insert “Where a public consultation is carried out”.

(5) In subsection (4), in the words before paragraph (a), for “subsection (1)” substitute “subsection (1ZA)”.’—(Karin Smyth.)

This amends the duty to consult in relation to regulations about human medicines and medical devices. It gives the option of consulting such persons as the relevant authority considers appropriate instead of a public consultation.

Brought up, read the First and Second time, and added to the Bill.

New Clause 94

Medicines and medical devices regulations: parliamentary procedure

‘In section 47 of the Medicines and Medical Devices Act 2021 (regulations: procedure), for subsection (3) substitute—

“(3) Regulations under Part 1 are subject to the draft affirmative procedure.

(3A) Regulations under Part 2—

(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—

(i) provision made in reliance on section 6(1)(a) (fees);

(ii) provision amending the meaning of ‘appropriate practitioner’ or ‘approved country health professional’ for the purposes of Part 12 of the Human Medicines Regulations 2012 (see regulation 214 of those regulations);

(iii) provision amending any of the following provisions of the Human Medicines Regulations 2012—

• regulations 217C(3) or 217CA(3) (original pack dispensing for products containing relevant substances: definition of ‘relevant substance’),

• Schedule 13 (prescription only medicines for which community practitioner nurse prescribers are appropriate practitioners),

• Schedule 15 (requirements for specific products subject to general sale),

• Schedule 16 (patient group directions and vaccine group directions),

• Schedule 17 (exemption for sale, supply or administration by certain persons),

• Schedule 18 (substances that may not be sold or supplied by a pharmacist without a prescription in reliance on emergency provisions),

• Schedule 19 (medicinal products for parenteral administration in an emergency), or

• Schedule 21 (medicinal products at high dilutions);

(iv) provision amending regulation 250 of the Human Medicines Regulations 2012 (restrictions on persons to be supplied with medicinal products: exceptions) for the purpose of changing the products to which any exception from time to time provided for by that regulation applies;

(v) provision that is consequential on provision of a description mentioned in any of sub-paragraphs (ii) to (iv);

(b) are subject to the made affirmative procedure if they—

(i) contain only provision that is made in reliance on section 7 (emergencies),

(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health, and

(iii) are not within paragraph (a);

(c) are subject to the draft affirmative procedure if they are not within sub-paragraphs (a) or (b).

(3B) Regulations under Part 3—

(a) are subject to the negative procedure if they contain only provision made in reliance on section 12(1)(a) (fees), and

(b) are subject to the draft affirmative procedure if they are not within paragraph (a).

(3C) Regulations under Part 4—

(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—

(i) provision made in reliance on—

• section 17(1)(a) (fees), or

• paragraph 9 of Schedule 2 (supplementary provision about civil sanctions);

(ii) provision amending or revoking regulation 1ZA of the Medical Devices Regulations 2002 (expiry of certain provisions) or consequential on such provision;

(b) are subject to the made affirmative procedure if they—

(i) contain only provision made in reliance on section 18 (emergencies), and

(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health;

(c) are subject to the draft affirmative procedure if they are not within paragraph (a) or (b).”’—(Karin Smyth.)

This changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure. The changes all relate to regulations about medicines and medical devices (although the procedural provisions relating to certain other matters are restated in the amendment).

Brought up, read the First and Second time, and added to the Bill.

New Clause 95

Medical devices etc: parliamentary procedure for certain fees regulations

‘In Schedule 7 to the European Union (Withdrawal) Act 2018 (regulations), in paragraph 12—

(a) in sub-paragraph (1) for “relate to altering the amount of a fee or charge to reflect changes in the value of money” substitute “fall within sub-paragraph (1A)”.

(b) after sub-paragraph (1) insert—

“(1A) Provision falls within this sub-paragraph if it relates to—

(a) altering the amount of a fee or charge to reflect changes in the value of money,

(b) altering the amount of a fee or charge to be charged in connection with the exercise of a function which a public authority has by virtue of provision made under section 8C in connection with the EU medical devices Regulations, or

(c) altering the amount of a fee or charge to be charged under the Blood Safety and Quality Regulations 2005 (S.I. 2005/50).

(1B) In sub-paragraph (1A)(b) ‘the EU medical devices Regulations’ means—

(a) Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC, or

(b) Regulation (EU) 2017/746 of the European Parliament and of the Council of 5 April 2017 on in vitro diagnostic medical devices and repealing Directive 98/79/EC and Commission Decision 2010/227/EU,

as they have effect from time to time by virtue of Article 5(4) of the Windsor Framework.”’—(Karin Smyth.)

This allows regulations altering certain fees in relation to medical devices etc to be made subject to the negative resolution procedure. At the moment those regulations are subject to the affirmative resolution procedure.

Brought up, read the First and Second time, and added to the Bill.

New Clause 1

National Maternity Commissioner

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

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

(a) oversee NHS maternity services;

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

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

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

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

(3) The person appointed as Commissioner must—

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

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

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

This new clause would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise of maternity services, and not a political appointment.

Brought up, and read the First time.

[Helen Morgan]

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

--- Later in debate ---

[Dr Johnson]

As the hon. Lady said, new clause 1 seems somewhat redundant, because the Government appear to have decided to appoint a maternity commissioner.

New clause 13 asks for a report. Before I go any further, I should say that I am a member of the Royal College of Paediatrics and Child Health and have attended the delivery of many babies as a paediatrician at different levels of seniority. I should also say that I am a member of the British Medical Association, that I continue to work as an NHS consultant paediatrician and that I worked at Nottingham University hospitals NHS trust in late 2012 and 2013.

I have great sympathy with the reasoning behind what the hon. Member for North Shropshire is proposing. We have all been shocked by the many reports we have read, the circumstances we have heard about, the tragedies that have occurred over many years and the challenges that are faced by maternity care. I am not sure that writing more reports is going to help; I think we need more action rather than words.

The hon. Lady mentioned the taskforce. I was disappointed that it took the Government so many months to establish it, that it took so long for it to meet and that it has met only a few times. As we have talked about things such as Healthwatch and the HSSIB, the Minister has shown her enthusiasm to get on with things and ensure that the recommendations made in the varying reports are implemented. I would therefore be interested to understand how that will occur in maternity.

My understanding is that the Government are going to produce a plan on how to deliver the recommendations in the recent report, and that is going to be available by Christmas. However, that means that we will then be in a situation where the Government came into power in mid-2024 and then spent a year writing a plan—the 10-year “Fit for the Future” plan. Around the time that they published that, they decided that they needed an urgent maternity report; that was going to take a few months, but it ended up taking another year in of itself. Now we are going to take another six or seven months writing another plan on how to implement the plan we have written, based on the plan we wrote before, based on the plan we did not have at the general election.

I am interested to understand how the Government are going to convert the good intentions I am sure they have into action. In particular, their manifesto promised that thousands more additional midwives would be trained. I would be interested to know what progress they have made on that.

[Karin Smyth]

I am grateful to the hon. Member for North Shropshire for bringing this discussion before the Committee. I put on record our thanks for the work she has done in this area and for her engagement with me, and indeed with officials at the Department, to help us understand it more clearly, particularly in the light of the new clause.

Hon. Members across the Committee are committed, as are the Government, to ensuring that women, families and babies receive the care and support they need. We know that the vast majority of births are safe and that there are outstanding examples of care in the NHS. However, where things do go wrong, it can have a devastating impact on women and their families.

That is why the Government launched the national investigation into NHS maternity and neonatal care, chaired by the noble Lady Baroness Amos. Baroness Amos brought the findings from past reviews, local rapid reviews and new evidence from families and staff together into one clear national set of recommendations, which as we heard was published last week. The Government also launched the maternity and neonatal taskforce, chaired personally by the Secretary of State, which will translate Baroness Amos’s recommendations into action.

As we heard, Baroness Amos recommended the appointment of a statutory maternity and neonatal commissioner. We have accepted that recommendation, and I know there is support for it across the House. To be clear, the Secretary of State stated last week that we are committed to putting the role on a “statutory basis” as soon as possible.

I am afraid I cannot give the hon. Member for North Shropshire a more detailed timetable at the moment, because we are currently looking at options to legislate at pace, including potentially through this Bill, subject to discussions through the usual channels, while also—this is crucial—giving the taskforce the opportunity to shape the scope of the role. That was one of Baroness Amos’s urgent actions, and we accept it as a crucial first step in overseeing systemic improvements to care and outcomes and earning back the trust of women and families.

The maternity and neonatal commissioner will champion the voices of families and drive forward that necessary change. The Secretary of State will remain accountable to Parliament for maternity services. The role will be discussed urgently with the taskforce and will have a relentless focus on driving those improvements, which will include co-chairing the taskforce.

As the Committee knows, these are complex matters. The Government, having accepted the Baroness Amos’s recommendation, intend to legislate as soon as practicable. Our immediate priority is to work quickly through the taskforce to define the scope and responsibilities of the role. I know that the hon. Member for North Shropshire will not press the new clause, but I commit to keeping in touch with her and other hon. Members as this work progresses.

[Dr Johnson]

We talked about clause 1—on the abolition of NHS England—at the beginning of the Bill. The Minister was keen at that time to take unelected individuals out of the picture and create accountability by returning things to democratic control through the abolition of NHS England and putting them back in the Secretary of State’s hands. However, this proposal essentially does the reverse with maternity care, taking it out of the hands of Ministers and the Secretary of State and putting it into the hands of a commissioner. Could the Minister explain that?

[Karin Smyth]

I am sorry, but I did not get the end of that sentence. However, I think the hon. Lady was saying that the Bill essentially abolishes NHS England. Again, as I have said repeatedly, nobody is opposing that. As is well known, the recommendations on the maternity commissioner have come through a separate process. Given the need for public assurance and to earn back the trust of women and families, as well as—I think the hon. Lady said this herself—the shocking revelations that have come through some of this work, Baroness Amos recommended a maternity and neonatal commissioner to drive through these changes and give confidence to the system. That is why we are going to accept her recommendation. Accountability for maternity services obviously remains with the Secretary of State, who will be co-chairing the taskforce. I hope that addresses the comments the hon. Lady made.

On new clause 13, we know that the vast majority of births are safe, but the devastating trauma experienced by many through failures in care must be brought to an end. The CQC has an important role in assessing whether patients are receiving safe, effective and high-quality care, and it is essential that it can do that objectively and independent of Government. It is therefore not appropriate to impose a duty on the Secretary of State to ensure particular ratings.

--- Later in debate ---

[Edward Argar]

My questions will be very brief. I am conscious that, given that these are mostly Liberal Democrat new clauses, for once I will be asking the hon. Member for Winchester for a response, not the Minister.

New clause 4 would require that contracts be laid before Parliament. I would be grateful if the hon. Gentleman can tell the Committee how many such contracts he thinks would end up being laid before the House in any given year, based on historical data, and therefore how much parliamentary time that would take up. Does he envisage that being handled by an affirmative or negative statutory instrument? What will the process be?

I can see what the hon. Gentleman is trying to do, but I have a certain wariness, along the lines of that expressed by the hon. Member for Bury St Edmunds and Stowmarket. Although it is important that we have appropriate protections and scrutiny, when we are procuring services and technology for the NHS we should be looking for the most effective and best tools that have those safeguards but can do the job that eminent surgeons and clinicians need them to do in order to do their work for patients.

[Karin Smyth]

I am grateful to hon. Members for tabling these new clauses. I recognise the concerns behind them. Contracts involving NHS data, digital services and technology must be subject to proper scrutiny. Patients expect their medical information to be protected, and NHS staff expect the systems that they use to be safe and reliable. The Government agree that Parliament should be entitled to test how those protections work.

I also want to be clear that the Government want British businesses to win more public contracts and build stronger UK capability in digital and technology. The Government are already using procurement to support British businesses, jobs, skills and national security. More than 90% of UK public contracts are currently awarded to UK suppliers, and the Government have set out reforms to make procurement do more to support British industry and supply chain resilience.

I do not think that new clause 3 is the right way to achieve proper scrutiny. It would require the Secretary of State, within six months, to conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside the United Kingdom. That would include contracts regardless of the value—we heard a little about that from the Opposition—and of the services being provided, the type of data and whether there is evidence of any sort of concern. Risk is driven by the nature of the data involved, not just where the supplier is located. That is why the Government’s approach is based on targeted assessment and proportionate control.

We already have the tools we need in the Procurement Act 2023, which gives contracting authorities the powers to exclude suppliers and terminate contracts where the legal tests are met, including on national security grounds. They may also refer suppliers for a debarment investigation. The National Security Unit for Procurement supports Ministers in assessing suppliers on national security grounds, working closely with Departments and the intelligence community. In health and digital contracts, those procurement powers sit alongside data protection legislation and data protection impact assessments, in line with the digital, data and technology playbook. That is not an argument for complacency; we should continue to identify risks before procurement begins.

A broad duty of the kind in new clause 3 would risk becoming a reporting exercise and would not necessarily make the highest-risk contracts safer. It could, however, draw time and resource away from the assurance activities that matter most. The right approach is to strengthen the targeted controls, not to create a single statutory risk assessment covering every non-UK supplier.

Similarly, on new clause 4, a blanket “buy British” rule would not be the right test for NHS data contracts, although I hope that I have assured the hon. Member for Winchester that home-grown domestic products are absolutely what we are trying to focus on. The UK must treat suppliers from countries with reciprocal procurement access fairly. Our international obligations matter and are an important driver of the UK economy, including the World Trade Organisation agreement on Government procurement, which gives British businesses guaranteed access to £1.3 trillion in public procurement opportunities overseas annually.

As the hon. Member will understand, new clause 5 would require the Government to commit to a new programme of work to develop domestic capability, to reduce reliance on overseas suppliers of IT services and technology. The strategy would also require us to set out an approach to managing the risk associated with our current use of technology provided by overseas suppliers. I welcome the notion of encouraging domestic innovation to ensure the security and resilience of our IT infrastructure. However, ensuring the security of our data and the resilience of our systems is already embedded in everything we do. The new clause is therefore simply not necessary.

Hon. Members will accept that we want to see continued growth of digital and tech industries in this country; it is one of our real success stories. However, it will not be achieved by cutting across procurement law and not seeking the solutions that provide the best value for our money and the right service for the NHS. Our approach to securing the best IT and tech solutions should always be to seek the best on offer in a diverse, global market, not to prioritise based on location. Prioritising domestic providers means making a decision on grounds other than the quality, integrity or value for money of a solution.

I understand the concern behind new clause 43, which the hon. Member for Sleaford and North Hykeham spoke to. However, where public money is used to provide NHS services, there should be proper transparency about the contract, the service being delivered and the use of public funds. Patients and the public are entitled to expect that information is not placed beyond reach simply because a service is delivered through a contract. I do not think the new clause necessary, and I am concerned that it could create confusion about the operation of the Freedom of Information Act 2000. The Act already deals with information held by another person on behalf of the public authority. The key issue is not where the information physically sits. It does not matter whether it is held by the authority or by one of its commercial partners; what matters is whether it is held for the public authority’s purpose.

The Government agree with the principle of transparency, but new clause 5 would not improve the existing framework. It would risk duplicating duties that already exist, cutting across standard contract terms and creating uncertainty about patient information, which is rightly protected. For all those reasons, I ask hon. Members not to press the new clauses.

Finally, I say to the hon. Member for Winchester that we have already debated the single patient record. Public trust is key, and there will be multiple suppliers. We are bringing patients and the public with us and will continue to do so. The hon. Member asked about the FDP roll-out. I do not think it was about the supplier. I think it was about the money. It was about inertia in rolling out some good technology that provides good efficiency. It was also about capacity, capability and an attitude to productivity, which we absolutely need to drive more of.

[Dr Chambers]

I appreciate the Minister’s response and the comments of other Members, which were insightful as usual.

When we discussed whether carers could access parts of the single patient record, Members made very good points about privacy and historical health issues that a patient might not want a carer to know about. Those are very sensible concerns, but someone watching these proceedings or looking back over the record would think that there had been a lot more agonising over whether someone caring for a patient could access relevant information than over the potential systemic misuse of health information facilitated by private companies. A lot of people are worried about that when it comes to procurement, trust and sovereignty.

I thank the Minister for her comments on new clause 3. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 4

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.’”—(Dr Chambers.)

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.

Brought up, and read the First time.

Question put, That the clause be read a Second time.

Health Bill (Twelfth sitting)

Karin Smyth Excerpts

Committee stage
Tuesday 7th July 2026 Public Bill Committees

[The Chair]

Thank you. That is a matter of record. Any other takers? No.

[The Minister for Secondary Care (Karin Smyth)]

Clause 58 is about the time period for compliance with NICE recommendations on health and social care provision. As we have heard, it will enable that period to be determined by NICE or the Secretary of State.

NICE’s technology appraisals and highly specialised technology guidance play a vital role in ensuring that patients in England can access treatments that are clinically effective and a good use of NHS resources. When NICE recommends a new treatment, the NHS is usually required to make funding available within three months. That means that patients can consistently benefit from innovative treatment.

That said, there are cases where the three-month timeframe is just not realistic. That might be because of affordability pressures or practical challenges such as a stretched workforce. In those situations, a longer implementation period is needed to ensure that complex new treatments can be introduced in a safe way that does not disrupt services for other patients. For example, the period for NICE’s guidance on the drug Paxlovid for the treatment of covid was extended to 12 months to allow time for the NHS to put the necessary routine testing systems in place and train healthcare professionals.

I do not think the hon. Member for Sleaford and North Hykeham raised this issue, but the opposite is sometimes true, and the NHS issues guidance that provides swifter access to medicines and medical treatments. For example, cancer medicines can be funded from the point of a positive draft recommendation. At present, NHS England decides whether a NICE treatment is funded more quickly or in a shorter timeframe, while NICE determines whether the funding period should be extended, typically following a proposal from NHS England. The abolition of NHS England means that those roles and responsibilities will need to be reconsidered. The clause provides flexibility for the final decision on funding timelines to sit with either NICE or the Secretary of State, but it will not mandate which.

To the point raised by the hon. Member for North Shropshire, the Government intend to set out further details of these arrangements in regulations using the enabling power granted by this Bill. Importantly, the clause will not reduce NICE’s independent role in assessing the clinical and cost effectiveness of new treatments, nor will it weaken the NHS’s obligation to provide timely treatment. Instead, it will ensure that decisions on funding timelines remain flexible and sustainable, and that the system is equipped to respond effectively to future pressures.

I will now speak to amendment 78, which was moved by the hon. Member for North Shropshire. I recognise the vital role that NICE guidelines play in improving quality and consistency of care across the NHS. NICE’s guidance is developed by experts on the basis of rigorous assessment of the available evidence and provides an important benchmark for best practice, including for patients with myalgic encephalomyelitis. I know that the hon. Member intends to withdraw the amendment, but if she were to press it, the Government would not accept it.

To be clear—again, partly to the point of the hon. Member for Sleaford and North Hykeham—it is a long-standing and deliberate position that NICE guidance is not mandatory, which reflects the role it plays in supporting patient care. Crucially, guidelines do not override the professional judgment of clinicians, and it is essential that clinicians retain the flexibility to determine the most appropriate course of treatment for individual patients based on their specific circumstances. It is also important to recognise that NICE guidelines are often complex frameworks for care that must be adapted to local service configurations and patient need. Requiring full compliance with the NICE guideline would remove the ability of local service providers to ensure that ME services are appropriate to the needs of their local populations.

The hon. Member for North Shropshire made some important points about treatment of ME over the years, and many of us have encountered constituents with similar stories. I pay tribute to the hon. Member for Farnham and Bordon for his work supporting constituents with the condition. To be clear, the Department fully recognises the need for more consistent implementation of the NICE guidelines on ME. That is why we are already taking forward practical measures. In particular, the Department and NHS England are developing a service template specification, aligned to NICE’s guidelines, to support commissioners and providers in delivering appropriate services for people with ME. We will continue to work with stakeholders, the industry and the NHS in doing that.

Those steps will help to drive improvement in care without undermining clinical judgment or imposing inflexible statutory requirements. With that, I commend clause 58 to the Committee.

[Helen Morgan]

I thank the Minister for her words, particularly on amendment 78. As I said, I will not press the amendment to a vote, but I hope that the Minister will continue to bear in mind that provision for people with ME is extremely patchy and that a number of our constituents are suffering in the long term. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 58 ordered to stand part of the Bill.

Clause 59

Transfer of HSSIB’s functions to CQC

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 55, in schedule 8, page 110, line 23, at end insert—

“(10) If the Secretary of State certifies that it is in the interests of national security that the powers conferred by subsection (1)—

(a) should not be exercisable in relation to certain premises in which there is a Crown interest, or

(b) should not be exercisable in relation to certain specified premises for other purposes,

those powers are not exercisable in relation to those specified premises.

(7) In this section, ‘Crown interest’ means—

(a) an interest belonging to a government department or held in trust for His Majesty for the purposes of a government department;

(b) an interest belonging to His Majesty in right of the Crown;

(c) an interest belonging to His Majesty in right of the Duchy of Lancaster;

(d) an interest belonging to the Duchy of Cornwall.”

This amendment makes provision for the Secretary of State to disapply investigation powers under subsection 51J(1) to the Health and Social Care Act 2008, inserted by Schedule 8 of this Bill.

Amendment 56, in schedule 8, page 116, line 8, leave out subsection (9).

This amendment would allow the Commission to recoup charges in excess of the costs incurred in providing assistance.

Amendment 5, in schedule 8, page 120, line 16, at end insert—

“(2A) After paragraph 6(8) insert—

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

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

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

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

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

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

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

Schedule 8.

Clauses 60 and 61 stand part.

New clause 42—Funding for Care Quality Commission (CQC) investigations—

“The Secretary of State has a duty to make provision for adequate funding and resources for patient safety investigations conducted by the CQC, including some initiated by the CQC themselves.”

[Karin Smyth]

Clause 59 provides for the abolition of the Health Services Safety Investigations Body and the transfer of its functions to the Care Quality Commission.

Under the new arrangements, the Care Quality Commission will assume responsibility for carrying out investigations into incidents that have or may have implications for patient safety. It is really important to stress that the core purpose of that function remains unchanged: to identify systemic risks, support learning and drive improvements in the safety of health services, rather than determine blame or liability. It is a central measure in strengthening the framework for patient safety investigations and ensuring a more coherent and effective system for learning from incidents across health services.

With more than 70 types of channels or organisations through which patients or users can share feedback, the current landscape has led to fragmentation between investigation, regulation and improvement activity, thereby diluting the impact that insights from investigations might otherwise achieve. HSSIB has been isolated, undermining its efficacy. We will bring HSSIB into the mainstream as a core but distinct part of the CQC. That will enable HSSIB to use its functions more strategically, working in partnership with the national quality board. Clause 59 achieves that by conferring responsibility for those investigatory functions on to the Care Quality Commission through the provisions set out in schedule 8. In doing so, it embeds a comprehensive investigatory framework with an established statutory regulator.

The CQC will be one organisation with separate functions—a regulatory function and an investigative function—to preserve the integrity of each. Within the CQC, HSSIB will continue to operate as a discrete unit and retain its independence from providers, allowing it to identify learnings and take a no-blame approach.

[Janet Daby (Lewisham East) (Lab)]

The Minister will recall that in evidence, Dr Rosie Benneyworth, interim chief executive officer of HSSIB, spoke about the vital work of the organisation, especially with regard to investigations where vulnerable staff and workers do not feel confident about coming forward for fear of reprisal. HSSIB did great work in that area, and I am wondering whether the CQC will carry it on and take on board that learning.

[Karin Smyth]

I thank my hon. Friend for that point. I have met HSSIB and others on this issue, and it is a concern that staff are fearful of speaking up. That is obviously unacceptable, but we understand that it happens. That is absolutely the culture that we need to drive out, and we need to ensure that HSSIB’s learning about making sure there is a safe space to speak out, which I will come on to, is a core part of future work.

[Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

What we are talking about is not so much the safety of staff when they come forward, but the safety of patients, and whether we genuinely believe that the proposed modification to the arrangement will improve patient safety. That is the underlying point. Although the safety of staff is important, it is the safety of patients that we must bear in mind.

[Karin Smyth]

Of course, patient safety is what we need to get right. I will come on to that point, but there is a lot to get through with this clause. We can see its importance from the number of organisations and channels that exist. I have said that before, and I am sure we have all struggled as constituency MPs to support our constituents—either patients or staff—through the system and to understand the best route forward on patient safety. We all have the same aim, and we should be clear that the issue is how best to achieve that aim. My hon. Friend is absolutely right. The test is about impact, learning and making the system and the culture change.

My hon. Friend the Member for Lewisham East asked me about confidence, and the fear that staff sometimes have about speaking up, which is obviously an important part of that landscape. We want to make sure that we take forward the learning on both those points into the new body.

The new framework ensures that the essential characteristics of safety investigations are preserved. The commission will have a flexible power to investigate qualifying incidents that have or may have implications for patient safety, with a clear statutory purpose of identifying risks and improving systems and practices. We are maintaining the principle of safe space and introducing strong safeguards in the process, so that staff and the public can trust that they can speak of their experiences openly, without fear or favour, to provide learnings for the system.

We have included protections for safe space materials and restrictions on disclosure, including within the regulatory functions of the CQC, and limits on the use of reports in legal proceedings. That is designed to support openness and candour, and to provide confidence in the impartiality and independence of patient safety investigations. There are clear mechanisms for transparency and accountability, including the publication of reports, requirements to respond to recommendations, and oversight through a statutory review of the commission’s investigatory functions.

Clause 59 also provides the commission with the necessary powers to carry out investigations effectively, including powers to require information, enter premises and co-ordinate with other bodies while maintaining appropriate protections such as legal privilege and safeguards against self-incrimination. Although the commission will decide which incidents to investigate, the clause preserves a power for the Secretary of State to direct it to investigate a specific qualifying incident or category of incidents. That ensures that where issues of significant public concern arise, or where urgent scrutiny is needed or there is particular risk, there is a clear mechanism to ensure that issues are investigated.

The struggles of the Care Quality Commission have been well documented. We will only commence these provisions when we are satisfied that the CQC has improved. The CQC has been supported and held to account to recover its effectiveness, and we will continue to support it and work closely with the newly appointed chair on its journey to rebuild. We will work closely with the CQC to ensure its readiness to receive the investigations functions from the Health Services Safety Investigations Body. Maintaining a centre of excellence for investigations will be integral to the CQC’s culture. Without the clause, the opportunity to deliver the ambitions of the 10-year health plan would not be realised, nor would the broader patient safety landscape, as set out in the Dash review, be fully addressed. It is therefore a necessary and integral reform.

Clause 60 makes provision for the transfer of property rights and liabilities from the Health Services Safety Investigations Body to the Care Quality Commission in connection with the abolition of the former and the assumption of its functions by the latter. It is a key technical provision to ensure an orderly and legally complete transition between the two bodies. Where functions are transferred between public bodies, it is essential that all associated assets, obligations and legal arrangements are also transferred in a way that ensures continuity and legal certainty. The clause provides the statutory mechanism to achieve that.

The clause provides a flexible framework to enable the continuation of HSSIB’s actions and ongoing matters, including legal proceedings, and ensures that references to HSSIB in existing documents are treated as references to the Care Quality Commission to avoid legal uncertainty. The clause provides for staff protections equivalent to TUPE and allows for shared ownership or use of property where needed, supporting a smooth and effective transition.

The overall effect of the clause is to enable a smooth, comprehensive and legally robust transfer of HSSIB’s property rights and liabilities to the Care Quality Commission, ensuring continuity of function and avoiding disruption to ongoing operations. Without the provision, there would be risk of legal uncertainty and operational disruption during the transfer process.

Clause 61 is a necessary and practical provision. At its core, it provides a power through regulations for His Majesty’s Treasury to ensure that transfers made from HSSIB to the CQC are delivered smoothly and on a tax-neutral basis. Like the equivalent provision for the NHS England transfer in clause 3, it allows the Treasury, by regulations, to vary the way in which relevant tax legislation applies in relation to anything transferred under a transfer scheme or anything done in connection with such a transfer. That will ensure that the tax consequences of the transfer can be properly aligned with the policy intention of a smooth and orderly transition.

Importantly, the scope of the clause is limited to specified “relevant taxes”, including income tax, corporation tax, capital gains tax, VAT, stamp duty and stamp duty reserve tax. As with clause 3, without this power there is a risk that the transfers could trigger unintended tax liabilities that would divert public money away from frontline services and undermine the policy intent of the legislation. Clause 61 therefore protects value for money and ensures that organisational change does not come with avoidable fiscal cost.

Clauses 59 to 61 and schedule 8 are necessary to strengthen the framework for patient safety investigations and ensure a more coherent and, crucially, effective system for learning from incidents across health services to make all our constituents and patients safer. I therefore commend them to the Committee.

[Dr Johnson]

These clauses are about patient safety. As has been pointed out this morning, patient safety is the absolute key here: that is well recognised across the House, among the public and across the national health service. Before going any further, I declare an interest as a patient of the NHS, a member of the British Medical Association, a member of the Royal College of Paediatrics and Child Health and a consultant paediatrician.

When I was interviewed in 2012 for my current consultant role, I was asked to deliver a presentation about how I could demonstrate to the trust board that the paediatric services in the hospital were safe. The first question I posed—Members will be pleased to know that I will not go through the whole presentation—was: “What is safe?” Are football stadiums safe? Is the London underground safe? Are aeroplanes safe? Broadly, yes, I think we would say they are safe, but they have not been without incident or safety issues.

Healthcare is similar. It involves millions of people, clinical judgment, human decision making and huge variability in the way that patients can present with different symptoms for different problems at different times. Is healthcare safe? Yes, it is safe. Again, however, we know from the many reports we have read that there is a long way to go to make it better and we need to prepare for that. We need to make sure that we design out room for error—that we design processes that limit the opportunities for error—use technology to limit the risk of error, and train people in a way that reduces the risk of error.

One of the key factors in that work is accepting that where there is human decision making, mistakes can happen, and that we need to identify and learn from those mistakes. One of the main ways of doing that is striking a balance between accountability and blame. If there is insufficient accountability, there can be an unclear escalation process, such that people do not know who to go to when they identify a problem. There can be a careless culture, which can develop in places where there is not enough accountability. However, if there is too much focus on fault and determining whose fault something is, we can get a blame culture. That can lead to a failure for people to come forward and therefore to a failure to learn from mistakes. It can lead to a culture of cover-up, whereby people try to avoid getting either themselves or their colleagues into trouble.

That is where HSSIB comes in because, like the air accidents investigation branch and the similar bodies for rail and shipping, it provides a safe space. That safe space is important in ensuring that people can speak up freely without fear, and know that we can get to the bottom of a problem and understand why and how something went wrong, because that is how we fix it.

At the time that HSSIB was established, there was consensus about it. The General Medical Council said:

“We support the creation of a ‘safe space’ approach to investigation. This is consistent with our guidance to doctors about their responsibilities to learn from mistakes and reflect on their practice, and their duty to take part in systems of quality assurance and quality improvement to promote patient safety.”

The British Medical Association told Parliament:

“We welcome the establishment of the HSSIB…Doctors must feel able to report errors and reflect on their own mistakes openly, without the fear of these reflections being used against them at a later stage. Only then can true improvements to patient safety be made.”

Similarly, NHS Providers told Parliament:

“NHS Providers welcomes the creation of the HSSIB as an opportunity to develop a just culture in the NHS and a focus on learning…For the HSSIB to succeed in contributing to improved patient safety, any investigations associated with it must be carried out independently and without conflict of interest, and be perceived as such.”

Indeed, the Minister for Secondary Care herself is on the record as having said:

“HSSIB is a really important new body…It must absolutely be built on the highest standards of trust when it comes to the wider system and the general public.”––[Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 564-565.]

I think that I have demonstrated that the creation of HSSIB was a matter of consensus and it was confirmed that it was the right thing to do.

In order to work, HSSIB needed to be independent and without conflict of interest. NHS staff backed it, the providers backed it, the patients backed it and even the Minister backed it. That is what makes the Government’s plans for HSSIB so perplexing. I am not aware of a single royal college or union that supports folding it into the CQC.

Essentially, Ministers have said that this is being done because of the Dash review. “The Dash review says so,” they argue, “so that’s what we’re going to do.” I have huge respect for people who say, “I’ve asked for some experts’ advice, and they have given it, and therefore I should follow it.” However, Ministers also commissioned the report by Lord Darzi, which said that

“a top-down reorganisation of NHS England and integrated care boards is neither necessary nor desirable”,

and yet here we are, doing exactly that. It is perfectly possible for Ministers to take one report as gospel and another as guidance. I would be grateful if the Minister could explain that.

The other reason given for this measure is that it will declutter the landscape, yet few people outside Government seem to think that HSSIB is responsible for cluttering the landscape. For example, the Health Foundation wrote in its submission that

“the government needs to do more to explain how the abolition of HSSIB and transfer of its functions to CQC will meet its aim of reducing complexity and, most importantly, maintain the essential focus on improving patient safety.”

NHS Staff Standards

Karin Smyth Excerpts

Monday 6th July 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

Today, I would like to inform the House of the publication of the NHS staff standards, which will make staff experience an organisational priority within the NHS.

It is crucial that we look after the people who look after us, not only because it is the right thing to do for our hardworking staff, but because their experience directly impacts staff retention and absenteeism, ultimately affecting quality of patient care and overall organisational performance. That is why the 10-year health plan committed to developing a new set of staff standards, outlining minimum standards for employment across a range of areas in order to improve staff experience. Today’s announcement delivers on that commitment and will ensure that NHS staff feel supported, valued and engaged in a positive work environment.

The new standards will focus on the areas that we know are a priority for staff. These are: supporting line management; improving staff health and wellbeing; promoting flexible working; violence prevention and reduction; tackling racism; and sexual safety.

There has been some good progress improving staff experience, including through the NHS people promise, and there are strong examples across the system where organisations have been prioritising the wellbeing of their staff. However, compliance has not been mandated, meaning the benefits have not been consistently felt across the NHS.

The staff standards aim to provide clarity and consistency, and ensure that all organisations are working to the required level. That is why the standards set out the steps that organisations should take to ensure that meaningful action is taken at board level, with clear metrics to assess performance.

Central to the standards are the accountability measures that underpin them. Implementation of the standards will be compulsory, and organisations will be measured against them in the NHS oversight framework, alongside a range of other assurance mechanisms.

While the standards have been set at a national level, they will be put into practice locally. They have been developed through close engagement with the social partnership forum, and employers and trade union representatives should work together through their local partnership arrangements to apply the standards in a way that fits local services and staff needs.

Launching the staff standards is an important step, but only the start. We will work in partnership with the SPF to refine the standards and the metrics that underpin them, to ensure that the standards remain fit for purpose and drive the changes that we and NHS staff want to see. The accountability and assurance mechanisms, including the NHS oversight framework, will be further refined. We will also implement regular employer-level reporting, in line with the 10-year health plan commitment.

We see every day the dedication and commitment of NHS staff. I am proud to be taking this key step to prioritise staff experience and create workplaces where people want to stay and thrive.

[HCWS189]

Health Bill (Eleventh sitting)

Karin Smyth Excerpts

Committee stage
Thursday 2nd July 2026 Public Bill Committees

The Committee should also consider the genuine need to access such information. While I can see the benefits, which I have outlined, there is the potential for every possible determinant of health to end up in the single patient record. I am trying not to be flippant, but whether someone drives a car, where they went to school and their parents’ medical histories could all be relevant to their medical history. Although I completely understand the intention and the way in which the hon. Member for Winchester wishes to expand the single patient record, we are in danger of making it such an enormous beast that it becomes unwieldy and unusable. We need to be really cautious before going down a route where it essentially becomes a repository for the story of people’s lives.

[The Minister for Secondary Care (Karin Smyth)]

Wherever possible, the single patient record will build on source records such as GP records. As such, it will include relevant patient information and, where appropriate, digital markers such as those suggested in the amendments. We have had some useful discussion as a result of the amendments, but such considerations are generally operational, and legislation is neither necessary nor practical.

On amendment 71, Members will know that the Government have been doing significant work in support of a digital medical marker for firearms. Medical information for firearms licensing provided by the applicant has been a mandatory requirement for every firearm and shotgun licence application since November 2021, as we have heard, when the new statutory guidance for chief officers of police on firearms licensing was introduced. When any individual applies for a firearms licence, the applicant’s doctor must provide details of any relevant medical conditions, such as depression, dementia, mental health conditions or drug or alcohol abuse.

A digital maker is placed on the GP patient record when a certificate is granted, and a GP can alert the police if a licence holder has a relevant medical condition. The digital marker automatically flags to the GP if a patient is suffering from a relevant medical condition and is a firearms certificate holder. It is true that the marker is not legally mandated, but it is supported by the British Medical Association and the Royal College of General Practitioners, and the former issues guidance to GPs about the firearms marker.

GPs already have professional duties to consider patient and public safety, and existing firearms licensing arrangements support GPs to share relevant concerns with the police where appropriate, while the responsibility for licensing decisions rests with the police. Data shows that, since its introduction in 2023, the marker is being used and that GPs are notifying police of medical issues that have arisen. There is nothing to suggest that the system is not effective.

[Dr Johnson]

Is it not also the case that anyone who is aware that an employee or relative has a licence and is concerned about their mental health can make such a report?

[Karin Smyth]

I am afraid I do not know the answer to the hon. Lady’s question, but if it is relevant, I will try to get back to her on it.

People applying for a licence must now indicate whether they have seen a medical practitioner other than their GP. The Government also intend to make a statutory instrument to require licence holders to inform the police if they consult a third-party medical practitioner who is not their GP.

The single patient record will build on and connect with information from GP source records where appropriate; no new provision is needed for that to happen. That process should be agreed as part of operational arrangements with the profession, in line with the current approach to markers in the GP record. If it is agreed that it would be beneficial for health and care professionals to have wider access to the firearms marker, the single patient record could facilitate that, but we do not intend to fill the Bill with detailed operational requirements such as that.

We do not believe that the SPR is the appropriate vehicle for having a debate about regulations requiring a report on the merits of a mandatory marker. As the hon. Member for Farnham and Bordon said, we should not expand the clearly defined scope of the single patient record—the scope is limited to direct care—to include a debate about what is stored more generally in NHS records. For those reasons, I ask the hon. Member for Winchester to withdraw amendment 71.

On amendment 72, as I have already outlined, the single patient record will build on and connect with existing source records, such as GP or hospital records, wherever possible. Where a person’s status as a military veteran is recorded, it will be possible to make that information available in the single patient record. Therefore, the provisions already ensure that the information is made available, where veterans opt to have that status recorded—that addresses some of the other issues raised by the hon. Member for Farnham and Bordon. There is no need to make any statutory requirement to ensure that staff have that information and consider any necessary adjustments or potential treatment options that may be relevant to ensure safe and effective care.

In addition, the clause contains powers to make regulations to allow people involved in the provision of an individual’s direct care, including that of any veteran after they have left the military, to access their single patient record. We want the single patient record to improve the accessibility and effectiveness of care for everyone. That includes making sure that military veterans can access necessary support and that staff can provide them with appropriate care. Furthermore, duties in the Armed Forces Act 2006 require the NHS and local authorities to have due regard to the armed forces covenant, which, of course, I fully support. For those reasons, I ask the hon. Member for Winchester not to press amendment 72.

[Dr Chambers]

I thank all hon. Members for their input, and the Minister for her insights. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

--- Later in debate ---

[Dr Johnson]

I am advised to declare that, although I am not a licence holder of a shotgun or a rifle, my husband has both a shotgun and a firearms licence.

[Karin Smyth]

I am grateful to hon. Members for this debate. Meaningful public engagement will be key to the success of the single patient record—we absolutely understand that—in building awareness and in designing the system. It has to have digital inclusion at its heart, but adding statutory requirements for public awareness campaigns and risk assessments is not the way forward. Amendment 49 seeks to put such a requirement on a statutory footing. I want to reassure the Committee and all Members: as the right hon. Member for Melton and Syston said, public awareness is absolutely key and will be integral to success. Work is already under way to ensure that we do that; we do not need to wait, nor should we be constrained by the proposed amendment.

In 2024, we began extensive public engagement on the use of data across health and social care, which showed strong support for the single patient record. We have heard that most people felt it was

“long overdue and a necessary step towards better care”.

The public engagement findings indicated support to progress at pace on the concept of a single patient record, to resolve the frustrations that patients and the public have when they have to repeat their story at multiple health and care settings.

As we move towards our ambition to give all patients in England access to a core set of their data through the single patient record from 2028, we will maintain a sustained drumbeat—as they say in the jargon—of public communications to raise awareness of the single patient record. We have heard some examples of where the Government do that well. Of course we want to learn from such examples across the country and from previous Government campaigns that have worked well, to explain the benefits and safeguards in plain English, and to signpost accessible information and feedback routes for patients and the public. I heard the comments made about people who may be excluded or have particular disabilities, including some older people—from conversations with my own constituents, it is often older people or those with multiple disabilities who can have their experience enhanced. We should make no assumptions about who does or does not feel excluded in this space; we need to learn from them all.

Furthermore, we have already published public-facing single patient record information and a dedicated feedback route. We will continue to co-create plain English, easy-read and translated materials, frequently asked questions and “voices heard/action taken” updates with public panels and patient groups ahead of roll-out. We will build on what we learn from that ongoing work as we develop the regulations. For those reasons, I respectfully ask the hon. Member for Sleaford and North Hykeham not to move amendment 49.

On the lead amendment, moved by the hon. Member for North Shropshire, we recognise, as I hope I have assured the Committee, that digital inclusion is an important issue. To quote another Member, we are eager to get it right, and we are taking it very seriously. Digital inclusion is a key driver in addressing health inequalities, supporting individuals and empowering people to better manage their health, which is at the heart of our 10-year plan. It is a system-wide issue, and one that the health and care system is taking action to address. We have considered this as part of the equality impact assessment of the single patient record provisions in the Bill, and will continue to keep those issues and potential mitigations under consideration throughout the development and implementation of the SPR. Therefore, although we agree with the aim of the amendment, we do not consider it necessary. Indeed, it would duplicate work that has already been done.

[Helen Morgan]

We have not seen a full design of the single patient record yet, but it is difficult to envisage what it would looks like for somebody who does not have access to the internet. It is not just older people; it is obviously a significant problem in deprived areas as well. Can the Minister elaborate on what that might look like for somebody who does not have a device or does not have broadband or mobile access? How will they be able to access their medical record? We might need to understand that before we move forward.

[Karin Smyth]

The hon. Lady makes an excellent point. Part the difficulty is that the powers in the Bill that enable the Government to bring forward a single patient record are separate from the secondary routes whereby we describe and work through the detail of regulation. All those considerations have to be very clear. The hon. Lady and I have spoken regularly about the lack of broadband access in her community, which remains a huge problem. All those considerations need to be worked through with the team. They are varied and multiple, and we need to bring parliamentarians and the public with us in doing that, as we bring forward secondary regulations.

NHS England’s digital inclusion framework, as currently, supports the delivery of the 10-year plan by addressing those particular connectivity and skills issues, as well as confidence and accessibility. That work is already partly in train through NHS England. We need to build on that and bring it forward as we come forward with the regulations. I visited the team up in Leeds around some of the digital inclusion they have already been doing from the app. It is very impressive how much they are doing with people to develop the app. I think people would agree that we can take some of that learning forward, because it is about making sure that digital transformation is inclusive and aligned with the ambition in the 10-year plan to personalise care, reduce inequalities and create a health system that works for everyone.

In addition, as set out in the “Managing health services for others” guidance, since February 2026 the NHS has had a process to allow proxy access to the app, which should also support people who, for example, do not have the skills to do it for themselves. Alongside those improvements, it is policy to undertake an inequality and health inequalities assessment prior to hosting anything new on the app. Again, that helps to identify, mitigate and monitor unintended negative impacts on vulnerable and marginalised populations before implementing new policy, services and procedures, as raised by the hon. Member for North Shropshire. That process should identify and consider the mitigations for the groups identified in the amendment.

I hope that Members can see how seriously the Government have taken the development of digital access so far. We absolutely recognise that we have to get it right to enable this record, which the public and population so desperately want to see. That work has already been undertaken and it will continue. For those reasons, I ask that the amendment be withdrawn.

[Helen Morgan]

The importance of the amendment is that it requires this problem to be monitored in an ongoing way. Monitoring something usually makes the situation improve, so I will not withdraw the amendment.

Question put, That the amendment be made.

--- Later in debate ---

[Karin Smyth]

This is another important discussion to have on the record to give patients and the public confidence as we introduce the vital single patient record. I start by stating that the security and privacy of people’s health data is paramount, and we will build the strongest safeguards possible into the record. Members from across the House have asked how those safeguards will be built into how the system is designed and operated, which is what we are doing.

It will operate on a roles-based access control model, similar to other NHS patient record systems where access to patient information is restricted to the authorised user only. The single patient record will go a step further by applying advanced cloud-based audit and oversight capabilities, enabling near real-time monitoring of system access and detection of unusual or inappropriate patterns. That will allow NHS security teams to track and detect access patterns, and to quickly intervene if specific records are accessed by staff who have no clinical relationship with the patient in question.

The single patient record will ensure that just because a clinician has permission to view a specific patient record, that does not mean they are authorised to do so without a clinical need. The security and access arrangements will be set out in the regulations themselves, which will be debated, rightly, in Parliament. Therefore, it is not necessary to set them out in a plan beforehand.

Furthermore, there are already existing enforcement arrangements that provide sanctions for inappropriate access to patient data, which will also include accessing the single patient record. I commend my hon. Friend the Member for Ashford for his extremely helpful intervention, in which he highlighted his own experience in this field. Some of the examples that we heard again today, including Southport, Nottingham, the recent case in Cambridge and others, are truly shocking to people. Clearly, that should never happen, but sadly it has. As my hon. Friend rightly outlined, there are provisions in place for training people on information governance and tracking when that happens.

Additionally, I want to be clear that the Computer Misuse Act 1990 makes it an offence to use a computer to access information in an unauthorised manner, such as a person accessing information without a legitimate reason. Inappropriate or unauthorised access to health records—often referred to as snooping—is a serious offence that can lead to severe penalties, including dismissal, criminal prosecution and financial penalties. Regulated healthcare professionals, such as doctors, nurses and pharmacies, can be reported to their respective professional bodies, which can result in them being struck off in serious cases.

The information commissioner also has powers to investigate and take action against infringements of data protection legislation, which can include monetary penalties, enforcement notices, undertakings, prosecutions and reprimands. Furthermore, patients have a right to access data that is held about them under the data protection legislation, and those rights will continue to apply to the single patient record. For those reasons, I ask the hon. Member for Sleaford and North Hykeham to withdraw her amendment.

[Dr Johnson]

We think this is an important issue, so we would like to divide the Committee.

Question put, That the amendment be made.

--- Later in debate ---

[The Chair]

With this it will be convenient to discuss the following:

New clause 7—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 8—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.”

[Karin Smyth]

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. The way we currently manage health records is letting patients down. That must change. Patient information is fragmented, so care is fragmented.

Local shared care records have demonstrated what can be achieved. The OneLondon shared care record is used by more than 100,000 frontline staff, with estimated monthly savings of £4.6 million, and around 45,000 patients are reported to have benefited from the Greater Manchester care record in March 2026, with 15 minutes of treatment time saved per patient.

Successful as some local shared care records are, however, they do not provide a uniform, comprehensive single record across England. The single patient record will allow people to have access to a summary of their full health record and provide relevant health and care providers with access to the health and care information they need to provide effective joined-up care.

This is not a new problem and patients have not been silent about it. For more than a decade, patient groups and organisations across the country have been calling for exactly the kind of change that the single patient record will deliver. As far back as 2013, National Voices captured it simply and powerfully:

“I would like to tell my story once.”

The call has only got stronger. Our independently delivered public deliberations found strong support for the single patient record. It was described as a long-overdue fix to fragmented care, while the survey of 2,000 people found more than three quarters in favour of a single patient record. The Committee has heard directly from a range of stakeholders about the benefits a single patient record could have for patients and their care.

Clause 47 enables the Secretary of State to make regulations for the purpose of creating and operating the single patient record. The purpose of regulations made under this clause is to bring together patient information and make it available to patients and their relevant health and care providers such as GPs, hospital doctors, social care providers or others involved in their direct care. Only information concerned with direct care will form part of the system.

We have also included strong safeguards. The security and privacy of people’s health and social care data are paramount, and we will build the strongest of safeguards into the single patient record. It 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. Permissions to access patient information will be restricted to authorised users only, with an audit trail of who has accessed a patient’s data. The Secretary of State must also consult appropriate persons before making regulations and must have regard to ensuring that adequate safeguards are in place to prevent misuses of data.

--- Later in debate ---

[Gregory Stafford]

That is an interesting question. I do not know the answer, but perhaps the Minister can pick that up.

The Bill also creates powers for financial penalties. It sets out a process for notices and opportunities to make representations and a right of appeal. Those procedural protections are sensible, but the Bill does not tell us who might be fined or what conduct would trigger a penalty, and it does not set out a maximum penalty level. Those decisions, again, are left to regulations.

It is also important to remember that the Bill does not replace existing data protection law, as I think the Minister outlined in her opening remarks. Organisations will still have to comply with the Data Protection Act and other UK data protection rules. However, the Bill would provide a new statutory basis for processing information through the single patient record. That makes the wording of the Bill especially important. Ultimately, public confidence will determine whether the system succeeds. People are generally willing for information to be shared when it improves their care, but they also expect transparency, security and accountability and expect to know who can see their information and why. Those expectations are entirely reasonable.

There are several questions that I believe the Committee should ask before these powers are granted. Will patients have a genuine choice about participation? Will they be able to restrict access to particularly sensitive parts of their records? Who exactly will be able to access the system? Will patients be able to see a record of who has viewed their information? What minimum standards will apply? How will misuse be identified and punished? What independent oversight will exist? Those are not technical details; they are central to public confidence.

In conclusion, the clause will create a legal framework rather than a system itself. It will give broad powers to establish the single patient record while leaving many of the most important questions to future regulations. Clearly most people support the goal of improving patient care, but because the system will involve some of the most personal information that people have, Parliament should ensure that patient rights, safeguards, transparency and accountability are clearly built into the framework from the beginning. It should ensure that questions are asked now rather than decided on later.

[Karin Smyth]

I turn first to new clause 7. Patient data is at the heart of the NHS, and it is important to help plan and run health and social care services; we have discussed that before, and a lot of these points have already been recorded in our earlier conversations. The security and privacy of people’s health and care data are paramount. To be clear, the Bill does not rewrite our data protection laws; it works alongside them, allowing the NHS to use existing, lawful frameworks to share information safely and legally for the direct care of patients. Article 25 of the UK general data protection regulation already applies to the federated data platform, and will apply to the single patient record. The new clause is therefore not necessary.

In the NHS, there are different ways in which patient information is used, and not all of them involve asking for explicit consent each time. For example, if a GP refers someone to a hospital, that person would not expect the clinician reviewing the case to ask their permission before looking at their medical record; their agreement is understood as part of seeking care. That is called implied consent. Although a national data opt-out exists, it applies only to data used for secondary purposes such as research and planning.

The single patient record is expected to operate roles-based access control, whereby permission to access patient information is restricted to authorised users only, with an audit trail of who has accessed the patient’s data. Inappropriate or unauthorised access to health records, often referred to as snooping, is a serious offence. There are mechanisms to manage that, including prosecution and fines.

In 2025-26, we invested £75 million across health and social care, building on the £375 million invested since 2017. Through our ambitious cyber improvement programme, we are tackling the changing cyber risk head on, expanding protection and services to better protect the health and care system. The single patient record system is expected to be assessed as critical national infrastructure, with the highest standards of cyber-security and information governance to meet our existing duties to keep personal data safe under the data protection legislative framework.

I turn to new clause 8. No decision has been made about who will be the IT suppliers of the single patient record. It is expected and intended that it will be delivered through contracts with multiple suppliers, which will reduce dependency on a single supplier. Furthermore, no decision has been made as to how, if at all, the single patient record will link to existing infrastructure such as the federated data platform. As hon. Members will expect, I would not support using the Bill to try to rewrite the contract for the federated data platform.

Hon. Members have discussed a wide range of issues relating to this area. They probably know that negotiating the intellectual property in relation to software in digital services is complex and often contentious. The new clause would make it a condition of any single patient record IT supplier contract that the NHS owns the intellectual property in data connector software, regardless of the circumstances. In practical terms, that would be likely to disincentivise suppliers from offering their services if they were required to sacrifice the IP of a product. It is unnecessary to impose such a condition, as there are other ways in which the NHS can ensure that software is reusable, such as broad general licences to use the data connector software in whatever manner, requirements to use industry standard code and interfaces, and information standards.

The recent changes to the NHS information standards in the Data (Use and Access) Act 2025 make relevant IT suppliers accountable for meeting information standards and enable the Government to monitor and enforce compliance with information standards by IT suppliers. We wish to see a vibrant UK market in digital and technology, while ensuring that patients get the best technology to improve care outcomes and to keep the NHS financially sustainable. That will give the NHS more choice and help to improve standards while supporting economic growth.

We have had what they call a wide-ranging discussion on some things that are not actually in the clause. I agree with the hon. Member for Farnham and Bordon that it is absolutely right, and we have heard some excellent examples from Members with clinical experience. My hon. Friend the Member for Lichfield will now be forever known as Data Dave—sorry about that. The hon. Member for Sleaford and North Hykeham has clinical experience and my hon. Friend the Member for Ashford has NHS experience, as do I. That experience is really valuable. The Liberal Democrats tabled amendments and had a long list of questions, most of which are addressed in various pieces of information that we have put forward. However, I take the point about the intellectual difficulties of what the clause does. We all agree with it, as does the country, and patients think it already happens.

We are an outlier in this sphere. The Government are going to change that situation. However, these questions and concerns are the reason why we take through secondary legislation, which is something that we all understand but the outside world does not. We need to bring people with us. Our officials have come to talk to Members of Parliament about the Bill. I am open to suggestions from Members about the best way to address the issues, and particularly about the best way to inform Members on behalf of constituents. These discussions are important to building public trust and security.

I will finish on a broader point. I commend clause 47, which gives an enabling power, but let us be very clear that patient information will still be held in the system in which it was originally created. These bodies, whether GPs or hospitals, will continue to be responsible for ensuring that the data is handled securely and lawfully and is accessed for valid reasons only. As I mentioned earlier, we have shared systems operating already. Some parts of the country and some of our constituents are already experiencing some of the benefits of a shared system. We will use that experience and learn the lessons of the past, under whichever Government, to build for the rest of the country the shared systems that some people have already. We will come on later to provisions on devolution arrangements, on working for the future and on operating more efficiently across devolved areas.

[Joe Robertson]

I thank the Minister for clarifying that the data will continue to be stored and held in the databases in the electronic record-keeping system where it is currently kept. I am not looking for her to give me a detailed solution on the spot, but does she accept that unless there is seamless interoperability across all those systems the single patient record will not be realised, and that we are still an awfully long way from seamless interoperability across England, let alone the UK?

[Karin Smyth]

The hon. Gentleman tempts me to spend the next hour talking about the shocking state of the capital and infrastructure systems that we inherited from the previous Government, but I will not. Of course they do not work: that is one of the biggest issues around staff morale. We saw through the 10-year health plan, particularly with clinicians having to log on to nearly 10 different systems, how that impedes progress and efficiency at a local level. Where it is rolled out, the federated data platform helps to make systems more efficient, particularly in local hospitals. We heard in our evidence sessions about maternity and frailty, which are the areas in which we will be testing and rolling out this approach to make the best use of it on the ground. Alongside that, the work to make systems more interoperable and efficient at a local level continues. I commend clause 47 to the Committee.

Question put and agreed to.

Clause 47 accordingly ordered to stand part of the Bill.

Clause 48

Information about health service products

Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

Clause 48 will make amendments to the health service products legislative information gateway to allow the Government to continue to disclose certain information concerning the pricing and supply of health service products, which are items that include medicines that are used in the NHS. We recognise the importance of the effective flow of information between central Government about the pricing and supply of health service products to the NHS. Data sharing is governed by a clear legal framework defining who can access it and under what conditions. That supports the controls that the Government are able to exercise in relation to the pricing and supply of health service products.

Clause 48 will maintain the current safeguards for confidential and commercially sensitive data, ensuring continuity as NHS England’s functions are redistributed to the Secretary of State and integrated care boards. It will achieve that by enabling the Secretary of State to share pricing and supply information with people who provide services to them, such as primary care providers. That is essential to preserve the sharing of information and operation of the service that they provide for patients where that process is currently managed by NHS England.

As a consequence of the changes being made, the Secretary of State will be able to share relevant information with third-party service providers, such as providers of the software that primary care service providers use. They will be able to receive relevant data to make lawful disclosures of that information for specific purposes, those being the provision of certain services to the primary care service provider. This will ensure that there is no disruption to how data flows across the system.

This change will simply enable those who receive essential data to continue to do so following the abolition of NHS England. I commend the clause to the Committee.

Question put and agreed to.

Clause 48 accordingly ordered to stand part of the Bill.

Clause 49

Health and social care information: delegation of functions

--- Later in debate ---

[The Chair]

With this it will be convenient to discuss the following:

Clause 50 stand part.

Amendment 6, in schedule 7, page 96, leave out lines 38 and 39 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) any 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 7, in schedule 7, page 100, leave out paragraph 14.

This amendment is consequential on Amendment 6.

Schedule 7.

[Karin Smyth]

Clauses 49 and 50 explain our approach to the transfer of NHS England’s existing data and information functions to the Secretary of State. Slightly counterintuitively, I will start with clause 50 before turning to clause 49.

Clause 50 inserts schedule 7, which takes existing NHS England information functions and transfers them to the Secretary of State for Health and Social Care, as part of a single centre for data and digital policy in the NHS. The schedule also includes changes to existing information functions. This will support the shift from analogue to digital and allow us to make the most of opportunities from data and AI, as set out in the 10-year health plan. The changes will not weaken the fundamental safeguards in place to protect health and care data, nor fundamentally change rules relating to how confidential patient information can be used.

I will now outline some key changes made by the clause. It will ensure that information systems for the NHS are set up, where appropriate, not just for the collection and analysis of data but for processing more generally. This will make it easier to support machine learning and artificial intelligence activities, among other uses of data.

The clause extends the extent of chapter 2 of part 9 of the Health and Social Care Act 2012 to the whole of the UK, and provides for the Secretary of State to establish information systems in the interests of the health service or adult social care in England, or in connection with the provision of care across the British Isles, as NHS England currently can.

The clause enables the Secretary of State to issue guidance to health and social care bodies on the processing of information. It transfers to the Secretary of State NHS England’s powers to require and request information, and such requests will be able specify the form, manner and time within which the information requested is to be provided.

The clause also allows the Secretary of State to publish information obtained in the operation of an information system, including information about service providers. Where NHS England had a duty to publish such information, it is right that the Secretary of State should retain discretion in that regard. Obviously, there may be circumstances in which the publication of data would not be appropriate, and the clause does not give the Secretary of State complete freedom to publish personal information. The Secretary of State may publish personal information without patient consent only where it is for the protection of life or health, or for the protection of public safety or security. It is possible that there could be circumstances—for example, in relation to infectious disease—in which information is published that could lead to an individual being identified. None the less, the change simplifies the process of publication while maintaining a high bar for the publication of personal information.

The Secretary of State’s power to disclose information—for example, to health bodies—other than by publication will be slightly different from NHS England’s current power. The grounds for disclosing personal information will largely mirror the current grounds, with a few additions, including in respect of facilitating clinical trials or other research. This will help to address barriers to data access for research while preserving existing rules on confidentiality. As with his powers of publication, the Secretary of State will also be able to disclose information for the protection of life or health, or for the protection of public safety or security.

The Secretary of State will be bound by certain existing duties on NHS England, including a duty to have regard to any relevant advice from the Confidentiality Advisory Group when publishing or disclosing information in accordance with his data functions. The Secretary of State will retain the regulation-making power to establish an accreditation scheme for information service providers, which will now include a broader range of providers, including public bodies.

Clause 49 permits the Secretary of State to delegate certain functions relating to health and care information. Currently, some of those functions can be delegated by NHSE via arrangements with third parties or under regulations. The clause will insert new section 251ZF, which allows the Secretary of State, by arrangement, to delegate to persons specified in regulations functions relating to information standards.

Information standards help to reduce fragmentation in digital and data services. They include mandatory requirements for how information is recorded, shared, governed and supported by IT. Increasing interoperability and consistency in digital and data is essential to increasing value for money, reducing the burden on staff and, ultimately, improving the quality of care. The continued use of information standards is key to the 10-year health plan’s aim of improving the interoperability of digital and data services across the health and care system. This will provide the Secretary of State with the flexibility to delegate such functions to persons who have the required technical expertise, where necessary.

Clause 49 will also insert new section 277G, which enables the Secretary of State to direct public bodies to exercise a wider range of his information functions, defined as “relevant information functions”. This includes not only information standards but other information functions, such as the Secretary of State’s duty to establish and operate information systems. The measures will provide the Secretary of State with important flexibility to delegate such functions to persons who have the required technical expertise, where necessary.

In all, the changes are necessary not just to effect the transfer of data functions to the Secretary of State but to enable better data use for the benefit of the NHS now and into the future.

[Dr Johnson]

I have a couple of questions. In lots of ways the provisions derive from clause 1 and the abolition of NHS England. Schedule 7 refers to operating a system in the interests of the health service, which is not the same as operating it in the interests of the patients. Does the Minister have any comments on that? The Nuffield Trust has pointed out that schedule 7 would not pass over to the Secretary of State NHSE’s duty to report to Parliament. Is that because the Minister thinks that duty is duplicated elsewhere and is therefore not necessary?

Under the previous legislation, the Care Quality Commission was slightly stronger and could make a mandatory request that NHS England establish a system, and NHS England had to comply with that unless it related to an existing exception. Now if the CQC makes a request, it goes to the Secretary of State, and whether it is agreed to is then somewhat more optional. Will the Minister say why she needs to change that power?

[Helen Morgan]

I want to speak to amendment 6, which is tabled in my name, and amendment 7, which is consequential upon it. Amendment 6 would ensure that the CQC and NICE can

“continue to make mandatory requests to the Secretary of State to establish an information system”,

as they currently can with NHS England. At the moment, NHS England has a duty to co-operate with the CQC and NICE, and that is often enough for a collaborative approach that allows the CQC to access the data it needs.

But the duty that applies to NHS England is not being passed on to the Department of Health and Social Care. The CQC raised the issue in written evidence to the Committee, saying that the duty

“has been an important mechanism”

that has

“supported receipt of patient safety incident reports…information sharing between regional teams, and the development of central data sharing solutions.”

The CQC went on:

“Without an equivalent duty, we would be reliant on there being sufficient capacity and willingness within DHSC to share information, with no statutory backstop. This could inhibit our ability to receive the information”

needed

“to keep people who use services safe. Challenges in this area are often cultural and rely on the subjective judgment of individual data controllers as to whether particular data sets can be shared, how these should be used and what the timeliness of sharing should be, leading to protracted piecemeal conversations and delays.”

As we have harrowingly heard over the past week, there is often reluctance to share data, particularly when there is a defensive culture in certain NHS institutions. Our amendment seeks to address the gap. I hope that what I have outlined is an oversight from the Government, not a deliberate attempt to reduce transparency or reduce regulator access to key data. The wider changes in schedule 11 will omit section 288 of the Health and Social Care Act 2012. The Government are dropping this key wider duty in a schedule entitled “Minor and consequential amendments”. We do not think it is minor. It holds major implications for patient safety and transparency.

On a wider note, it seems counterintuitive that the CQC, as regulator, does not have easy access to the data collected nationally in the health service.

[Karin Smyth]

Let me respond to the hon. Member for North Shropshire on amendments 6 and 7. As she said, amendment 7 is consequential on amendment 6, so I will take them together.

I think we can all agree that the CQC and NICE should have access to the information they need to undertake their important work. Amendment 6 is not required to ensure that. Clause 50, and the associated changes in schedule 7, maintain the current ability for any person, including NICE and the CQC, to request the establishment and operation of an information system. However, NICE and the CQC will not be able to make the equivalent mandatory request they used to be able to make to NHS England because NHS England is to be abolished.

Amendment 6 seeks to maintain the current position when, in reality, mandatory requests were practically never made under the current arrangements. They were thought necessary when a separate arm’s length body had responsibility for collecting data about healthcare. There is no need for the Secretary of State to be subject to the same mandatory requirement as they are responsible for oversight of the entirety of the NHS and the adult social care system, and for its effective regulation.

Furthermore, the CQC has a statutory power, under section 64 of the Health and Social Care Act 2008, to require the provision of

“documents, records (including personal and medical records) or other items”

the CQC considers “necessary or expedient” for the purposes of its regulatory functions, from a range of health and social care commissioners and providers.

On amendment 7, the Government agree that a code of practice setting out strict standards for how health and care organisations must handle confidential patient information is an important component of a healthcare system that uses data safely and effectively. That is why clause 50 allows for the insertion of new section 252ZA into the National Health Service Act 2006, to transfer to the Secretary of State the duty to publish a code of practice on confidential patient information. For those reasons, I ask the hon. Member for North Shropshire not to press amendments 6 and 7 to a vote.

The hon. Member for Sleaford and North Hykeham asked about duplication. I think the answer to her question is yes, but if that is not correct, I will make sure that I respond to her accordingly.

Question put and agreed to.

Clause 49 accordingly ordered to stand part of the Bill.

Clause 50 ordered to stand part of the Bill.

Schedule 7

Health and social care information systems etc

Amendment proposed: 6, in schedule 7, page 96, leave out lines 38 and 39 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) any 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.’”—(Helen Morgan.)

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.

Question put, That the amendment be made.

--- Later in debate ---

Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

Clause 51 makes changes to section 42 of the Statistics and Registration Service Act 2007, which governs how information collected at the registration of births, deaths and other life events may be shared for specific purposes. That information plays a vital role in supporting public services, including health service planning, population analysis and the delivery of care. The UK Statistics Authority may already share this registration data directly with a range of public bodies, including the Secretary of State and integrated care boards.

Clause 51 adds NHS trusts and NHS foundation trusts in England to that list, providing a clear statutory route for sharing statistically codified registration data with trusts and foundation trusts responsible for delivering services on the ground. The clause is not about expanding the type of information that can be shared or widening the purposes for which it may be used, and does not create new datasets or weaken existing safeguards. All information sharing remains subject to the same statutory controls and protections that already apply. I commend the clause to the Committee.

Question put and agreed to.

Clause 51 accordingly ordered to stand part of the Bill.

Clause 52

Arrangements with devolved authorities etc about information services

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to discuss clauses 53 to 57 stand part.

[Karin Smyth]

Clauses 52 to 57 are vital. The Committee has discussed our relationship with colleagues in the devolved authorities; these clauses ensure that arrangements with devolved authorities and the Crown dependencies can continue following the abolition of NHS England.

Turning first to clauses 52 to 54, although healthcare is devolved in England, Scotland and Northern Ireland, the devolved Governments currently make arrangements with NHS England to deliver a number of functions on their behalf. Clauses 52 to 54 enable those existing arrangements to continue following the abolition by giving the powers to the Secretary of State. The policy intent is not to impact or reach into devolved competencies, but to secure continuity and legal clarity through existing cross-border and UK-wide arrangements involving Scotland, Wales and Northern Ireland. This is about making sure that the current expertise and resources of NHS England remain available to devolved authorities once these functions merge with the Department of Health and Social Care.

The clauses will not give the Secretary of State any ability or power to do anything in relation to devolved authorities other than as mutually agreed. Arrangements will be fully voluntary and do not create a power for unilateral action; rather, they ensure that, where co-operation is wanted, there is a proper legal basis for it.

Under clause 52, the Secretary of State takes on the data functions of NHS England and, on request from the devolved authorities, to make arrangements for the provision of information services. Clause 52 additionally applies to Crown dependencies. There are a number of such arrangements already in place between NHS England, the devolved authorities and the Crown dependencies.

For example, NHS England provides the NHS login service for the NHS Wales app, as well as the electronic prescription service for Wales, and NHS England collects and analyses data for audits that span multiple devolved authorities, such as the national audit of pulmonary hypertension. These provisions will support continuity of those arrangements. We are making sure that, if it is appropriate, data functions that are transferring to the Secretary of State can be delegated. Proposed new section 294B of the Health and Social Care Act 2012 will allow that power to likewise be delegated to an appropriate public body.

Clause 53 provides a clear statutory basis for the Secretary of State, by agreement with the devolved administrations’ health bodies, to make commissioning arrangements for the Scottish, Welsh or Northern Ireland health services. This clause will help to ensure continuity for patients across the United Kingdom, reducing the risk of disruption, and support the effective commissioning of services where cross-border work remains the right approach.

Clause 54 enables the Secretary of State, by agreement with a devolved authority, to exercise certain education and training functions on that authority’s behalf and to provide services or facilities in connection with those functions. Education and training arrangements often work best when they are co-ordinated efficiently and supported by shared systems. At a time when every part of the health service needs a strong pipeline of skilled staff, it is vital that useful joint arrangements can continue with clarity and confidence as responsibility is transferred from NHS England to the Secretary of State. The clause updates the statutory framework and helps to ensure that shared arrangements supporting recruitment, training cycles and workforce planning can continue following the abolition of NHS England.

Clause 55 relates to clauses 53 and 54. The agreed arrangements are effective only if they can deliver in a practical and efficient way, which is why this clause enables the Secretary of State to direct a public body to exercise some or all of the Secretary of State’s functions under arrangements made with the devolved authorities in relation to commissioning or education and training under section 295 or section 296A of the 2012 Act. In short, it provides a mechanism to ensure that functions under agreed commissioning and education and training arrangements with devolved authorities can be exercised by the most appropriate public body in England. The clause also allows the Secretary of State to direct the public body in how those functions are to be exercised, including in relation to information obtained in the course of exercising them. It also requires directions to be published. Those features support both operational clarity and accountability.

On clause 56, public authorities in the Crown dependencies may seek expert advice or practical assistance from the health system in England. Following the abolition of NHS England, this clause transfers the existing power from NHS England to the Secretary of State, and provides a clear legal basis for the Secretary of State or ICBs to provide that advice and assistance for purposes connected with the provision of healthcare. The clause also makes clear that advice or assistance may be provided on such terms as a provider considers appropriate, allowing support to be given in a practical and transparent way that is tailored to the circumstances of the case, whether that involves technical advice, specialist expertise or other practical assistance in connection with the provision of healthcare.

Finally, on clause 57, clarity and consistency in legislation depends on clear definitions, particularly where a group of provisions are intended to operate together as a coherent scheme. This clause does not create any new powers or duties; rather, it provides the necessary interpretive framework to support the operation of the preceding clauses and ensure legal certainty and clarity. As a group, these clauses play a vital role in ensuring that existing arrangements with our devolved authorities and the Crown dependencies can continue following the abolition of NHS England. I commend them to the Committee.

Question put and agreed to.

Clause 52 accordingly ordered to stand part of the Bill.

Clauses 53 to 57 ordered to stand part of the Bill.

Ordered, That further consideration be now adjourned.—(Emma Foody.)