Health Bill

Peter Prinsley Excerpts

2nd reading
Monday 1st June 2026 Commons Chamber

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

I know of a quite frail diabetic patient with cancer, who underwent several operations as well as complicated chemo in London. He eventually decided that he was well enough to take a short holiday, so he went to Cornwall on the train. Unfortunately, shortly after arriving he was found in a state of collapse by his daughter, and taken to the nearest hospital late on a Saturday night. The doctors had no access to his medical notes, and no answer when they called the hospital in London, so they were puzzled. That situation is familiar to doctors. Patients are incredulous when they are told that we are unable to see all their medical records: “Surely everything is on the computer?”

As a surgeon before becoming an MP, I worked in at least three different hospitals. There was no compatibility between the records, which meant that transferring care was complicated and hazardous. I would be asked to advise on a patient from another hospital, relying on a dictated note from the referring doctor, but I could not access the clinical records, the results of investigations such as the pathology test, scans or, crucially, the operating records. Consultations were delayed as I stared at creaking computers, with numerous software programmes, each individually protected by ever-changing and forgettable passwords, that slowly booted up. That obviously needs to change.

I would link the NHS number to an unique single patient record. I would give ownership of the record to the patient, and let the patient be the custodian and the gatekeeper. That is the truly revolutionary idea. If someone could easily look at their medical record, with appropriate physician safeguards, they could monitor everything—blood pressure, heart rate—and perhaps there would be an incentive for them to look after their health a little better.

Let us imagine for a moment the power of anonymised medical data for a population of 70 million people. The NHS is perhaps the largest complete set of health data on a whole population in the world. That is a huge resource for informing health policy and medical research. By tracking the health outcomes of millions of our fellow citizens, we can sort out all kinds of diseases, such as heart disease, cancer and mental health disorders. I can think of no greater innovation, or more helpful measure to improve the health care of this nation, than a single patient record.

[Martin Wrigley]

All the features that the hon. Member is asking for are available to people within the Greater Manchester area. Exactly those things are there and work today, even down to the remote monitoring he mentions.

[Peter Prinsley]

I am grateful for that intervention, and I am aware that in various bits of the country such systems do exist. I would like to see a single patient record that is genuinely single, so that when my hon. Friend the Member for Stroud (Dr Opher), who is sitting next to me, writes something in the record, I can see it, and when I write in my record, he can see it, and no letters are passing back and forth between us. That is why I am sure that legislating for the mandatory single record is what we must do, and as a surgeon who has worked for 40 years in the NHS, I will do everything I can to help.

[Dr Simon Opher (Stroud) (Lab)]

It is a pleasure to speak in support of the Bill, which I believe has the power to transform patient care in the NHS. Particularly after the remarks of my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley), the House will be aware that I also have a vested interest in this, as I have been a working GP in the NHS in Stroud for at least the last three decades. Indeed, I did a surgery last Friday, and I excitedly told the other doctors that we are going to have a single patient record. Instead of being excited, they said, “It’s about time.”

Those of us working in the NHS have been calling for a single patient record for years, so it is about time that a patient can tell their story just once, and about time a GP knows what a consultant is saying and the consultant knows what the GP is saying. It is about time that, when a patient gets admitted to A&E, the doctors know what the GP has already done, and that, when a patient gets referred to a psychiatrist, they know which antidepressants have been taken. As my hon. Friend said, patients struggle to understand how all the doctors do not know what is going on. We got rid of the fax machine in our surgery only last year, so we are fairly behind on communication, but the Bill lays the foundation for that to be remedied.

The benefits of the Bill for patients are huge—their medical knowledge at their fingertips, just as they are for clinicians and for integration. We cannot have integration without a decent single patient record. On research, our data is a national asset. I fear that a company such as Palantir owning our data is a derogation of our duty, and that we should use that data as a fantastic resource. I am also worried about Palantir’s involvement with death in Gaza and the infringement of civil liberties under the Immigration and Customs Enforcement agency in America. Also, at the Chelsea and Westminster hospital, it seems that the benefits that Palantir said it would bring to the operating theatre were not provable. The data is owned at the moment by GPs, and if there is a spillage of data, GP practices are unlimitedly liable. We must change that; otherwise, no one will become a GP partner. We must also be careful, because excessive and over-the-top safeguarding could obstruct the single patient record, and that would harm patient care.

[Peter Prinsley]

Does my hon. Friend agree that we must have a single patient record, not simply federated records from other sources?

[Dr Opher]

I do agree, although that is a much bigger job. At the moment, mental health uses a different system from the hospital, and it would be great to unite them. I agree with that, but whether it would possible in the next couple of years, I am not so sure.

Let me quickly go on to NHS England. The administrative burden on GP surgeries from NHSE has been huge, as my hon. Friend has mentioned, and it will be fantastic to get rid of that. When GPs undergo CQC inspections we have to do pointless protocols to fulfil the criteria, and they involve weeks of work. I want to make a little bid here for a much more supportive, lighter touch approach when looking at proper data around GP surgeries, which we would not have to prepare for. That would be very popular with GPs.

I warmly welcome this Bill. It is about time we reduced the ridiculous administration around patients and allowed clinicians to properly care for patients, and it is about time we had a single patient record.

Health Bill (Second sitting)

Peter Prinsley Excerpts

Committee stage
Tuesday 16th June 2026 Public Bill Committees

[Laura Kyrke-Smith]

Q I come from a county with really significant health inequalities—people in the wealthy parts of the county live 10 or 12 years longer than people in some of the more deprived parts of Aylesbury, which I represent. I would love to hear your thoughts on how we ensure that local authorities, ICBs and the voluntary sector continue working well together through this, and specifically how we do that in a way that drives the reduction we need in health inequalities.

Maria Higson: I think we are all agreed that working at the neighbourhood level is absolutely the right way to go about that. That is where health inequalities can best be addressed, because that can be most nuanced and tailored. Working on that smaller footprint is really important. You mentioned voluntary, community and social enterprise organisations, and I think that is a hugely important part that has broadly been missed out from the conversation around these changes. We work closely with VCSE partners and we know they deliver huge amounts for the communities and understand the communities in which they are embedded very well, so making sure that the VCSE voice is part of those neighbourhood teams will be important for that nuance and tailoring in the local element.

Councillor Wright: I agree entirely. Local authorities are in a good position to engage the voluntary and community sector. But again, we are fighting for a voice with the NHS and they are fighting for a voice with us, so we need some honest conversations with ICBs, and a real strategy looking at those health inequalities and what is driving them. It will not purely be access to hospitals; it will also be access to meaningful employment, housing, transport, mental health or social isolation—there will be so much driving those wider determinants of health that are affecting healthy life expectancy. Local authorities are in a prime position to do that, and they need to be listened to. I think the challenge will be how we collectively say, “What needs to be done, other than implementing the Bill? How do we look at the whole health inequality picture and address it?”

Sally Burlington: I would agree with the others: tackling health inequalities is really difficult. Doing it the same way in every area would not work, particularly in a world where there is not enough resource to do everything we would all like to do. You have to tailor how you approach local service delivery and what is needed locally according to local needs, the local community capability, how people work and what their preferences are locally, and the neighbourhood health agenda is our best shot at tailoring in that way.

I think you will come on to Healthwatch, but we would have concerns that, in separating the Healthwatch duties to look at NHS and social care, we risk missing some of those who are most likely to need both, and that that could exacerbate health inequalities rather than make them better.

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

Q Which organisations or people do you envisage running the neighbourhood health centres? Will they be run out of general practice organisations, or will the local authorities themselves be best placed to run them, so as to join up hospital care with community services?

Councillor Wright: That is quite interesting; I was at a session this morning looking at communities, and there was a comment that for the NHS communities are about buildings, whereas for the local authority they are about people. I think it would be the ICBs and whoever they commissioned to provide neighbourhood health centres. I hope there would be enough input from the voluntary sector, the local authority, adult social care and public health—from everyone—but I see the ICBs as the commissioners and the people who organise them.

[Peter Prinsley]

Q So the ICB will commission it, but somebody will have to run it. Who should run a neighbourhood health centre?

Maria Higson: If we want to be as open to change as possible, my argument would be that that should be decided locally. Would it not be fantastic if, for example, some of them were led by VCSEs that worked in close partnerships and had clinics where GPs came in? You can envisage a whole number of different scenarios, led by local communities and local organisations. This plays back to the health inequalities point, but that is how you do it, although it relies on you being open to different models and not trying to do a one-size-fits-all, which is really tricky when you are trying to implement.

[The Chair]

Last word, Sally Burlington.

Sally Burlington: I strongly agree with that. If you were asking who is best placed to run them, the answer would be that it probably looks different everywhere, because it will rely on local leadership and local capability and capacity, which varies across all our sectors, so this is a really good opportunity to make the most of that leadership ambition and skills and capacity locally.

--- Later in debate ---

[Sojan Joseph]

Q I was listening to Dr Byrne’s concerns about confidentiality and trust. I want to declare that I have worked in the NHS in the mental health sector for many years. I worked in one of the biggest mental health trusts, Kent and Medway mental health NHS trust. We use an electronic patient record called Rio. As Dr Cocker said, before anyone is given access to the record, they have to have training on information governance and data protection, and access is given based on their role. That system creates an audit trail, so patients can request to see how many people have accessed their information in the last month or two—there are facilities on the system to check that. Is staff training and raising awareness among patients important for creating trust and confidentiality?

Dr Byrne: Those things are very important, yes. There are some technical solutions. Again, the SPR is an opportunity to look at that across the system, because systems vary greatly in the sophistication of their audit function, for example. Even when there is an audit function, if someone has legitimate access through their role as a doctor or a nurse, it can be difficult to know whether their access in any particular case is legitimate. These are not common occurrences, but it is extremely distressing for patients if their confidentiality is breached for any reason.

It is not simply a matter of technical controls. We need to look at how we build stronger, more effective deterrents across the system by having effective sanctions when incidents do occur. I am keen to look at that and delighted that the Department of Health and Social Care and NHS England are, I think, very interested in having that conversation with me. At the moment, it certainly seems that there is a variable response across the system to inappropriate access.

Looking ahead to the SPR, we need to look at that make improvements, so that the public can have faith that, given the harm that it can cause them, it will be taken very seriously if anyone does access their records inappropriately. There are technical, cultural and system aspects to think about here. The SPR is definitely an opportunity to do that, and I am very keen to work with other stakeholders on that.

[Peter Prinsley]

Q I am an ENT surgeon. What do you think about giving the patient ownership of the single patient record as well as discretion over whether the information in that record is revealed to the clinical team?

Dr Byrne: It is an interesting idea, but I am not sure. I heard your question earlier about data controllership specifically in this regard. You will not necessarily like my answer. There are two ways of answering the question; perhaps straightforwardly, legally, but also clinically. I will start with the legal answer, which in some ways is easier. Data controllership in data protection law is a very technical term; it is determined by who is making the decisions about processing the means of the data. An organisation running and controlling an electronic patient record would be the data controller. Obviously, this is ultimately a question for the regulator and the Information Commissioner’s Office to determine, but that would be the legal position, nevertheless.

Clinically, we have to come back to thinking about what a patient record is for. Primarily, it is to provide good care in the context of the clinician-patient relationship. If you prioritise the needs of either side of that relationship, I think it is problematic; the needs of one must not outweigh the needs of the other.

The clinical record is there to enable clinicians to record what someone is presenting with, the difficulties they are having, what investigations are appropriate, the findings and what the plan is. It needs to be there for that tool to work. To take you on a slight thought experiment, if it was entirely held within a patient’s control—however loosely we use that term, legally or otherwise—and we could all amend, correct, change or add our diagnoses, findings and treatments, that might be clinically problematic. That may not be the answer you want, but it is the straight answer, if I am honest, from both a clinical and legal perspective.

[Peter Prinsley]

Q I would love to amend the figures in my bank account—I would like to be able to go into my Lloyds bank account and add a nought to the end of the balance figure—but I cannot, because the bank controls that. But I am the one who has access to the data.

Dr Byrne: I totally support that ambition. Patients and the public having more agency in their care, strengthening that relationship, and them being able to access their information through the NHS app is a great thing. That is hugely helpful, and there is real potential with the SPR to strengthen that. We have landed on agreement.

[Dr Johnson]

Q Do you have any thoughts on the separation of elements of the record such as safeguarding records and sexual health records? We have heard about carers being able to see parts of the record. Surely there are circumstances where we may want people to see parts of the record but not others, or people may wish to share some parts and not others. Are you aware of any provision being made for that?

Dr Byrne: At the moment, I think it is too early to say. Those are absolutely important questions that will have to be addressed in the design. At the moment, I am not sure how the programme intends to deal with those questions, but clinically, that needs to be thought about. There are complications that need to be thought about very carefully in terms of the record and the access. Sometimes that is clinically complicated, but I am not aware of what the plans are for that.

Health Bill (Fourth sitting)

Peter Prinsley Excerpts

Committee stage
Tuesday 23rd June 2026 Public Bill Committees

[Karin Smyth]

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

I commend the three clauses to the Committee.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

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

Clause 4

Reducing inequalities

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

I beg to move amendment 13, in clause 4, page 3, line 22, leave out lines 22 to 29 and insert—

“1C Health improvement and health inequalities duty

(1) In exercising any functions relating to the health service, Secretary of State must have regard to the need to—

(a) improve the health of persons in England,

(b) reduce inequalities between the people of England with respect to their ability to access health services, and

(c) reduce inequalities between the people of England with respect to the outcomes achieved for them by the provision of health services.

(2) Health inequalities ‘between the people of England’ means health inequalities between persons, or persons of different descriptions, living in, or in different parts of England.

(3) ‘Health inequalities’ means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.

(4) Under subsection (3) ‘general health determinants’ are—

(a) standards of housing, transport services or public safety;

(b) environmental factors, including air quality and access to green space and bodies of water;

(c) employment prospects, earning capacity, and any other matters that affect economic security;

(d) access to public services;

(e) the use, or level of use, of tobacco, alcohol or other substances, and any other matters of personal behaviour or lifestyle, that are or may be harmful to health;

(f) any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors.”

This amendment would amend clause 1C of the National Health Service Act 2006 to introduce a duty on the Secretary of State to have regard to health improvement and health inequalities.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 29, in clause 4, page 3, line 22, leave out lines 22 to 29 and insert—

“1C Health improvement and health inequalities duty

(1) When considering whether or how to exercise any functions, the Secretary of State must have regard to the need to—

(a) improve the health of persons in England,

(b) reduce health inequalities between persons in England, and

(c) reduce inequalities between persons in England with respect to their ability to access health services and to the outcomes achieved for them by the provision of health services.

(2) Health inequalities ‘between persons’ living in England means health inequalities between persons, or persons of different descriptions, living in, or in different parts of England.

(3) ‘Health inequalities’ means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.

(4) ‘General health determinants’ are—

(a) standards of housing, transport services or public safety,

(b) environmental factors, including air quality and access to green space and bodies of water,

(c) employment prospects, earning capacity and any other matters that affect levels of prosperity,

(d) the degree of ease or difficulty with which persons have access to public services,

(e) the use, or level of use, of tobacco, alcohol or other substances, and any other matters of personal behaviour or lifestyle, that are or may be harmful to health, and

(f) any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors.

(5) In subsection (1)(a), the reference to improving the health of persons includes a reference to mitigating any detriment to health which would otherwise be occasioned by the exercise of the Secretary of State’s functions.

(6) In subsection (1)(b), the reference to reducing health inequalities includes a reference to mitigating any increase in health inequalities which would otherwise be occasioned by the exercise of the Secretary of State’s functions.”

This amendment would amend clause 1C of the National Health Service Act 2006 to introduce a duty on the Secretary of State to have regard to health improvement and health inequalities, reflecting the duties placed on combined authorities and CCAs in the English Devolution and Community Empowerment Act 2026.

Amendment 34, in clause 4, page 3, line 29, at end insert—

“(c) reducing inequalities between the people of England with respect to hospital transportation access.”

This amendment would create a duty for the Secretary of State to have regard for reducing inequalities in England with respect to hospital transportation access when exercising functions in relation to the health service.

Amendment 30, in clause 4, page 3, line 29, at end insert—

“(2) In discharging this duty the Secretary of State must have regard to the need to involve all departments of government in reducing health inequalities, and must take reasonable steps to ensure that other all departments consider the impact of their policy proposals on health inequalities.”

This amendment would require a whole government approach to addressing health inequalities by requiring the Secretary of State to involve all departments in the discharge of their duty in relation to health inequalities and took reasonable steps to ensure other departments consider the impact their policies might have on health inequalities.

Clause stand part.

New clause 19—Health improvement and health inequalities strategy—

“(1) Within six months of the passage of this Act the Secretary of State must publish a health improvement and health inequalities strategy.

(2) In preparing the strategy under subsection (1) the Secretary of State must consult all bodies which they consider appropriate.

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

(a) long-term targets related to health improvement and the reduction of health inequalities in England,

(b) provision for the establishment of a public authority with functions for additional monitoring and reporting on progress towards the targets set by subsection (3)(a), and

(c) any other provisions the Secretary of State considers appropriate.

(4) All Ministers of the Crown must have regard to the strategy under subsection (1) in carrying out their functions.

(5) Within 12 months of the publication of the strategy under subsection (1), and every 12 months thereafter, the Secretary of State must prepare and publish a report on the implementation of the strategy.

(6) ‘Health inequalities’ means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.”

This new clause would require the Secretary of State to publish a strategy for health improvement and the reduction of health inequalities.

[Peter Prinsley]

I apologise for being a little delayed, Sir Jeremy. I am moving the amendment on behalf of my hon. Friend the Member for Stoke-on-Trent South (Dr Gardner). It would place a clear duty on the Secretary of State to have regard to health improvement and health inequalities when exercising functions.

Between 2011 and 2021, the UK was one of only five high-income countries where healthy life expectancy fell. Over the same decade, we faced a cost of living crisis, the covid-19 pandemic and economic decline across the post-industrial regions. We cannot shy away from the fact that ill health is rising. Economic inactivity due to sickness is at its highest level since 2012, and we witness a widening disparity in health outcomes. People living in the most deprived areas of the UK, on average, live just 52 years of healthy life. There is now a 16-year gap in life expectancy between the richest and poorest parts of the UK. Even within individual constituencies, the life expectancy gap can be as wide as seven years between local postcodes.

The purpose of the amendment is to ensure that decisions taken at the highest level of the health system consistently reflect the reality that health outcomes differ sharply depending on where someone lives, the conditions that they live in and their opportunities to achieve good health. The amendment would require the Secretary of State to have regard to the need to improve the health of persons in England. The intention is that this duty would include the need to reduce inequalities in health. That is in addition to the duties that are already in the clause, relating to inequalities in access to and outcomes of healthcare.

At present, the Bill brings together old duties on the Secretary of State and NHS England to reduce inequality in access to and outcomes from NHS services. Those are too narrow and do not reflect the wider determinants of health that the Government have pledged to tackle through their 10-year plan. The amendment would strengthen the duty to reflect the wider cross-Government goals for health improvement and health inequalities. That would make an important statement of the Government’s commitment to improving health and tackling health inequalities, and would set in train an important step towards achieving them.

The amendment also provides a clear definition of “health inequalities” and “general health determinants”. Health inequalities means inequalities in respect of life expectancy or general state of health, which are wholly or partly a result of differences in respect of general health determinants, including housing standards, environmental factors, public transport, economic factors and other wider determinants of life expectancy. The amendment has been drafted to mirror the wording of the newly enacted section 45 duty on combined authorities in relation to health improvement and health inequalities under the English Devolution and Community Empowerment Act 2026.

Accepting the amendment would ensure consistent focus on the mission of creating a fairer country where everyone lives for longer, from the top of Government to regions and neighbourhoods. By setting this out explicitly, the amendment would ensure that future Secretaries of State cannot overlook the wider conditions that shape health outcomes. In sum, the amendment would require that when decisions are made, the Secretary of State must consider their impact on health improvement and on distribution of health across the population.

The amendment is supported by the Health Equals coalition, including 27 organisations that wrote an open letter to the Minister on 15 June. Those organisations range from the Health Foundation to the King’s Fund, Ramblers UK and the Wildlife Trusts, showing the breadth of support from across the sector. The cross-party Health and Social Care Committee also recommended that the clause be amended in this way.

Embedding this duty in legislation would strengthen accountability and ensure that the reduction of health inequalities is treated not as a secondary consideration, but as an integral part of how the health system is led and managed. If accepted, the new duty would ensure clear alignment at national and local levels about the importance of prevention.

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

It is a pleasure to serve under your chairmanship once again, Sir Jeremy. I will speak generally about the amendments on health inequalities, and specifically about some points that the group of amendments homes in on.

On the general principle of dealing with health inequalities, the sentiment behind amendment 13 is important, and I support hon. Members’ motivation for tabling it, but I question exactly what “persons of different descriptions” means. Does it relate to protected characteristics, which employment law deals with, or to geography? I suspect that it is both, and I wonder whether there are more considerations than those two. It would assist us if the amendment were clearer on that, notwithstanding the fact that clarification may be made during the debate or to the amendment itself if it is accepted later. I have concerns about what “persons of different descriptions” means. Certainly, in everyday English, every individual could be described as a person of a different description, so the phrase does not have any particular legal meaning.

If the phrase means something equivalent to protected characteristics, I wish to say something about health inequalities affecting those of different ages. I am the Member for Isle of Wight East, which, of course, has an older population. I want people of all ages to have equal access to health and social care, and inequalities in access to be levelled out and removed, but it is not only older people who find accessing health services difficult, not least for reasons of physical access; the entire population within an area with an older age demographic is affected. The Isle of Wight has a small local authority. We are fairly unique, in that we are surrounded by water and have a higher age profile, which, taken together with other challenges, makes health equality a challenge for the entire population, not just older people. The issue is aggravated by other considerations, primarily relating to geography.

Amendment 34, tabled by the hon. Member for Winchester, refers to hospital transportation access. That can mean a lot of different things in different places. I support at least the aim of putting more pressure on the Secretary of State and the Department and encouraging them to recognise and eradicate inequalities in hospital transportation access. For my constituents, accessing specialist services means crossing a body of water, which is not only a physical barrier—a ferry has to be taken—but a cost barrier, because ferries cost money. I understand where the hon. Gentleman is coming from, given the challenge in my constituency, but of course other places have different but challenging hospital transportation issues.

Amendment 30, tabled by the hon. Member for Oxford West and Abingdon (Layla Moran), the Chair of the Health and Social Care Committee, refers to cross-departmental working to ensure that health inequalities are taken into consideration. I think this is key. Of course the primary responsibility for health inequalities rests with the Department of Health and Social Care, but it is by no means the only Department with that responsibility. The more we think about the various inequalities that exist in this country, the more we realise that other Departments have considerable responsibility. We hear from politicians—of all parties, but particularly the Labour party in government—about better joined-up working between Departments, but without something more concrete in Bills such as this one, that will remain one of those aspirations that many talk about but few actually achieve.

The most obvious Department to help achieve the reduction in health inequalities is the Ministry of Housing, Communities and Local Government, given its responsibility for local government funding. Of course, local government has primary responsibility for delivering social care and public health within its area. It is a well-known feature of the system we have in this country that healthcare is free at the point of use and delivered effectively by central Government, while social care is a combination of different provision but private funding and local government have the largest role to play, and too many people fall through the gaps in those fundamentally different ways of funding two parts of the system. Unless MHCLG is bound into the way we reduce health inequalities, even with the best intentions of the Secretary of State for Health and Social Care, it clearly will not be delivered in a comprehensive and holistic way.

I refer again, as an example, to my area, which has a higher age demographic but a small unitary authority with a lower funding base. It is a matter of public record that the funding decisions made by the current Government at the beginning of this year have meant an effective reduction in funding for my local authority, notwithstanding its responsibility for an older population and the existing challenges in delivering social care. That is an argument that I and my constituency neighbour, the hon. Member for Isle of Wight West (Richard Quigley), are making to the Government in an ongoing conversation about how we can resolve that issue. We are having that conversation with MHCLG, notwithstanding the fact that it has a very direct impact—the biggest impact, in my view—on health inequalities in my constituency and the effectiveness of the Government’s 10-year health plan and their intention to improve the general health of the population. That is the probably the key departmental relationship that will be relied on to deliver the reduction in health inequalities.

The Department for Transport also has responsibility for this. If we refer to its responsibilities for reducing health inequalities outside the context of this argument, people might scratch their heads and wonder what we are talking about. but as soon as it is brought into a real-life example within this debate, it makes sense that the Department for Transport has some responsibility for reducing health inequalities. However, we will not achieve all we want to unless that responsibility is made more obvious and specific, named somewhere in some Bill. We have an option to achieve our intention to have joined-up decision making, and to ensure that every decision in any Department that has the potential to impact health inequalities is considered, whether in a formal impact assessment or just in the ordinary day-to-day decision making and mindset of the relevant Ministers, Secretary of State or departmental officials.

--- Later in debate ---

[Karin Smyth]

The hon. Lady pre-empts my next comments. I absolutely agree with her, and so do the Government. That is why we are improving living conditions through the new decent homes standards, which set standards across all rented sectors. Awaab’s law requires social landlords to act promptly to fix housing hazards. Since coming into government, we have launched the warm homes plan, the Keep Britain Working review and the homelessness strategy. In April, we published a renewed women’s health strategy, marking a decisive shift to ensure that women and girls receive the care, respect and outcomes that they deserve. Last November, we published England’s first ever men’s health strategy, to improve the health and wellbeing of all men and boys. Within the Department, we are reviewing the Carr-Hill formula and the Advisory Committee on Resource Allocation to ensure the funding matches need.

However, there is much more to do. The Minister for Public Health and Prevention, my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson), will continue to engage with key stakeholders, including representatives of Health Equals. I have a meeting with representatives of that body this week.

I sympathise entirely with the motivation underpinning amendment 13, which was moved by my hon. Friend the Member for Bury St Edmunds and Stowmarket, and I commend hon. Members for working on this important agenda, but I am not convinced that the amendment is necessary. I note that it draws on the duty that was recently placed on combined authorities by the English Devolution and Community Empowerment Act 2026, with a view to creating a similar duty for central Government.

Fortunately, I can reassure hon. Members that the Secretary of State already has a duty to secure improvement in the health of people in England, and the power to take such steps to improve public health as they consider appropriate. We would not want to narrow the definition of the existing duty, because health inequalities come from many causes, as has been discussed. As I have said, we are already working across central Government and local government to address those wider inequalities, including in housing and air quality, and by getting more people into work.

The hon. Member for Sleaford and North Hykeham said that innovation might expand inequalities across our country, but we have seen a shocking expansion in the inequality gap across our country. That is what we are seeking to reverse, as we have made clear in our 10-year health plan, and the Bill will ensure that that happens. That is why we say that we will take the best to the rest; we are not about taking people down.

Finally, I turn to amendment 34 in the name of the hon. Member for Winchester. He has spoken before about his constituents’ experience, and I have spoken with him about the new hospital programme, his constituents’ reliance on transport to access hospital appointments, and the difficulties experienced in more rural areas, which the hon. Member for Isle of Wight East also mentioned. That is why, in our 10-year health plan, we are very clear about our strong commitment to rural and coastal communities—we are the first Government to do that.

We agree that reducing inequalities in hospital transport is important. The Bill already places a duty on the Secretary of State to

“have regard to the need to…reduce inequalities between the people of England with respect to their ability to access health services”.

Inequalities in access to transport to receive care fall under the scope of that duty. As such, the amendment is superfluous.

I also offer the reassurance that NHS England has been implementing a range of actions to reduce inequalities in patient transport, including the speeding up of reimbursement for patients eligible for the healthcare travel costs scheme. I also inform the Committee that the cancer plan included a commitment to provide up to £10 million a year to pay for the travel costs for cancer care for children and young people, and their families, as people have long campaigned for.

Some important issues have been raised in this debate, and I am sure that we will return to them. In the meantime, I ask my hon. Friend the Member for Bury St Edmunds and Stowmarket to withdraw the amendment. I commend clause 4 to the Committee.

[Peter Prinsley]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 4 ordered to stand part of the Bill.

Clause 5

Patient involvement and choice

[Dr Johnson]

I beg to move amendment 59, in clause 5, page 4, leave out lines 2 to 4 and insert—

“(1) In exercising functions in relation to the health service, the Secretary of State must act with a view to enabling patients to make choices with respect to aspects of health services provided to them, including to make choices as to the provider of those services.

(2) For the purposes of subsection (1), the Secretary of State must ensure that patients who are referred for a service to be provided outside a hospital setting (‘out-of-hospital services’) are offered a choice of provider of that service from among the providers available in their integrated care board area and, where relevant, in neighbouring areas, in accordance with regulations made under section 14Z45B.

(3) Regulations under section 14Z45B must provide that, where an out-of-hospital service is to be provided to a patient, the integrated care board must—

(a) offer the patient a meaningful choice of at least two providers capable of providing the service, which may include NHS bodies and independent sector providers approved to provide that service under arrangements with the integrated care board;

(b) provide the patient with information to support an informed choice, including for each available provider—

(i) indicative waiting times;

(ii) the location at which the service would be provided;

(iii) the quality ratings or outcomes data applicable to that provider for that service where such data is available; and

(iv) whether any costs would be incurred by the patient in travelling to or receiving the service at that provider;

(c) not exclude from the list of available providers any provider approved solely on grounds of commercial interest or organisational type; and

(d) take all reasonable steps to give effect to the patient's choice within a clinically appropriate timeframe.

(4) For the purposes of this section, ‘out-of-hospital services’ means services—

(a) provided in community, primary care or ambulatory settings rather than in a hospital inpatient or outpatient department; and

(b) which the Secretary of State specifies by regulations as being within the scope of the choice obligation under subsection (2),

and may include diagnostic services, audiology and hearing aid care, podiatry, dietetics and nutrition, physiotherapy, ambulatory cardiac monitoring and such other services as the Secretary of State may specify.

(5) In specifying services under subsection (4)(b), the Secretary of State must have regard to—

(a) the potential for the expansion of choice to reduce waiting times for the relevant service;

(b) the availability of sufficient independent and NHS providers to make genuine choice meaningful; and

(c) the desirability of ensuring access to choice for patients in all parts of England, including in rural and deprived areas.

(6) The Secretary of State must publish, and lay before Parliament, within 12 months of the date on which this Act is passed, a statement setting out—

(a) the out-of-hospital services for which choice obligations under subsection (2) will initially apply;

(b) the timetable for extending the choice obligation to further services; and

(c) the support that will be made available to patients, in particular those with limited digital access or literacy, to exercise the choices to which they are entitled under this section.

(7) The Secretary of State must review and update the statement required by subsection (6) at intervals of not more than two years.”

This amendment strengthens the new patient choice duty inserted by Clause 5 from a general aspiration into a specific, enforceable right to choose between providers for out-of-hospital services.

--- Later in debate ---

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

I rise to support my hon. Friend the Member for Sleaford and North Hykeham on amendment 59.

The amendment fosters competition. That is not ideological; the Government themselves have accepted, in clause 5, that competition and choice are important. As my hon. Friend said, this is about ensuring that patients have real choice, and not just something that the Secretary of State has thought about. If one provider has a waiting list of 30 weeks, for example, while another can see patients in just four weeks, patients should clearly be given the opportunity to choose the faster option. By expanding patient choice and making better use of the available capacity, my hon. Friend’s amendment has the potential to reduce bottlenecks without necessarily increasing overall NHS spending—that is a good thing.

Importantly, the amendment allows patients to choose between all approved providers, including NHS bodies and independent sector providers. It prevents integrated care boards from excluding suitable providers simply because of their organisational type. I think all Committee members believe in provision that is free at the point of use, but that can come from a number of different providers, including the independent sector.

[Peter Prinsley]

Does the hon. Member recognise that there are circumstances in which independent provision within a district has the effect of disabling the NHS service? A pertinent example is the ophthalmology world. Services have become difficult to deliver in NHS hospitals because large numbers of NHS staff have chosen to work in the independent sector. That makes the comprehensive provision of a service in an eye department difficult, as the staff are all off operating on cataracts.

[Gregory Stafford]

I do not recognise the characterisation that the hon. Gentleman puts forward. He is essentially saying that, by allowing the private sector to carry out operations and procedures, we are somehow making the NHS unsustainable. The follow-on from that logic is that we remove all private sector providers and practice so that every single doctor, nurse and therapist is working in the NHS. I do not think that he is arguing for that situation, but it is the logical progression of his argument.

--- Later in debate ---

Currently, NHS England has a legal duty to promote innovation. That is set out in section 13K of the NHS Act 2006, which was it was inserted by the Health and Social Care Act 2012. As the Government are abolishing NHS England, that duty will disappear. The Government have chosen for clause 6 of the new legislation to place the duty on the Secretary of State instead. If innovation is encouraged and supported across the health service, it can unlock better outcomes and higher productivity, which is good for the Government, taxpayers and patients.

[Peter Prinsley]

Does the shadow Minister accept that, in order to encourage innovation within the health service, we need to do whatever we can to support clinical academics? It is within the academic departments of universities, where people are working in hospitals and teaching in medical schools, that we see the most fruitful innovations.

[Dr Johnson]

The hon. Gentleman is right, but there are pressures and challenges for clinical academics, which he will be aware of. I am sure the Minister, in summing up, will tell us what she is doing about those.

We need to support innovation in all parts of the health service, not just in university hospitals. One of my concerns is that there has been a drive towards a hub and spoke model. There are good reasons for that, and there have been some good outcomes for patient care, but in some cases it restricts innovation in the peripheral parts of the model; it can disincentivise innovation and make it more difficult. We need to consider how we support innovation in all areas of the NHS.

--- Later in debate ---

Education and training

[Peter Prinsley]

I beg to move amendment 33, in clause 7, page 4, line 31, at end insert—

“(2) Training under subsection (1)(a) includes training in general health determinants as defined by section 107ZB of the Local Democracy, Economic Development and Construction Act 2009.”

This amendment would place a duty on the Secretary of State to ensure that the health and care workforce is adequately trained in the wider determinants of health such as housing standards, exposure to air pollution, occupational risk, and use of harmful substances like tobacco.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 50, in clause 7, page 4, line 32, at end insert—

“(4) After subsection (2) insert—

‘(2A) The Secretary of State must publish independently audited forecasts of the NHS’s workforce needs every five years.’”

This amendment would require the Secretary of State to publish independently audited forecasts of the NHS’s staffing needs every five years.

Amendment 54, in clause 7, page 4, line 32, at end insert—

“(4) The Secretary of State must exercise functions under this section with a view to ensuring that managers in the NHS, who have appropriate clinical training, must also undertake clinical care.

(5) The Secretary of State must record the proportion of direct clinical care provided by those with professional qualifications both in terms of the proportion of their areas and full time equivalent by pay grade, and the Secretary of State must increase the proportion.”

This amendment would require the Secretary of State to ensure that NHS managers who are clinically trained must continue to undertake clinical care.

Clause stand part.

New clause 44—Medical training places—

“The Secretary of State must double the number of medical school training places to 15,000 by 2031-32.”

This new clause would put a duty on the Secretary of State to double the number of medical school training places.

New clause 45—Data collection: clinically trained staff—

“(1) The Secretary of State must collect and publish data on the numbers and proportion of NHS staff are qualified to deliver nursing and clinical care who delivering nursing care, or clinical care of any kind, and those who are not.

(2) Information under subsection (1) must be collected according to HCAS pay scales.

(3) Information under subsection (1) must include numbers of nursing and midwifery staff.

(4) Information under subsection (1) must be published quarterly.

(5) The NHS and ICBs are under a duty to comply with any requests from the Secretary of State for data for this purpose.

(6) Information under subsection (1) must include the proportion of time spent delivering clinical care as a proportion of the individual’s total working hours.”

This new clause would require the Secretary of State to collect and publish data on the numbers and proportion of clinically qualified staff who are delivering clinical care, broken down by HCAS pay band.

[Peter Prinsley]

As the Committee knows, my hon. Friend the Member for Worthing West (Dr Cooper) is one of the five medical doctors in the parliamentary Labour party. It is a great pleasure to move the amendment, which she tabled.

The amendment is about education and training. My hon. Friend would like us to consider whether there should be an additional subsection after proposed new subsection (1)(a), which is about ensuring that

“there are sufficient people with appropriate education and training to meet the workforce needs of the health service”.

My hon. Friend would like to include within that specific training about wider health determinants, which, as we discussed earlier this morning, consist of things like housing, air quality, occupation, and substance abuse—tobacco, alcohol and so on. Her opinion is that that needs to be specifically incorporated into the legislation.

[Gregory Stafford]

I shall speak briefly to the amendment that was just moved by the hon. Member for Bury St Edmunds and Stowmarket. I do not mean this rudely, but it is a relatively motherhood-and-apple-pie amendment. The onus would be on the Secretary of State to recognise that smoking, exposure to air pollution, occupational risk and harmful substances are bad, but I think we all agree on that. If the Secretary of State, or any future Secretary of State, does not already recognise that, I would be pretty surprised.

I have a number of issues with the amendment, the first of which is that it expands some central duties without clear limits. Potentially, it could be a gateway to what I would describe as interventionism. Perhaps, too, it lacks some of the prioritisation or proportionality that I would like to see in the Bill—as I have said, however, I think that otherwise the training element is pretty good.

Moving to amendment 50, in the name of my hon. Friend the Member for Sleaford and North Hykeham, I entirely support it. This amendment would be extraordinarily useful, because the NHS publishes independently audited forecasts of the workforce every five years, but the amendment would lead to better long-term planning. Regular, independently audited forecasts would help the NHS to anticipate staffing needs, plan training and recruitment, and use resources more effectively and with more efficiency.

Amendment 50 would also increase transparency and trust. One of the key things that we will need to do as a Parliament when the Bill becomes an Act is to convince the public that, when this new world of how the NHS is going to be managed and operated comes in, they can have confidence that the treatment they get is the best that it can be and that those who are being trained and working in the NHS get the training that they require and are being established as some of the best in the world.

Independent audits would make such forecasting more credible and give reassurance to the public and the stakeholders that the workforce planning is evidence-based and not potentially politically influenced, which is one of the big problems about having the Secretary of State in charge of everything throughout the Bill. The key thing must be improved patient care. Accurate workforce predictions will ensure that we have the right number of healthcare professionals available. We will see a reduction in shortages and more consistent, high-quality care.

I support amendment 54, in the name of my hon. Friend the Member for Sleaford and North Hykeham, because it ensures that clinically trained managers maintain patient-facing roles, making better use of scarce clinical expertise and improving workforce efficiency. It strengthens accountability, like amendment 50, by tracking and increasing the proportion of care delivered by qualified professionals, helping to optimise staff deployment and reduce pressure on frontline services. I have some concerns about amendment 33, but amendments 50 and 54 have my support, and clause 7, hopefully amended, will also have my support.

Health Bill (Fifth sitting)

Peter Prinsley Excerpts

Committee stage
Tuesday 23rd June 2026 Public Bill Committees

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Before the lunch break I was saying that, in essence, clause 7 states what the Secretary of State’s job is. It moves the function of planning the workforce from NHS England to the Secretary of State, which is a reasonable thing to do. I talked about the previous Government’s record on opening new medical schools and how that has helped with the number of clinical staff.

We also talked about workforce planning. The Government are due to produce a workforce plan, but it is not clear when it is due to come out. It was due to come out at the end of last year, but it did not; it was then due to come out in the spring, but now it is the summer. Given the Prime Minister’s resignation, it is not at all clear when it will come out. Will the Minister let us know whether it will come out before the summer recess, this week or whenever?

I quoted some of the concerns of the Royal College of Nursing, the British Medical Association, of which I am a member, and others. Those concerns include the workforce plan. Those organisations have seen what we have not seen, so they have been asked to comment on something that we have yet to see. That brings me to new clause 44, which is in my name.

Before the general election, Labour promised that it would double the number of medical school places. The now Chancellor of the Exchequer promised to double the number of medical school training places, as did the now Secretary of State for Science, Innovation and Technology. Once the general election had passed and Labour was in government, the promise was reiterated. At oral questions in October 2024, the now former Health Secretary said:

“This Government are committed, as we were in opposition, to doubling the number of medical school places”.—[Official Report, 15 October 2024; Vol. 754, c. 683.]—

but there has not really been any progress.

During a debate this year on the junior doctors’ foundation programme, I asked the Minister for Care whether the Government’s intention was still to honour that pledge. He said:

“Yes, that is the Government’s intention.”—[Official Report, 22 April 2026; Vol. 784, c. 133WH.]—

only to later submit a written correction stating that the Government had never committed to doing so. Are they going to, or not? It is not clear.

Labour promised to double the number of medical school places, but now that pledge appears to have been airbrushed out of history. Can the Minister please explain why she and her colleagues deemed the workforce pledge essential before the election but not after it? Can she tell us whether it is Government policy? In essence, my new clause 44 asks Members on the Government Benches to vote for what they promised before the election and have promised since.

New clause 44 is very simple: it stipulates that the Secretary of State must double the number of medical school training places by 2031-32. That is what Labour promised, so it should be fairly easy for Labour Members to vote for it. I hope that the Committee will support the new clause, which only requires Ministers to do what their party promised before it came into government.

If the Government are not keen on committing to clear targets, they can at least commit to full scrutiny of their workforce plans. Of course, there is a risk that the House has been misled. Either the promise was made or it was not. The Minister for Care said that it was promised and then submitted a written correction to say that that was inaccurate and that it was never Government policy, but if it has been stated by the Secretary of State at the Dispatch Box, representing the Government, then it is Government policy. Can the Minister help to clarify that point? If the House has been misled by either her former boss or the Minister for Care, perhaps she can clear that up for us. Perhaps the vote will help.

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

Does the shadow Minister agree that if we doubled the number of medical students, we would simply not be able to accommodate those people as young doctors unless we also doubled the number of training places? After five or six years, those medical students become young doctors. If we are to correct any problem with the medical workforce, it is insufficient to simply state that we will double the number of medical students.

[Dr Johnson]

The hon. Gentleman is right. When all the new doctors that the Government have promised have been trained, they will need jobs and postgraduate medical training, and there are issues with that. Nevertheless, the Government asked the public to vote for them on the basis that they would double the number of medical school places. Many of the hon. Gentleman’s colleagues produced little videos to that effect, which can be viewed on Twitter. They toured the newsrooms saying, “Please vote for us, we’re going to double the number of medical school places.” They suggested that there would be a revolution in Government to make sure that there were enough doctors. This is important—more doctors would help.

All new clause 44 does is ask the Government to commit to doing what they have said that they will do—or to say that they will not. Either way, we have had the Secretary of State saying one thing and a Minister saying the opposite and then correcting it, so we need clarity. The public deserve that. The Minister herself said that they would double the number of medical school places so that we have the doctors that our NHS needs. If they do not double the number of medical school places, it follows that they will not have the number of doctors that the NHS needs. Presumably that is in their workforce plan, but it needs to be cleared up.

Amendment 50 would put a duty on the Secretary of State to publish independently audited forecasts of the NHS workforce every five years. The logic is straightforward: if the Government believe that their plans are sufficient, they can be compared to an impartial assessment of the workforce. The previous Government published a workforce plan in 2023, setting out how to tackle existing and future workforce challenges over several years. That included doubling the number of medical school places. Yet three years later, this Government are on course for a new plan that is reportedly far less ambitious—we will find out in a minute.

The workforce affects whether patients can be seen on time, maternity wards are safely staffed and elderly patients get the dignity they deserve. It is the difference between the NHS meeting the challenge of an ageing population or slipping into decline. If Labour Members are confident that the Minister’s workforce planning is robust, I expect that they will support my amendment, which requires an independently audited forecast. If they are not willing to support it, that suggests that they know this Government cannot be trusted to deliver the workforce that patients need.

Amendment 54 and new clause 45 were also tabled in my name. Amendment 54 would require the Secretary of State to look at the amount of clinical work that NHS managers undertake. As a clinician, I have increasingly noticed that highly qualified clinical practitioners come in, become the person on the ward who can be relied on, and then go off because they get promoted to a nine-to-five job that is easier and pays more, but does not deliver clinical care.

The chief medical officer, for example, still delivers clinical care, and the amendment probes the Government to consider how many nurses and clinicians in hospitals are delivering clinical care. I asked that in written questions, and the Government did not know the answer. It is materially important information, particularly when looking at the Dash report, which talks about an explosion in the number of people who are clinically trained but not providing clinical work—instead, they are creating guidelines and monitoring whether other clinicians are doing the work. If more of those people were engaged in clinical activity, that might improve the quality of both the guidelines and care, because more junior staff would have senior staff around to help them.

--- Later in debate ---

[The Minister for Secondary Care (Karin Smyth)]

I thank hon. Members for bringing this discussion before the Committee. The Government are committed to ensuring that the NHS has the right people in the right place and with the right skills to care for patients when they need it. We will be publishing our 10-year workforce plan imminently. I cannot give the shadow Minister any more details on that at the moment, but it will set out the action to create a workforce that is ready to deliver the transformed service set out in the 10-year health plan. High-quality education and training for the NHS workforce will be fundamental to that, and clause 7 is in keeping with that commitment.

Before turning to the clause, I will address some of the issues raised during the debate and in the amendments. I understand the intention behind amendment 50, but I cannot accept it. The 10-year workforce plan will set out the staffing needs of the NHS for the next 10 years. That goes further than the amendment calls for and will be updated every two years in line with our manifesto commitment to publish regular, independent workforce planning. It is only because the Government have set such a clear direction for the service through the 10-year health plan that we can credibly set out a sustainable approach to staffing the NHS over the long term.

As hon. Members will understand, workforce planning is a complex topic. It is closely related to the wider service planning, which is why we have engaged so widely with independent experts to develop our forthcoming workforce plan. To divorce the process of workforce planning from service planning in the way that is suggested by amendment 50 would not produce a more reliable or useful set of forecasts. However, it would reduce the potential for innovation and reform of the kind that is needed and which the Government have set out so clearly in the 10-year plan for the NHS. I can only conclude from listening to Opposition Members that they really did learn absolutely nothing from their time in office or, indeed, from the problems with their workforce plan, which focused on headcount but notably did not reform care, did not look at new patterns of care, did not look at retention or training, and created some of the bottlenecks and problems that we have had to deal with.

Our commitment will be guided by the workforce plan, which is why we cannot accept new clause 44. Decisions on training numbers must be guided by workforce need, and that will have to be considered as part of the forthcoming plan. Adding to the point made by my hon. Friend the Member for Bury St Edmunds and Stowmarket, whatever the Government’s position on the number of medical school places that will be required in the future, fixing a number in primary legislation would be unhelpful as it would limit our ability to adjust target training numbers subsequently to reflect any changes in workforce need.

I was asked about correcting the record. The last Government did double places in their 2024 workforce plan, and I commend the movement of medical schools across the country. If the former Secretary of State is reported in Hansard as having said something contrary to the correction of the record by my hon. Friend the Minister for Care, we will of course pick that up.

Amendment 54 and new clause 45 look to reduce flexibility and increase bureaucracy for a workforce that is simply trying to deliver what is best for patients. On amendment 54, I think we can all agree that we need strong leadership and management to deliver national priorities, including the 10-year plan’s three shifts. Having a clinical voice in management positions is vital and many of our board-level and senior leaders are also clinicians. While some choose to carry on with clinical practice, others might prioritise their managerial role, and it is right that they should have that flexibility. Prescribing that all NHS managers with clinical experience must also undertake clinical care risks reducing board capacity and expertise, including clinical leadership, and disincentivising opportunities for management experience at a time when the NHS has seen a reduction in the number of managers per NHS staff from 2010 to 2025. We do not think that simply prescribing that requirement would benefit clinicians, managers or, crucially, the wider health service, so we oppose the amendment.

New clause 45 would require the collection of further data on the proportion of time spent on clinical care. Detailed statistics on the number of staff working for NHS provider trusts broken down by profession and pay band are already published by NHS England on a monthly basis. Adding requirements to that is not simple. There is not a centrally held collection of data about NHS staff time, and setting one up would have costs both centrally and for NHS trusts to collect specific data. It is also not easy to separate out clinical care meaningfully. Clinicians spend time in supervision, education, safeguarding, quality improvement and clinical leadership, and the amount of time they spend on different activities can vary from month to month. The new clause risks putting more burdens on NHS staff if they are being asked to record what they are spending time on beyond existing procedures. We therefore cannot accept it.

I turn to amendment 33, which was moved by my hon. Friend the Member for Bury St Edmunds and Stowmarket, on workforce training. It would require the Secretary of State to intervene in the content and design of healthcare programmes. Standards of proficiency, conduct and performance of registered professionals are the statutory responsibility of independent healthcare regulators, although universities and practice partners develop the specific content and design of programmes to meet those standards. It is vital that the independence of regulators and universities is maintained to respect their expertise in designing standards and curricula that ensure public safety.

We have published our 10-year health plan setting out major NHS reforms, including moving from sickness to prevention. Supporting healthcare workers to address the wider determinants of health will be essential to delivering that shift. That is why we are providing the “All Our Health” e-learning on critical public healthcare topics for people working in the health and care sector, and revitalising the “making every contact count” approach to ensure that every contact that a person has with the healthcare system supports a shift to prevention.

I assure colleagues that our upcoming 10-year workforce plan will set out plans for ensuring that we train the staff we need so that we have the brightest people and the right skills to support patients. For those reasons, I ask my hon. Friend to withdraw the amendment.

Finally, I turn to clause 7. The Secretary of State already has an overarching duty in relation to the education and training of the NHS workforce. Currently, that duty is partially delegated to NHS England. NHS England also has a duty to ensure that there are sufficient numbers of appropriately trained healthcare workers across England. Clause 7 will simply merge those existing duties into a single, robust education and training duty on the Secretary of State.

The Secretary of State will be entirely responsible and accountable for exercising relevant functions with a view to ensuring that there is an effective system for the planning and delivery of healthcare education and training, and that we have enough healthcare workers with the right training to meet England’s health service needs. Bringing those duties directly under the responsibility of the Secretary of State will reduce bureaucracy, streamline oversight and enable the Government to provide national strategic leadership across the NHS workforce.

I reassure colleagues that accountability will not be diluted. Bringing these responsibilities into the Department will create clearer, stronger lines of accountability with the education and training of the NHS workforce. Ultimately, the Secretary of State will continue to be accountable to Parliament for the health service in England, including for the planning of education and training and ensuring sufficient numbers of trained healthcare workers. I commend the clause to the Committee.

[Peter Prinsley]

I am happy with those assurances, so I beg to ask leave to withdraw amendment 33.

Amendment, by leave, withdrawn.

Amendment proposed: 50, in clause 7, page 4, line 32, at end insert—

“(4) After subsection (2) insert—

‘(2A) The Secretary of State must publish independently audited forecasts of the NHS’s workforce needs every five years.’”—(Dr Caroline Johnson.)

This amendment would require the Secretary of State to publish independently audited forecasts of the NHS’s staffing needs every five years.

Question put, That the amendment be made.

--- Later in debate ---

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve with you in the Chair, Sir Roger. I have concerns similar to those of the shadow Minister about clause 10. Proposed new section 12E allows Ministers to vary the proportion of activity by provider, and I am interested in the rationale behind that. The powers to retain the provider mix were put in place because of concerns that the NHS would be privatised by the back door, so the requirement to maintain the mix is there for a reason.

As we heard earlier when discussing ophthalmology, there are risks to using private provision for certain NHS activities, as there can be unintended consequences—a bit like the deregulation of buses. In ophthalmology, private providers do thousands of cataract operations very efficiently, but the less exciting and more critical work of preventing people from going blind, which is done in NHS hospitals, is under threat because so many people want to work in easy and profitable areas. I am concerned that that will occur in more areas of the NHS if the Bill allows more privatisation. Although I do not have an ideological problem with the NHS contracting out to private providers—that has worked well to bring down elective waiting lists, for example—the provisions to protect the mix are important.

I am not sure that amendment 53 really moves us forward; it just requires the Secretary of State to consider who benefits from the change in mix.

[Peter Prinsley]

It is true that the situation in ophthalmology is now quite serious, but is the hon. Lady aware of the problems in radiology and pathology? Some hospitals are unable to recruit histopathologists or significant numbers of radiologists, who provide key services, because the personnel necessary to run those services have been attracted into a private system, although they are contracted to the NHS. That jeopardises the ongoing services for urgent and emergency care.

[Helen Morgan]

The hon. Gentleman outlines an unintended consequence of the NHS contracting out to private providers. There are ways to get the pricing of those services right, but the clause could introduce that unintended consequence.

Why is this proposal included in the Bill, and what does the Minister see it being used for? Is there a risk that a future Government might use it to bring much more privatisation into the NHS? The general public consensus is that that would be a bad thing. What safeguards can she put in place to ensure that does not happen?

Health Bill (Sixth sitting)

Peter Prinsley Excerpts

Committee stage
Thursday 25th June 2026 Public Bill Committees

[Karin Smyth]

Primary care is the front door to the NHS and is critical to delivering our neighbourhood health agenda. The neighbourhood health service will bring care into local communities, ending fragmentation and preventing unnecessary hospital admissions. To support that, alongside clause 14, which I will discuss shortly, we have tabled new clauses 22 and 23 and new schedule 1, to strengthen action in the event of local pharmacy challenges and streamline the appeals process.

On new clause 22, many hon. Members will know how the closure of a local pharmacy can significantly affect a community. Pharmacies close for a range of reasons: voluntary closure, business failure or emergencies affecting the premises or surrounding area. Even where a pharmacy remains open, unforeseen or unexpected events can disrupt access for local people.

The NHS Act 2006 sets out how ICBs should commission pharmaceutical services in normal circumstances and what can be done if those arrangements fail. Section 133 of the Act is intended to deal with exceptional situations where standard commissioning processes are too slow and rapid action is needed to restore provision while long-term solutions are put in place, if required. However, the current wording of section 133 is widely interpreted as applying only to large-scale national emergencies, as it refers to inadequate provision affecting a significant number of people. It is unclear whether that would cover more localised situations, such as a village cut off by flooding following a bridge collapse, or where the only pharmacy serving an area closes unexpectedly, creating an urgent unmet need, as we have seen happen. It is also unclear how the Secretary of State would authorise alternative arrangements.

To address those issues, new clause 22 ensures that ICBs can respond swiftly to exceptional circumstances, regardless of scale. It removes the unnecessary provision for the Secretary of State to make arrangements himself and clarifies that authorisation to ICBs should be given through directions. The directions will be limited to six months, with the possibility to extend further if required. This change maintains appropriate national oversight while preventing misuse of the powers. It is a sensible and proportionate amendment that gives the system the flexibility it needs in exceptional circumstances while retaining proper safeguards.

New clause 23 and new schedule 1 simplify the appeal framework for NHS pharmaceutical services by allowing appeals that are currently split between different routes to be heard by a single appeal authority. At present, where concerns arise about a pharmacy contractor, different appeal routes may apply depending on whether a case is characterised as one of fitness or of performance. In practice, however, that distinction is not always clear and the current system can create unnecessary complexity and duplication.

New clause 23 and new schedule 1 address that problem, providing for such appeals to be heard through a single route, which we intend to designate in regulations as NHS Resolution. It is a practical and proportionate change; NHS Resolution already has substantial experience in handling disputes involving NHS pharmaceutical services and is well placed to provide a clear, consistent and independent route of appeal. Importantly, this measure does not change the position in relation to the fitness to practise of individual pharmacy professions. Cases concerning individual practitioners will continue to be dealt with separately by the General Pharmaceutical Council.

By simplifying the framework, this measure will help to ensure that related issues can be considered more coherently, reduce fragmentation in decision making and support the effective oversight of NHS pharmaceutical services. In short, it aligns the appeal system more closely with operational practice, reduces unnecessary complexity and preserves the appropriate safeguards for individual practitioners.

The remaining Government amendments are consequential on those changes, or are technical changes that have emerged as necessary following drafting of the wider Bill. I will speak to new clause 21 in particular, as it updates section 132 of the 2006 Act so that the legislation reflects current commissioning arrangements for pharmaceutical services. Section 132 currently allows, in addition to retail pharmacy business, arrangements to be made with individual doctors and dentists for the provision of pharmaceutical services.

That wording reflects an early model of care. In practice today, arrangements for primacy medical services are made with GP practices, not individual general practitioners, and patient lists are held at practice level. New clause 21 therefore brings the legislation into line with the way services are already commissioned and delivered. It will mean that, where such arrangements are made with dispensing doctors, they are made with GP practices rather than individual GPs. It also removes provision to make such arrangements with dentists, to reflect the fact that that provision is redundant.

In summary, new clause 21 is a technical amendment, which does not change current practice but simply updates the statute book to reflect modern NHS arrangements. Patients in rural areas eligible to receive medicines from the dispensing doctors will continue to receive that service as they do now.

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

I have received representations from rural dispensing practices in my constituency about the provision of vaccination services. I understand that dispensing general practitioners are having difficulty securing the funding to provide vaccinations, particularly the new meningitis vaccination for young people. Does the Minister envisage that the change being proposed will have any effect on that arrangement?

[Karin Smyth]

The changes here, as I have outlined, are bringing practices in line in terms of the regulation. I think the issue my hon. Friend really addresses is the arrangement between those local practices and the ICB as the commissioner on where the service is provided. Ordinarily a commissioner would seek to make sure that a rural area had provision from somewhere in particular; I am happy to talk to my hon. Friend outside the Committee if there is a problem in his local area.

Health Bill (Seventh sitting)

Peter Prinsley Excerpts

Committee stage
Thursday 25th June 2026 Public Bill Committees

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

I am not entirely clear why there is a problem with the financial incentive. People coming off lists that they have been on for a long, long time may well have a clinical condition that is changing. In my practice, I deal with the management of children with glue ear, who need to have grommets. From time to time, the condition fluctuates and the glue ear goes away.

Equally, the reason that we do a tonsillectomy is that people get recurrent acute tonsilitis, but it is actually quite a good idea for people to wait some time because often the recurrent acute tonsilitis simply settles down and they do not need their operation. Sometimes, when a patient comes into hospital for an operation on their tonsils and I ask them, “When did you last have an attack of tonsilitis?” they say, “I can’t remember.” We have to take account of the fact that the condition of the patient may fluctuate.

[Gregory Stafford]

The hon. Gentleman is entirely correct, and I think I said some moments ago that I am not against a validation of the list—I think I even said that I am not against some sort of financial incentive to clear the list. My concern is the extraordinary jump in the baseline in the last month or so: 351,000 people have been removed from the list for no apparent reason.

While I have been having anecdotal discussions with patients, my hon. Friend the Member for Sleaford and North Hykeham has been doing something a little more robust. It would be interesting to see the outcome of her endeavours and researches and to find out exactly what is happening in those areas. Anyone with a modicum of inquiry and common sense would say that the significant jump that we have seen in a single month deserves at least a level of interrogation, which the hon. Member for Bury St Edmunds and Stowmarket is not allowing in his comments.

--- Later in debate ---

[Karin Smyth]

I will move on. It is absolutely right that integrated care boards, as local commissioners, retain the ability to manage their services and waiting lists effectively, given the shocking numbers that they have inherited. This is complicated, difficult work: commissioners have to balance demand, capacity and clinical need, and a prohibition such as the one set out in the amendment would threaten to remove legitimate flexibilities that are required at the local level to ensure that services are delivered safely and efficiently.

We are clear that systems should not be setting minimum wait times that exceed the 18-week constitutional standard, but hon. Members will appreciate that not all elements of waiting are inappropriate. In many cases, they reflect clinical pathways, sequencing of care or the need to prioritise the most urgent patients. It is imperative that clinical judgment and urgency remain the key drivers of prioritisation, which is something the amendment threatens to remove.

Turning to amendment 52, I recognise that Members across the House are committed to ensuring that all patients receive the NHS care they need in a timely manner. Validation is a routine and long-standing part of waiting list management by providers. It ensures that patient records are accurate, that patients are on the best pathway to meet their needs and that they still need their appointments. Routinely validated waiting lists will support a return to the 18-week NHS constitutional standard.

Reasons for removal as a result of validation include a patient no longer needing their appointment or there being a duplicate appointment. The previous Government left behind some systems and trusts in such a poor condition that they give out duplicate appointments, and we need to resolve that as part of our work. Other reasons for removal include a patient’s record not being properly updated following treatment or a clinical decision—another sign of the inefficiency that the previous Government left behind.

[Dr Prinsley]

I am interested to hear what the Minister has to say, but does she agree that this is yet another reason why we must go full speed ahead to get the single patient record sorted out?

[Karin Smyth]

Once again, my hon. Friend is absolutely right. He is expert on this issue and has outlined to us some excellent clinical examples. I look forward to debating the single patient record further in Committee.

Importantly, any patient removed from a waiting list should be notified alongside their GP. Data on the total number of removals from waiting lists is published by NHS England. That data includes, but cannot separately identify, patient pathways removed as a result of validation. The Department remains committed to the transparent publication of official waiting list statistics following the abolition of NHS England, although there are no plans to publish more detailed breakdowns. NHS staff are delivering record levels of elective activity, which has enabled us to meet our interim target of 65% of patients being seen within 18 weeks.

--- Later in debate ---

My genuine fear—quite apart from local government reorganisation, the lack of mayoral authorities in some areas and the risk, highlighted by my hon. Friend, that a mayor coming from one part of the system but not reflecting the views of another part of the geography could be the representative—is that we lose the central link between health and social care on a local footprint.

[Dr Prinsley]

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

[Edward Argar]

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

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

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

Health Bill (Eighth sitting)

Peter Prinsley Excerpts

Committee stage
Tuesday 30th June 2026 Public Bill Committees

[Gregory Stafford]

On clause 29 and the relevant amendments, the membership model and the council of governors were originally introduced to give patients, staff and local communities a formal voice in the governance of NHS organisations. I worry that by removing them the clause concentrates power in the hands of the trust board at a local level and, potentially, the Secretary of State at a national level, while reducing opportunities for local scrutiny and public participation. As my hon. Friend the Member for Sleaford and North Hykeham said, there is a real danger that organisations will be independent in name only.

That brings us back to the never-ending tension in the Bill between the centralisation of power in the Secretary of State, through the abolition of NHS England and all the other bodies we have talked about, and the Government’s stated desire to have more accountability for decision making at a local level.

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

I am aware of the role of governors in some of our NHS trusts and the way in which they are appointed, but governors have said to me that they are sometimes disappointed by the level of influence they can in fact have in their trust. Can the hon. Member think of examples of where governors have particularly influenced the activities of individual trusts? I have not found that to be the case in my experience.

[Gregory Stafford]

The hon. Gentleman’s intervention neatly brings me to my next point. I have some sympathy for his viewpoint—and apparently the viewpoint expressed to him by governors—that in many cases, if not most, governors do not have the teeth, the influence or the ability to change things in the way they would like. My argument is very similar to the one we will expand on later regarding the abolition of the Healthcare Services Safety Investigations Branch and Healthwatch: the Government’s response to something not working as effectively as it could is to abolish it, but why not give those organisations the teeth—the powers—to achieve the things they were set up to do, unless the hon. Gentleman and the Government feel that there is no need, in Healthwatch’s case, for that level of independent scrutiny or, in governors’ case, that level of independent influence on boards?

There is a fundamental difference here: the Conservatives would take something imperfect and make it better; the Government’s response is to take something imperfect and abolish it. That is the wrong way round.

Health Bill (Tenth sitting)

Peter Prinsley Excerpts

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[Dr Chambers]

Amendment 9 would place the mental health investment standard on a statutory footing, requiring ICBs to increase mental health spending at least in line with the growth in their total programme funding. Amendment 10 would enable the Secretary of State to implement financial penalties if ICBs failed to comply. New clause 27, tabled by the Chair of the Health and Social Care Committee, my hon. Friend the Member for Oxford West and Abingdon (Layla Moran), is similar. It is quite reassuring to see that the policies of the Liberal Democrats and of the Health and Social Care Committee are fairly well aligned.

The Darzi report highlighted that 20% of the NHS caseload is mental health, yet at the time it was receiving just under 10% of the NHS budget in funding, and now it is receiving 8.4%. To put that in the context of real lives, when I was first elected in 2024, there were just over half a million children and young people on mental health waiting lists; as of last week, there were 1 million. While the Government have done commendable work in reducing waiting lists for physical conditions, mental health cases are increasing—and fast.

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

I am very interested in the increase in the number of people waiting for mental health care, particularly mental health assessments. Does the hon. Member think that that is because the funding is inadequate, or is there some other reason why the waiting list numbers have been shooting up?

[Dr Chambers]

I would happily speak for several hours on the multifaceted reasons why young people in particular are struggling with mental health. One of my passions is ensuring that people get intervention and support before they require clinical care, but at the moment that is not happening. For a whole variety of societal reasons, including young people applying for 300 or 400 jobs and not even getting a response, more and more people are ending up on mental health waiting lists.

The mental health investment standard has been widely hailed for bringing about positive change in the health service. It protects funds and provides certainty for services that are seeing dramatically rising demand and, importantly, it provides certainty about future finances. Placing it on a statutory footing in primary legislation would make it more transparent and prevent it from becoming a political football. It would also help to stop the watering down of targets that seems to have happened over the last few years. Claire Murdoch, NHS England’s national mental health director, essentially resigned over those changes.

To pick up on the point made by the hon. Member for Bury St Edmunds and Stowmarket, the Milburn report and the report by the Children’s Commissioner this week showed that the number of children referred to mental health services in England has risen by over 10% in just one year—it is now at more than a million. The pressures on NHS services and funding are clear. If funding is not protected, there is a real risk that it will be cut due to competing demands.

One thing I found when speaking to staff at Winchester’s A&E department is that when mental health patients turn up, having been unable to get support and often having already been on a waiting list, sometimes for more than 18 months, the average time they spend in A&E is more than 18 hours, during which some of them require constant supervision. So, we are badly supporting people with mental health issues in the most expensive part of the NHS. We cannot afford to let the mental health crisis in this country continue slipping out of control, and funding for NHS mental health services is an essential part of stopping that.

New clause 33 would require the Secretary of State to

“conduct and publish an annual review into the number and length of delays for patients’ receipt of mental health treatment across rural and urban areas.”

Something I found interesting growing up on a farm and working as a vet is the almost unrecognised mental health issues in rural areas. That is partly because many people who work in rural vocations have minimal contact with people outside their workplace. Sometimes the vet and the postman might be the only people that a farmer sees in one, two or three weeks. There are a lot of questions about why disparities in accessing treatment in rural versus urban areas exist. Alternative approaches are needed, and some of the ideas floated have included mental health support officers for rural GP surgeries, or training vets up as mental health first aiders, because they might be a point of contact for a farmer and recognise when they are struggling.

Different communities require help in different ways, and farming communities often feel overlooked. They are vital for keeping the nation fed and fit and healthy, but they have a job that involves working from before 5 or 6 in the morning until late at night. If services are provided that do not fit with that person’s lifestyle and job restrictions, they can often struggle to access them, which, when coupled with having virtually no mobile signal and poor broadband, means that people in rural areas are sometimes cut off in more ways than one.

The Mental Health Act 2025 had a fairly limited focus on providing care to those with the most acute mental health problems. We need to look at preventive measures to ensure that people are supported through difficult times in their lives. These new clauses will require a report from local authorities so that we can ensure that they are providing tailored support to those in need. The Liberal Democrats strongly believe that early intervention and preventive services are key to tackling to mental health issues. These new clauses would urge mental health service providers to look beyond putting out the fire. This is about moving from crisis management to ensuring that people are supported in their local communities so that they do not reach the point of crisis. We need to treat mental health as seriously as we treat physical health. I know the Minister agrees with that; we think these new clauses will enable the Government to deliver on that ambition.

--- Later in debate ---

We are also improving access to mental health care in rural areas. I pay tribute to the hon. Member for Winchester. He could speak for a very long time on this area and we all value his experience as a vet. Anyone can self-refer to NHS talking therapies via the NHS app and we are rolling out community-based mental health centres, making support easier to access closer to home. As a Government, we are committed to reducing delays for mental health treatments, although I am not convinced that requirements to undertake an annual review will support us in delivering on that commitment. Indeed, it would risk distracting from delivering those changes. For those reasons, I again ask the hon. Member not to press the new clause.

[Dr Prinsley]

We are talking about investing in mental health services, and we should consider more widely the causes of the mental health disorders that we are having to approach. If we are spending public money, we may be better off spending it on dealing with the causes of mental health problems rather than the consequences.

[Karin Smyth]

My hon. Friend touches on what I will come to as I conclude my remarks on the next new clause. He is absolutely right. The wider determinants of mental health need to be part of developing these services, as with physical health.

On new clause 34, I reassure the Committee that the Government are taking significant steps to improve mental health services in this area. We have recruited over 8,500 extra mental health workers since July 2024, we are accelerating the roll-out of mental health support in schools and colleges, and we are investing a record £16 billion in NHS mental health services this year. Furthermore, there will remain a requirement, as introduced in the Health and Care Act 2022, for mental health expertise on local integrated care boards.

However, as my hon. Friend just said, we know that good mental health and wellbeing requires more than improving NHS services. It requires concerted action to promote positive mental health and tackle the causes of mental ill health. That is why we are developing a new cross-Government mental health strategy for England, to be published later this year. It will take a whole-system approach, recognising the role of schools, employers, the voluntary sector and local government, and representing all parts of the country in promoting positive mental health and preventing mental health ill. The strategy will also go further on reducing the stigma and discrimination associated with mental health conditions, with a focus on improving mental health literacy across the population.

Finally, the new clause risks imposing unnecessary burdens on local systems. For those reasons, I ask the hon. Member for Winchester not to press it. I hope he feels assured that the Government will take forward many of the Committee’s concerns in the mental health strategy.

Health Bill (Twelfth sitting)

Peter Prinsley Excerpts

Committee stage
Tuesday 7th July 2026 Public Bill Committees

[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.

Health Bill (Thirteenth sitting)

Peter Prinsley Excerpts

Committee stage
Tuesday 7th July 2026 Public Bill Committees

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

The shadow Minister is absolutely right. Perception is a problem, but the reality on the ground is perhaps an even greater problem. Both are issues here with what the Government plan.

There could be a reason why this merger, or the abolition of the Health Services Safety Investigations Body, needs to happen, but we have not seen that compelling argument. We have seen some attempts at justification, but they seem to be incredibly thin—and that is being generous.

The principal argument seems to be that there is a busy and confusing landscape when it comes to investigatory and regulatory bodies. The figure Dr Dash put forward was something like 150 different organisations; she was asked to review just six of those. Even if she were to have abolished all six, it clearly does nothing to reduce the busy and confusing landscape. My hon. Friend the Member for Farnham and Bordon made that point well.

A busy and confusing regulatory landscape should not be a justification for getting rid of an essential investigatory body and disincentivising the investigation process and whistleblowing and disclosures, by tying it up with the regulator, which itself may be at fault. Streamlining and dealing with a busy and confusing landscape are objectively good reasons to do something, but not this. That is the central point.

As my hon. Friend the Member for Farnham and Bordon referred to, the question was put to Dr Dash, the author of the recommendations, when she gave evidence: what happens if there is a problem with the Care Quality Commission once HSSIB has become part of it? I think we rightly expected a fairly clear answer on that. The answer was a rhetorical response:

“‘What happens if the problem is this organisation or that one?’”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 8, Q9.]

That was the response from Dr Dash. But we are not talking about whether there is a problem with this organisation or that one; we are talking about the CQC, the organisation that HSSIB will become.

If there is a problem with another organisation, HSSIB can investigate it; if there is a problem with the CQC now, HSSIB can investigate it; but when HSSIB becomes the CQC, there will plainly be a problem with investigating the CQC. When that question was put to the author of the report on whom the Government are relying, no answer was provided. The reply to my hon. Friend the Member for Farnham and Bordon was a rhetorical question.

I urge the Minister to reflect. There is a major issue here that has not been addressed. Until she, or those on whom she relies, can articulate the answer, I urge her to delay these proposals.

[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.

[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.

--- Later in debate ---

[Edward Argar]

I will confine my remarks to group 47, conscious that the next group will give us an opportunity to discuss local arrangements, so I will stick to the national ones.

We are all aware of the significant role that Healthwatch England plays, as well as its popularity and the trust that many people place in it. As a former Minister in the Department, I was on the receiving end, on occasion, of some sharp—or firm—suggestions from Healthwatch England, but that is what it was there for. It was there to be the grit in the oyster. It often made useful suggestions, and its independence meant that it could put reports not only to me but to the public—it published them. It could give them, for example, to my hon. Friends who served on the Health and Social Care Committee and, if it wished, go to the media to make sure that that voice was heard.

That is where, for me, the challenge with what is proposed comes in, because a new directorate in the Department, staffed by civil servants, will simply not be able to do that. We all know that those who work in a Department, however excellent they are, report upwards ultimately to the permanent secretary and to Ministers. They are answerable to the political leadership of the Department. Would they be able to decide that something was coming through regularly from patient feedback and publish it independently, without ministerial approval or that of the permanent secretary, or hand it to the media? Would that director be able to champion the patient voice by going on television, irrespective of any ministerial approval?

The reality is, of course, that they could not. It would all be kept in-house in the Department, part of a closed process that would not alter decision making in reality, because that is already happening in the Department. The Department should already be looking at reports from Healthwatch England as part of decision making by Ministers and senior officials. What this simply does is remove the independence. It weakens that voice by making it something that happens within the Department rather than in the public sphere because, quite rightly, those officials will not be able to have their own independent voice out there, irrespective of the leadership of the NHS or the Minister.

I genuinely worry that what we see here is the continuation of a theme that has run throughout other aspects of this legislation—a theme of centralisation, of removing independent external challenge and bringing it inside the system, be it the Department or the NHS. When that happens, my fear is that the people who will lose out will be the patients, whose voice will no longer carry as loudly.

[Dr Prinsley]

I rise to speak to new clause 74 on behalf of my hon. Friend the Member for Rugby (John Slinger), who is in the Gallery, and also to some extent on behalf of my predecessor, Jo Churchill, who was the Member of Parliament for Bury St Edmunds and Stowmarket before me, and was also a Health Minister. This is about Healthwatch and the patient voice. The amendment tabled by my hon. Friend the Member for Rugby suggests that the Secretary of State create an impact report within 12 months of the Bill passing through Parliament to assess what the impact of the amalgamation or integration of the functions of Healthwatch into the ICB would in fact be, and in particular look at the effectiveness of the complaints procedure and the way in which complaints were responded to.

The theme is also that which we spoke about this morning on whether an organisation can successfully interrogate itself. I believe that with the appropriate safeguards it probably could, but I do think that the suggestion that there ought to be a formal report on the impact within 12 months is something worth considering.

[Gregory Stafford]

It is a pleasure to serve under your chairmanship again, Ms Lewell. I think right hon. and hon. Members will be disappointed to know I am not going to speak too long on this, but they need not worry: in the next grouping, usual service will resume.

I want to pick up a few points on the abolition of national Healthwatch. When we took evidence from Sarah Woolnough of the King’s Fund, I asked her a fairly open-ended question about when she gave evidence at the Health and Social Care Select Committee. I put it to her that she

“seemed to suggest that the Government could achieve what they needed to in the 10-year plan without this reorganisation.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 15, Q23.]

She gave me an answer that essentially said it could all be done without the need for the reorganisation that is in the current NHS Bill. I then asked Mr Jacob Lant, a representative from National Voices, whether he would agree with that and, unprompted, because I did not mention Healthwatch in my question, he replied:

“Yes. I kind of think, as the debate goes on, that—with the changes to Healthwatch in particular—you could achieve so much without legislation. You could beef up the internal functions for listening to a patient and engaging with them without legislation—there is no requirement for that. You could invest more resource in that, and you could do the same with Healthwatch.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 16, Q24.]

We already know from the evidence that we received, unprompted, from National Voices and the King’s Fund that the abolition of NHS England will not solve the problems that the Minister, the Government and the Department think are there, and indeed it could be done in a different way.

I listened closely to the hon. Member for Lichfield. He seemed to be presenting a number of problems, but the solution that the Government have come up with does not hold water. As right hon. and hon. Friends have said, the removal of Healthwatch England and the introduction of a director for patient experience simply does not work because the independence—which is so fundamental to the HSSIB that we talked about— of local healthwatches, which we will talk about, and of Healthwatch England is fundamental to the ability of that organisation to do its job.

In a previous career I worked for the Getting It Right First Time programme in the NHS. When that programme first started, it sat outside the structures of what was then NHS Improvement, latterly NHS England. At that point we could make recommendations to the NHS— I do not mean this flippantly —in a way that was unrestricted. As soon as we were brought into NHS England, into a governmental structure, the recommendations that we put forward were looked at and scrutinised and we were told often, “We do not have the money to afford that”, or, “That is not in our plan.” And that is precisely what will happen if recommendations are put through the director of patient experience. As others have said, when this director of patient experience arrives at a Select Committee, he or she will be there to represent and defend the Department and Ministers, understandably, because that is who he or she will work for. They will not be able to stand up, go on television or the radio, do the broadcast interviews or make representations, because they will be a creature of the system rather than a scrutineer of the system and an advocate for patients. That is a fundamental problem, and while I accept that there may be ways to improve Healthwatch England, as Members have outlined, this simply will not do it.

--- Later in debate ---

[Helen Morgan]

I am very grateful to serve under your chairship, Ms Lewell. My hon. Friend the Member for Winchester has made some general points about Healthwatch and the importance of an independent patient voice; I will not reiterate them, because he made them very well, but I want to speak specifically about local healthwatches and the benefits that they bring.

I find it quite difficult to hear in this room, so I hope the hon. Member for Lichfield will correct me if I have misunderstood the gist of his speech, but I was frankly astonished by the suggestion that if local managers had heard about the problems at Mid Staffs or at Shrewsbury and Telford hospital NHS trust, the concerns raised in those extremely serious scandals would have been addressed. The reality is that the management of both providers knew exactly about the concerns in those trusts, and they did not address them. That is why we have Healthwatch.

The hon. Member for Lichfield may be aware that my parents live in Stone, which was in the Mid Staffordshire constituency at the time. My mum was a clerk to Staffordshire county council, and I recollect very strongly that the health scrutiny committee at that council questioned the trust about its appalling mortality rate and was constantly reassured that there was nothing to see here. It absolutely failed to mark its own homework. The suggestion that my constituents Kayleigh and Colin Griffiths, who fought for the Ockenden report on Shrewsbury and Telford, did not first try the local services is, I think, missing the point.

With the Ockenden report on Nottinghamshire a couple of weeks ago, we also saw that the hospital trust commissioned several reports into its own maternity services, which found that it was failing. Instead of acting on them, it brushed them under the carpet and commissioned another. The suggestion that providers are capable in the current culture of dealing with those issues does not, I am afraid, hold true in the way it should across every trust.

[Dr Prinsley]

Is it the hon. Member’s belief that that is something that Healthwatch would have been able to deal with, support and prevent?

[Helen Morgan]

The hon. Member will know that Healthwatch was introduced almost as a direct consequence of the Francis review of Mid Staffordshire, so that was certainly the intention. I have discussed the variability of healthwatch organisations across the country and the fact that they are not as well funded as was originally intended. Although I take the point that they have not effectively delivered that alarm-raising service in every case, if they were properly funded and used in the way that they were envisaged to operate, they would be able to spot such issues.

[Dr Prinsley]

rose—

[Helen Morgan]

I am going to go on and give some examples. Central to the value and success of the Healthwatch network is its local focus and the fact it is centred in communities. Where it has worked well, that has allowed Healthwatch to earn trust and build relationships, especially with harder-to-reach communities, as we have discussed. I take the Minister’s point that we know about those harder-to-reach communities, but the reality is that we are not engaging with them, and that is important.

--- Later in debate ---

[Dr Chambers]

The size of the contract would be pretty much irrelevant; what matters is the implications arising from the contract being signed. Does a contract potentially compromise our data sovereignty? Alternatively, if a contract failed for any reason, whether it was because of the action of a state actor or a non-state actor, would the service continue to function?

[Dr Prinsley]

I am grateful to the hon. Member for taking my intervention and I am sorry that it is late in the afternoon. The question we are faced with is this: what is the best system to serve our patients? If the best system turns out to be a system that is procured from another country, would he in principle always object to that?

[Dr Chambers]

I would not always object to that, because the whole point of the new clause is that such a contract would come to Parliament and then might well be approved if it turned out to be the best system and in our national interest. The thrust of all three new clauses is to ensure that we do not get exposed and make ourselves vulnerable, which could affect the functioning of the NHS and compromise people’s data. A future Government could set up their own AI system in the UK. How would data be used by that system? We are looking at future-proofing people’s privacy and future-proofing the ability of our country to deliver a service properly.

There is also an economic opportunity. We should always prioritise domestic suppliers where possible, and even cultivate them, and help them to innovate and develop, because spending potentially tens of millions of pounds with foreign companies will not do anything to grow our own economy. Given the world-beating talent in our country, we see no reason why the long-term effect of domestic options to foreign systems could not be developed with sufficient Government support. As such, where a contract is signed with a foreign supplier, new clause 4 would require the Secretary of State to take steps to support domestic alternatives. We recognise the complexities involved with NHS procurement, and our new clauses represent one vision built on the core principles of domestic resilience and digital sovereignty.

I have a few questions for the Minister, which I would appreciate some comments on. How do the Government intend to build trust in the single patient record to make sure that it is not undermined, rather like the federated data platform has been? Does the Minister agree that the poor reputation of Palantir and distrust has been an important element in the slow roll-out of the federated data platform? Has she considered undertaking a risk assessment with a national security focus of current NHS digital and tech contracts? Does she agree that, in an ever more turbulent world, building domestic capability in this area is central to the security of our country?

Does the Minister agree that the domestic life sciences and tech sector is more than capable of developing and scaling many of the systems that we rely on foreign companies for at the moment? The Government have very much positioned AI and technology as the NHS’s white knight. We agree that the potential is huge, but do the Government not think that the NHS needs a long-term digital strategy to support a joined-up development and roll-out of these systems and technology? An analogy to this is how the defence investment plan and future defence procurement can help prioritise and boost economic growth in the UK. We think this is another way that economic growth could be nurtured.

Health Bill (Fourteenth sitting)

Peter Prinsley Excerpts

Committee stage
Thursday 9th July 2026 Public Bill Committees

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

I agree with the broad thrust of the points made by the hon. Member for North Shropshire in highlighting the impact of corridor care on patients, on families and on those seeking to provide the care for those patients. I suspect that pretty much all of us, in our own lives or as constituency MPs, will have come across examples of that and the impact that it has on our constituents, or on our friends and family members, so it is a very important point.

Before I turn to new clauses 12 and 56, I will briefly address new clause 84, tabled by my hon. Friend the Member for Sleaford and North Hykeham. It is a very moderate and reasonable proposal, in that it seeks simply for data to be made available and published on where 12-hour-plus waits in A&E have contributed to avoidable deaths. That should not be a challenge; I suspect that that data is already extant in some part of the system. She is proposing a very moderate measure, which would pull all that together in one place, and allow it to be focused on and looked at in the round, rather than in disparate little penny packets of data. That is a very reasonable proposition.

The only challenge that I see is, sadly, in proposing it for integrated care board areas. Were the ICBs still what the Conservatives had conceived them to be—a number of geographical areas mapping on to an upper-tier authority social care provider—that data would have been even more meaningful, because it would have been more granular. The risk with the mergers and acquisitions—for want of a better phrase—among ICBs to form ever-larger areas is that that granularity is increasingly diluted. I fear that the genuinely positive benefits of what my hon. Friend is proposing might be somewhat diluted by virtue of what the Government are doing.

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

On the publication of data on avoidable deaths, new clause 84 states

“where waits of more than 12 hours in accident and emergency departments was a contributory factor.”

Does the right hon. Member consider it likely that there is any great accuracy in the assessment of whether a death was avoidable?

[Edward Argar]

The hon. Gentleman makes a valid point, and I suspect that he has seen this issue in his professional career. Often, when a death occurs in a clinical setting, multiple factors are contributory. I think that that is why my hon. Friend the Member for Sleaford and North Hykeham framed this as she has, as “a contributory factor”—not the sole factor or the individual most significant factor, but that it could reasonably be deemed by a clinician or by those collecting the data that the long wait contributed to the death, because had that patient been seen, for example, in two hours rather than 12 hours, better clinical outcomes might have been achievable.

I take the hon. Gentleman’s point, however, that with many of these things—both clinicians and coroners grapple with this—it is often complex to determine the actual most significant contributory factor. My hon. Friend the Member for Sleaford and North Hykeham may correct me, but I think that is why she framed new clause 84 as she did, to allow for that degree of a lack of total certainty in such contexts. Nevertheless, the hon. Gentleman makes a reasonable point.

I can see what the hon. Member for North Shropshire is seeking to do in new clauses 12 and 56: not unreasonably, she seeks to cast light on the impact of corridor care on patients, families and those caring for people. My only challenge would be—I will enlarge on this in a little more detail—that a narrow focus on corridor care, while understandable, slightly loses the bigger picture. Corridor care is, for want of a better way of putting it, a subset, a consequence, of a much broader systemic challenge.

The Minister will probably know this as well; when I was first appointed to her job, one of the first conversations I had in the context of secondary care was about the importance of flow through our acute hospital systems, from a patient either presenting at A&E or arriving by blue light at A&E, to being treated, and the ability of A&E to function through those patients being seen, treated, and discharged or put into a hospital bed to become an in-patient. The ability to achieve the latter is dependent on the ability to discharge.

--- Later in debate ---

[Gregory Stafford]

I rise to support a lot of what my right hon. Friend the Member for Melton and Syston said. Across the Committee, I think we all agree that corridor care and care in other inappropriate settings should have no place in the NHS. No patient should be assessed, treated or left waiting in a corridor, in a cupboard or anywhere else because there is nowhere for them to go.

We owe it to patients and our constituents to be honest about the scale of the problem and be serious about ending it. That starts with measuring it properly, because if we do not collect the data, publish the evidence and track progress, inappropriate care settings risk becoming normalised. In May, nearly 3,000 patients were in corridor care, which was a 2.5% increase from the same time last year. In the same month, 50,000 patients waited in A&E for more than 12 hours, which was a 17% increase from the same period last year.

The Government continually miss their target on the 12-hour wait. I am not making a political point; this is a serious problem, and successive Governments are still struggling to ensure that it does not happen. We all know from our casework and our inboxes, and some of us know through personal experience or from loved ones, that too many patients are experiencing unacceptably long waits in A&E after a decision has been taken to admit them. That is bad for patients, bad for staff and bad for the wider functioning of our hospitals.

New clause 56 in the name of the hon. Member for North Shropshire acknowledges that the causes of delays extend far beyond the emergency department itself, and I will touch on that in a moment. Challenges in social care, discharge processes, step-down provision and workforce capacity all contribute to bottlenecks that leave patients waiting longer than they should. Although there might be legitimate questions about the precise mechanisms proposed in the new clause, I do not think there is any disagreement among the Committee about the principle that patients deserve timely access to a hospital bed and that excessive admission delays should not be accepted as the norm.

That is why I fully support new clause 84 in the name of my hon. Friend the Member for Sleaford and North Hykeham. Publishing data on avoidable deaths associated with waits of more than 12 hours would help to ensure that we, as a Parliament and as policymakers, remain focused on outcomes for patients, not just performance indicators. I am particularly persuaded by the proposal to publish that information at ICB level, notwithstanding the concerns raised by my right hon. Friend the Member for Melton and Syston, which I agree with entirely. It would at least give some allowance for those making decisions to look at the local variation and ensure that it is identified, however less local that will become.

Hopefully, good practice will be able to be shared between different areas, and the areas that face the greatest challenges will be able to receive both appropriate scrutiny and appropriate support. Of course, collecting and publishing data will not by itself reduce waiting times, but we cannot effectively tackle a problem that we do not properly measure. Sunlight is often the best disinfectant in these cases, and greater transparency can be a powerful driver of improvement.

At the heart, new clause 84 recognises the simple truth that every statistic represents a person, a family and a life, and if avoidable deaths are occurring as a consequence of prolonged A&E waits, we should have the courage to measure them, publish them and learn from them. That is why I support the new clause. As has been touched on in other speeches, and as I mentioned earlier, the issue of corridor care does not sit in isolation. In fact, it is not a cause of the problem; it is the symptom of many other problems within our health and social care network.

[Dr Prinsley]

When I was a young doctor—a registrar—in the 1980s, we had 300,000 beds in our health service. By the time I was a senior doctor in the 2020s, we had 140,00 beds—less than half the number of beds we had before. When I was a young doctor, corridor care did not exist; I had never heard the term. The hospitals were simply big enough. Does the hon. Member agree that the many years of decline in the total number of beds in our hospitals is an extremely important factor in the fact that we do not have enough beds for the patients sitting in the A&E departments?

[Gregory Stafford]

I respect immensely the hon. Gentleman’s experience. He described being a young doctor, but he is still a very young doctor/politician now. Of course, capacity is an essential part of this. He is a clinician, so I will not lecture him on this, but my suggestion would be that it is not about just capacity within hospitals. The Government’s shift is to try to get people out of hospitals and into community settings as much as possible, so it is capacity within the whole system that needs to be looked at. Going back and putting loads more beds into hospitals would not somehow solve this problem or create a healthcare system that is aligned with what the Government want, which is hopefully treating more people at home. On his general point, I accept that the more capacity there in the system as a whole, the more likely we are to solve some of the problem.

That neatly moves me on to my next point, which is about the whole-system approach to this. As hon. Members have mentioned, we have a potential problem with ambulances waiting in carparks, and unfortunately, trusts gamify the system when targets are put in place—they do not admit people through the door because it will hit their targets. As my right hon. Friend the Member for Melton and Syston mentioned, that has a knock-on effect for the people sitting in the ambulances and those who are potentially not receiving an ambulance because the capacity is not there. Likewise, at the other end of the system—though I suppose it is both ends of the system—social care needs to improve significantly. I am deeply disappointed that the Government have pushed another social care review that is probably not going to report until 2028, which is kicking the can down the road. I think it is essential that we get social care correct.

--- Later in debate ---

[Dr Johnson]

New clauses 12, 56 and 84 are about care in our accident and emergency departments and care in corridors. I do not want to rerun the debate on corridor care that we had in the Chamber last night, but corridor care does not provide safety, privacy and dignity, and it is unpleasant for the patient, their family and staff. If someone is in a corridor, how can they get changed, or use a commode or a bed pan? How can they be examined privately, and give information about their medical history without being overheard by a person walking down the corridor or the person in the bed next to them? Corridor care also has safety issues; for example, a patient may not be proximal to as much equipment, such as oxygen supplies and other equipment that might be required in the event of a collapse or arrest. It is not right and should not be the case that patients are cared for in corridors.

The hon. Member for Blaydon and Consett talked about the history, but I agree with my hon. Friend the Member for Isle of Wight East that the current situation and the future are what is important. A&E services are under pressure. Attendances went up by 2.5% last year, but in March 2025, 46,766 people waited more than 12 hours in A&E following a decision to admit before being moved to a more appropriate bed. That figure is up 8.8% on the previous year. The Government’s urgent and emergency care plan sought to improve that poor performance, but things have got worse. The latest NHS figures, from May 2026, show that more than 50,000 patients waited more than 12 hours following a decision to admit—17.1% higher than the May 2025 figure. The narrative that there was a problem but now things are getting better is not necessarily accurate. We keep being told that waiting lists are coming down, but they are higher than they were a month ago, and for those waiting for an admission or procedure, they are than they were a month ago and higher than they were a year ago.

[Dr Prinsley]

I wonder whether the hon. Member remembers that in 2010, when I believe there was an election—[Interruption.] Yes. The point I wish to make is that at the end of the previous Conservative Government, before Labour came back into office, waiting lists had reached an absolute record. Under the previous Labour Administration, waiting lists came down to almost nothing, but after 2010 they crept up and up, and by the time of the election in 2024 they had reached a record. I think she will recognise that Labour Governments have had strong records of reducing waiting lists, which is what we are doing now. We are only getting started, but it would be good to have some words of encouragement.

[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.

--- Later in debate ---

[Edward Argar]

Does my hon. Friend recognise the statistic that between 1997 and 2007, the then Government closed 32,000 hospital beds—more than double the number closed between 2010 and 2022? That is when the big reductions took place, and they failed to put in place an expansion of community beds to match that.

[Dr Prinsley]

rose—

[Dr Johnson]

I will come to the hon. Gentleman in a minute, but I need to answer my right hon. Friend’s question first. My right hon. Friend has a much better memory than me—I was much younger then—so I am sure his statistics will be accurate.

[Dr Prinsley]

I think the principal reduction that the right hon. Member for Melton and Syston described was a result of the change of practice in the way that psychiatry was managed. During that period, we closed the asylums—large hospitals on the outskirts of almost every town and city. That was the result of a change in clinical practice—the idea that patients should be managed within the community. However, we continued to close acute beds, and it is the acute beds in the district general hospitals that are the problem we are talking about.

[Dr Johnson]

I think we are going back full circle to the hon. Gentleman’s intervention on my hon. Friend the Member for Farnham and Bordon, when he suggested that the problem was that beds had historically been closed. Now he is making the point that there were clinical reasons why that happened, not just managerial reasons. I think that is an important thing to note.

Moving on from capacity, we also need to look at the workforce. I would be grateful if the Minister could tell us how soon “imminent” is in terms of the workforce plan. There was also a point picked up earlier—I cannot remember who picked it up; it might have been the hon. Member for North Shropshire—about discharge from hospital and pharmacies. One of the challenges that I find as a clinician is that hospital pharmacies often close relatively early, which means that it is more difficult to discharge patients in the evening. That is something for the Minister to look at. There is also, of course, the importance of social care, and ensuring the provision of social care beds both to prevent admission and to get people out of hospital as quickly as is safely possible.

That is the background to this group of new clauses. New clause 12, in the name of the hon. Member for North Shropshire, would require a report on corridor care to be produced six months after the passage of the Act, and then every 12 months, containing data at the hospital, trust and ICB level on the number of individuals receiving care in an inappropriate place. That seems sensible data to collect, but I believe the Government may already to be collecting it; the Minister may be able to enlighten us on that. The report would also set out the steps taken in that year to reduce the number of patients in inappropriate care spaces, the plans for the coming year to reduce that number further—as I said, it is going up at the moment—and the funding allocated to that. There is some sense to that. Then the Secretary of State would have to give evidence in front of a panel, called the “corridor care tribunal”, which would include patients, affected families and impacted NHS staff, who would be selected by Healthwatch and NHS royal colleges.

I have just a couple of points on that. One is that Healthwatch will be abolished by the Bill, which would make that challenging—perhaps the new clause would need to be redrafted. Also, I am a member of the Royal College of Paediatrics and Child Health and an NHS consultant paediatrician and, as far as I am aware, the royal colleges are independent of the national health service. They are separate; they are connected in terms of training, standards and advice, but I believe that they are organisationally independent. I am sure that the Minister will correct me if I have got that wrong.

I wonder whether the hon. Member for North Shropshire has considered whether the Health and Social Care Committee, which is elected and politically balanced, might be the right body to scrutinise those Government plans. My hon. Friend the Member for Isle of Wight East, who is a member of the Select Committee, is not here now, but—

Health Bill (Fifteenth sitting)

Peter Prinsley Excerpts

Committee stage
Thursday 9th July 2026 Public Bill Committees

[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.

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

Although it is true that hospital management could concentrate on dealing with the waits in A&E, surely it needs to concentrate on the flow through the entire hospital. Every department and everybody involved in the hospital has to be thinking all the time about the flow through the entire hospital. That involves having a pharmacy that is open at night and ensuring that social workers are there when they need to be—it involves all manner of things. Simply concentrating on a particular statistic in an A&E department will not actually deal with the problem.

[Helen Morgan]

I think our new clause addresses that point. As I mentioned, my own hospital trust, Shrewsbury and Telford, has improved ambulance wait times simply by improving the flow through the hospital and addressing some of the issues. I recognise that our new clause does not deal with pharmacy availability at weekends and overnight, which I know is a critical issue in many hospitals; on Report, we will certainly tidy it up to ensure that it does, but I take the hon. Member’s point.

My new clause would address the system-wide capacity issue that the hon. Member highlighted so carefully, both in last night’s debate and here today. We need more capacity across the whole system. Otherwise, we are just trying to push a lump in the carpet to a different place, but there will always be a lump somewhere. The new clause seeks to provide 6,000 more beds across the whole system, to allow flow through the system and to ensure that waits do not back up in the ambulance service, on corridors in A&E or outside wards, as they do currently.

Critically, we should address the point about NHS pledges and rights. The constitution is broadly agnostic about the time people wait on corridors, but is not agnostic about the time it will take for them to get cancer treatment. That is an inconsistency and we should sort it out, because I think our constituents consider the two things equally important.

I take the Minister’s point about new clause 12. I will not push it to a vote, but although trusts are held to account on their A&E performance, the missing piece is that the Secretary of State is not. That is what new clause 12 seeks to address, and I hope that the Minister will consider that on Report. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 14

Healthy life expectancy target

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

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

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

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

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

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

Brought up, and read the First time.

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[Dr Chambers]

New clause 14 is about healthy life expectancy. It would require the Secretary of State to make regulations to establish a statutory target for healthy life expectancy in Great Britain and publish a strategy every two years, setting out how the target would be achieved. New clause 79 would establish a public health committee and health creation unit to promote public health and cross-Government policymaking. New clause 80 would place a duty on all Ministers to consider health outcomes and the promotion of public health when exercising their duties. All three new clauses are closely related.

Over the last 100 years, life expectancy in the UK has been increasing for a variety of reasons, including vaccination, improved hygiene and medical advances, but worryingly, between 2022 and 2024, it decreased by 1.8 years for men and 2.5 years for women. That is the first time it has decreased in a while. There is an 11.1-year gap between the highest and lowest life expectancies, which is partly due to demographics and different socioeconomic situations. Socioeconomic disparity is causing a very significant difference in life expectancy.

We need wider whole-of-Government working to address the root cause of and contributing factors to ill health. DHSC, the NHS and social care deal with too much in silos, which is a problem across the whole of Government. There is too much siloed working. All Departments should be working with at least one eye on the health of the nation. That is what our new clauses seek to foster. A healthy life expectancy target would provide the basic metric for that aspiration, forcing wider thinking on prevention and ill health, rather than on waiting lists and hospital performance, as important as they are.

New clause 80 would place a duty on all Ministers to consider health outcomes and the promotion of public health when exercising their duties. That should aim to focus the minds of non-DHSC Government Departments that have a central role to play in the promotion of good health and longevity, whether that be housing standards or environmental regulations. We included health protection—areas such as clean water, for instance—as well as health promotion, which includes areas such as active travel.

New clause 79 would create a public health committee and a health creation unit to support its work, especially between Departments. This is an idea originally introduced under the coalition Government, designed to tackle obesity, alcohol abuse and other public health problems. Although we recognise that it was not perfect, given the Tories’ lack of engagement and spotty attendance, the desire to foster cross-Government thinking was definitely right.

[Dr Prinsley]

Would the hon. Member comment on what I consider to be almost the most successful and important Bill that our new Government have passed, on the effective abolition of cigarette smoking? As time goes by, that will save more lives than anything else we could possibly think of. I recognise that it was the initiative of the previous Government, but the fact that the new Government have managed to get it over the line is a massive achievement. That is very much underappreciated and certainly not spoken about anything like enough. We will never do anything as important as the abolition of cigarette smoking.

[Dr Chambers]

Yes, I sat on the Tobacco and Vapes Bill Committee for six weeks, going through the legislation line by line. One of the most interesting things about that Bill is not only that it will improve public health and life expectancy, but that it is probably one of the single most impactful pieces of legislation in terms of improving inequality and especially socioeconomic health outcomes. So many of the disparities in life expectancy between wealthy people and those living in relative poverty are due to levels of smoking—it is not just smoking, but that is a significant factor. It is good of the hon. Gentleman to highlight that.

During the coalition, the Tories recognised that the approach I described would send a powerful message that public health is the responsibility of all Government Departments. When it was scrapped, the then shadow Health Secretary, the right hon. Member for Makerfield (Andy Burnham), said that we could tackle Britain’s looming obesity crisis only if all Government Departments pulled together. We completely agree with that statement.

New clause 79 tries to address some of the issues that occurred back then, including by placing requirements on ministerial attendance and giving the Liaison Committee oversight to drive accountability. I am sure the Minister will agree that greater cross-Government working is needed. What are the Department’s plans to support that? If we want to tackle the various public health crises facing our country, we cannot do so without proper cross-Government working.

In my professional life, I was made an honorary lecturer at Bristol University veterinary school in the area of One Health, recognising that animal health, human health and environmental health are completely interlinked. It is difficult to improve one without looking at the factors that improve the others, and we need that kind of approach throughout all Government Departments.

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[Dave Robertson (Lichfield) (Lab)]

It is always a pleasure to see you in the Chair, Ms Lewell. I will speak briefly on new clauses 79 and 80. I really like the intent of these new clauses, and the idea of Government working better and more together, public health being more of an agenda, and trying to get people working together in that framework. I am pretty sure that every Member in the House would support that. I do, however, have some serious concerns about the wording.

New clause 79 proposes a new committee, whose membership would include at least one Minister from each Department and all Cabinet Ministers—I presume that that is in addition, so it would be all Cabinet members plus one other Minister from each Department, which makes it seem like quite an unwieldy committee. There comes a point when a committee, if it has 70 people in it, ceases to be a committee, particularly when it will also need to be chaired, have clerks and have various people in the room. I have concerns about its size. I also have concerns about the frequency with which it would meet, and the requirement that every single Cabinet Minister must attend a minimum of three times a year, which is the implication of the wording.

[Dr Prinsley]

Public health used to be clearly under the aegis of the national health service. Some years ago, public health officers became employees of the local authorities, and the thing became somewhat separated from the NHS. Does my hon. Friend agree that we must join public health more closely to the activities of the national health service? Public health was at the very foundations of the national health service. I do not know whether other Members have, like me, read A. J. Cronin’s famous book, “The Citadel”, which describes the health service’s origins; in fact, I understand it was the book that the original politicians had all read. It has a marvellous description of a typhus epidemic, caused by an infected drain running down the middle of a street in a little Welsh mining village. The doctors had been completely unable to get any of the authorities to deal with it, so one night—they were ex-military—they put a little dynamite in the drain and blew the whole thing up. That is well described in the book, and it just shows how public health was absolutely integrated into the foundational principles of the national health service.

[Dave Robertson]

My hon. Friend makes an important point about the centrality of public health to the founding of the NHS. Earlier in Committee, I said that the NHS was the greatest gift the Labour party had ever given the country, and I fundamentally believe that. He is absolutely right to mention the centrality of public health in that process. I also thank him for his recommendation of a book to read over recess—that is always a pleasure.

To return to new clause 79, I want to focus on what we are asking when we say that all Cabinet members have to attend this new committee. That would include the Secretary of State for Defence, and although I understand cross-Government working and the need for Departments to work more closely together, I am scratching my head over what actions we expect the Secretary of State for Defence to take to support public health, and especially over the fact that they will be required to attend this committee a minimum of three times a year with, in my reading of the wording, another Defence Minister.

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[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.

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[Dr Prinsley]

Much of the conversation around those trade deals relates to pharmaceuticals from the United States. Our patients should be able to access the best available treatments, whatever deals we cook up. We must support innovative research based in our own country, particularly clinical trials for new medicines. To do that, we need to support clinical academics—the doctors who work in universities and organise research. Does the hon. Gentleman acknowledge that the number of clinical academics fell under the previous Conservative Administration? Most clinical academics are now very senior, and we are not recruiting replacements effectively. We need to look after our home-grown pharmaceutical industry so that we do not need such trade deals.

[Gregory Stafford]

I certainly agree with the hon. Gentleman’s penultimate point: we need to support home-grown clinical academics and the life sciences industry in this country. As he has drawn me down that line, I declare that my wife works in the life sciences industry in the UK. I entirely agree with him on that point. However, if he is saying that a corollary is that we should not do pharmaceutical trade deals with other countries, I do not agree, because UK patients need the best medicines no matter where they come from. If that was not what he was saying and I am putting words into his mouth, I apologise, but that is how it sounded to me. I agree that we should support the home-grown, but obviously we need access to medicines from around the world.

That brings me to my concerns about new clause 76. I understand why the hon. Member for Winchester supports it, but the way it is written means that, for the lifetime of the Act, any trade deal with America would have to follow those strictures. Although I accept that he does not like the current deal or the incumbent in the White House, it seems odd that we are singling out in statute, and putting a stricture on, one country over every other. I still probably would not have voted for it, but the new clause might have been more acceptable had it referred to any trade deal with any country, or even a group of countries—I know he is a big fan of one particular group of countries. That might have made it difficult. It would be dangerous essentially for the Bill to put a stricture on a trade deal with one specific country—especially one that is probably our strongest ally. I think that sits very badly.

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[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.

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[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.

Health Bill (Sixteenth sitting)

Peter Prinsley Excerpts

Committee stage
Thursday 16th July 2026 Public Bill Committees

[Dr Danny Chambers (Winchester) (LD)]

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

Twelve young people die every week from undiagnosed heart conditions. One of those was Clarissa Nicholls, who died just before her 21st birthday, while on a year abroad in France. Her mother and friends have campaigned tirelessly not only to provide electrocardiograms to young people, but to raise awareness about early detection of heart conditions. Finding a heart condition does not mean that exercise must stop or that life goes on hold; it just means that appropriate alterations can be made to keep a person safe, active and healthy.

Such a scheme has been rolled out in Italy and has been hugely successful. The new clause would push the Government to look seriously at having ECGs for young people as an early identifier for potentially fatal conditions, so that we do not lose up to 12 young people a week due just to a lack of testing.

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

I thank the hon. Member for his speech. I would like to know whether he is aware of any evidence that mass screening of young people with ECGs will actually improve matters.

[The Chair]

As that was a speech and not an intervention, we will take the Minister before the hon. Member for Winchester responds.

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[Karin Smyth]

Well, what was a disaster was the Tories’ management of the capital estate pre-1997 and post-2010, if the hon. Member for Sleaford and North Hykeham wants to talk about disasters on capital planning. I could talk about this for a very long time, but I know the Committee is keen to move forward, and I addressed some of these issues in debate on a previous amendment. I am very proud of, for example, Southmead hospital in Bristol, which is one of the finest examples of a hospital in the country and was built under a PFI scheme. I received treatment there a couple of years ago, in facilities that are good for staff to work and patients to be treated in. It replaced a hospital that was falling down and in shocking condition, despite the best efforts of staff. We can see similar examples across the country.

Under the Tories’ management, and for some of the early PFI schemes under the last Labour Government, contracts were poorly negotiated. They had issues with, for example, management of inflation. We have learned lessons from that. The hon. Member for Sleaford and North Hykeham talked about some contracts, including one where, I think, her whiteboard was not working. We know what the lessons are to be learned from that, and we are doing exactly what a good Government do when they take charge—change it.

In the 14 years that the Conservatives were in power, they could have started negotiating these contracts differently at any point, but they chose not to. They chose to let the estate atrophy and fall down. That is bad for patients and the public. That is why I was proud last week to launch the Government’s capital plan, building for the future, looking forward and giving nine years of certainty for estates across all our constituencies.

[Dr Prinsley]

I agree with everything that the Minister has to say—what a surprise—but particularly the fact that when the new Government came in, they did something about these 40 “new” hospitals that were not full hospitals. The people of Bury St Edmunds were delighted to learn that their RAAC-affected hospital, which is tumbling down, will be one of the first to be reconstructed. We look forward to that and are grateful for the decisions made by the Government.

[Karin Smyth]

I thank my hon. Friend for that. Across the east of England, where we now have so many Labour MPs, everyone has been trying to rectify the mismanagement that local people have seen, particularly of the capital estate. I will not detain the Committee on the capital estate—one of my favourite subjects—for very long.

The hon. Member for Sleaford and North Hykeham is aware that the decision on neighbourhood health centres was announced in the autumn. The decision-making process was supported by a business case to examine the feasibility of developing a new model, learning the lessons of the past on public-private partnerships specifically to build neighbourhood health centres as part of our 10-year plan. That informed the decision to proceed. The business case was a strategic outline case, the purpose of which was to scope and identify the preferred way forward for a new potential model, in line with the Treasury’s five case model. We are now working with the National Infrastructure and Service Transformation Authority to develop this further, and we expect a further round of market engagement in the autumn.

I recognise the interest in making the business case available to both Houses, but that must be balanced with the need to develop an effective policy. Publication while policy development is ongoing would limit full, candid and proper deliberation. Civil servants and subject experts need to be able to engage in frank discussion of policy options to expose their merits, demerits and possible implications. Their candour in doing so would be affected by their assessment of whether the content of such discussions would be disclosed.

We are committed to building neighbourhood health centres across the country. That is what patients and the public deserve. We will obviously be mindful of public money and subject to the usual processes of the House, including the Public Accounts Committee. We will learn those lessons. We are in full discussion with NISTA. For those reasons, we are committed to developing good estate across our country. That is what our constituents deserve. I therefore ask the hon. Member for Sleaford and North Hykeham to withdraw her new clause.

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[Karin Smyth]

I am slightly confused, as I suspect other Committee members are, by the Opposition’s approach to the private sector, having had a discussion in relation to the previous new clause about not using the private sector and boosting work and employment opportunities in our country. They do have a slightly odd view with regard to this. As I said, our view is very pragmatic: it is to support the treatment of patients to get waiting lists down. That is what our constituents deserve. Where capacity can be used, we want to make sure that that choice is available.

[Dr Prinsley]

I am confused by the Opposition referring in their new clause to a requirement to “make regulations” in this respect, as the private sector is already widely used to reduce waiting lists where appropriate. However, we must also be aware of the problem we have with overuse of private facilities. That can have an effect on the provision of NHS services, because the number of available staff is limited. I think particularly of ophthalmology services, as we have created a situation in which the overprovision of private services has disabled the provision of ophthalmology services.

[Karin Smyth]

That is why I was clear in outlining that ICBs have a duty to make sure that they are financially sustainable and that their planning and strategic commissioning meets the needs of their local population. They need to balance those requirements.

Under the new clause, there is a risk that the Secretary of State, by setting blanket requirements, would contravene the level playing field provisions in clause 10 of the Bill. For those reasons, I ask the hon. Member for Sleaford and North Hykeham to withdraw the new clause.

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[Dr Prinsley]

I am listening carefully to what the hon. Member, who is a medical colleague of mine, has to say. Although I think that a fracture liaison service is an excellent idea, there are many, many aspects of medical care that require careful attention, such as the management of people with hearing loss—my own field—or the assessment of people with chronic renal failure. Does the shadow Minister believe that all aspects of each individual disease category require some sort of primary legislation?

[Dr Johnson]

Not necessarily, no, but this one does, because the Government clearly made a promise before the election. The former Secretary of State was clear that it would be one of his first acts—that is what he said—and it has not happened, so in this case we need to hold the Government to account. It is our job to hold them to account on their promises, and I am afraid that they are failing on this one.

To sum up, the Government need to get their act together, because otherwise more and more vulnerable people will come to unnecessary and potentially fatal harm. I look forward to hearing the Minister’s plans to accelerate the delivery of the Government’s promise—and fast.

--- Later in debate ---

[Karin Smyth]

Like my hon. Friend’s constituency, my constituency of Bristol South has a large tobacco industry legacy, and it is crucial to address respiratory disease in a way that looks at the whole person.

[Dr Prinsley]

Does the Minister agree that the single most effective thing that we have done for public health since we were elected is to get the Tobacco and Vapes Act 2026 passed? The gradual abolition of cigarette smoking will save more lives than anything else we could conceivably do in politics.

[Karin Smyth]

My hon. Friend tempts me to go down the path that we went down in another Committee. I recognise that the Tobacco and Vapes Bill took a long time to come through Parliament, despite having been started by the Conservatives under the right hon. Member for Richmond and Northallerton (Rishi Sunak). It faced a lot of opposition, but we are absolutely clear that that is the single most beneficial piece of work. The hon. Member for Sleaford and North Hykeham asked me about the future, in terms of vape shops and so on, and I have corresponded back to her on that issue.

Instead of what is proposed in new clause 49, we have established a robust, expert-led process. The national quality board will assess all proposals for new MSFs against a clear set of criteria, ensuring that we prioritise those areas where an MSF will deliver the greatest impact for patients. Alongside developing the first wave of MSFs, we are further strengthening the process, including by setting out a clear and consistent approach for assessing future proposals. Embedding an MSF in respiratory health in primary legislation would risk limiting that flexibility, rather than strengthening our ability to improve care, as my hon. Friends the Members for Blaydon and Consett and for Bury St Edmunds and Stowmarket have outlined, by taking the action that is so necessary to help and support people with respiratory disease.

Health Bill (Seventeenth sitting)

Peter Prinsley Excerpts

Committee stage
Thursday 16th July 2026 Public Bill Committees

[Karin Smyth]

May I put on record my thanks to all the excellent managers in the NHS? I am not sure whether I raised the bar, as the hon. Lady said, but it was a great career and one that I enjoyed very much. It is a difficult job, and we want to support managers in future. We cannot deliver our 10-year health plan without them. That is one of the reasons why we have already established a leadership college to support their development, as we committed to doing.

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

Does the Minister agree that managers in the NHS sometimes get a very bad press from the medical profession? I believe that to be wholly unjustified.

[Karin Smyth]

I thank my hon. Friend and the shadow Minister for their comments about NHS managers. I agree that they often get a bad press, and often from politicians as well. We cannot run the health service without both clinically and non-clinically trained managers, so we need to ensure that they have the right support to do their difficult job. My experience is that when the partnership with clinicians works well, it is really powerful. I have certainly learned a lot from working with some fantastic clinicians in my career.

We are absolutely committed to introducing a statutory barring system. We will do that by introducing secondary legislation within this Parliament to enable the Health and Care Professions Council to operate that barring system. We intend to do so as part of the planned secondary legislation to modernise the framework that governs the Health and Care Professions Council.

Changes to this legislation are subject to a statutory three-month consultation period, in addition to which this legislation will be novel and complex. It will require extensive stakeholder engagement to ensure that we develop a barring system that is proportionate and operates efficiently alongside existing frameworks, codes of practice and other regulation governing the work of NHS senior leaders. For those reasons, a 12-month timeline to bring forward the section 60 order is unfeasible. The new clause also sets out prescriptive duties on the content of the section 60 order; we would not wish to pre-empt the outcome of detailed policy development and consultation.

I welcome the support of the hon. Member for Sleaford and North Hykeham for the broad programme of initiatives to professionalise and increase the accountability of managers and leaders in the NHS. Although we do not agree that it would be proportionate to set a requirement in primary legislation to lay before Parliament a timetable to which those measures will be delivered, officials in the Department of Health and Social Care and in NHS England are already working in partnership with organisations across the health sector and will set out more on the individual timelines in due course. For those reasons, I ask the hon. Member to withdraw her new clause.

--- Later in debate ---

[Helen Morgan]

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

The new clause would place a duty on the Secretary of State

“to publish a strategy to combat anti-vaccine and medical disinformation”.

We increasingly see the impact of anti-vax and medical disinformation. Lower vaccination rates have been recognised as a growing threat to public health this year, and in February the NHS launched a new vaccination campaign following concerns about the declining uptake of measles, mumps and rubella vaccinations.

Disinformation, including anti-vax conspiracy theories, is dangerous and leads to increased levels of preventable illness. The leader of Reform UK has platformed prominent anti-vaccine conspiracy theories at his conferences, and Reform UK needs to be held accountable for its role in this. It is amplifying and importing the conspiracy theories and outright dangerous views of the US President and Robert F. Kennedy. The leader of Reform UK has refused to condemn Donald Trump’s medical conspiracy theories, including unfounded claims about autism and paracetamol. Those views have had a very real effect in the US, undermining and hollowing out important scientific and medical institutions to the detriment of the nation’s health.

[Dr Prinsley]

Does the hon. Member agree that the invention of vaccination by Jenner centuries ago is the single most important medical invention we have had in this country?

[Helen Morgan]

I absolutely agree. My mother and grandmother both had polio, which nobody would expect to experience in this day and age. That same grandmother’s sister died of diphtheria, and her father had smallpox. That was all just over 100 years ago, so it was not too long ago that people were experiencing what we now consider to be antiquated and unthinkable diseases.

The vaccination programmes that have been brought in over the past century have undoubtedly been game-changing for public health, not least for people growing up with working-class backgrounds, as my family would have been. That is why it is so important to deal with the disinformation that allows unscientific and dangerous anti-vax views to be communicated convincingly to the wider community.

--- Later in debate ---

[Dr Prinsley]

I am interested in what the hon. Member has to say about strike action. I was involved in trying to get the resident doctors’ strike stopped, but was unsuccessful for many months. I think she is talking about the principle of whether people involved in medical care should ever go on strike. If she were to apply the proposed measure to medical practitioners, would she introduce the same rule for nurses?

[Dr Johnson]

If the hon. Gentleman reads new clauses 81 and 82 together, he will see that one of them would require doctors not to go on strike, because they are involved in the clinical decision making across the piece, while the other would make provision for staff across the NHS to be on minimum service level provision. That is something that I maintained under the previous Government as well: I do not think that doctors should go on strike, in the same way that the police and the military do not go on strike.

Medical professionals are key to the functioning of a hospital in a way that means they should not go on strike. Other staff within the hospital provide an extremely valuable and important service, but often several individuals provide that service, so it might be possible to say, “We can have three here rather than five today and still deliver most of the service.” Fundamentally, I do not think that it is morally right for doctors to go on strike, because in effect they are saying to people, “We know you’ve been waiting for your knee replacement for a year and we know your knee hurts, but we’re not going to do your knee replacement today, because we’re going to go on strike for more cash.” I just do not think that that is right. [Interruption.] I will take an intervention from my hon. Friend the Member for Farnham and Bordon.

--- Later in debate ---

[Gregory Stafford]

Well—I just say carry on, that’s what I say!

[Dr Prinsley]

Will the hon. Lady take another intervention, Ms Lewell?

[The Chair]

That is up to the hon. Lady.

[Dr Johnson]

I am very happy to take an intervention.

[Dr Prinsley]

This is, obviously, a very interesting discussion. I agree—I actually do—that medical practitioners should not go on strike, but the question is whether that should be the law. I would apply the same question to nurses, a point that the hon. Lady has not answered.

[Dr Johnson]

For generations, it has not needed to be the law: doctors did not go on strike, because they recognised what would happen to patients if they did. Now that we know that doctors will go on strike, the landscape has changed. Consultants—I should say that I am an NHS consultant—have just balloted to go on strike, which will be fundamentally unsafe. The Government have a duty to keep people safe; first and foremost, that is the Government’s job. Doctors going on strike is fundamentally unsafe and should not happen. I agree with the hon. Member for Bury St Edmunds and Stowmarket that morally it should not need to be the law, but I think the evidence suggests that it does.

New clause 82 would make it

“an offence for medical practitioners to undertake strike action”,

and would provide for the Secretary of State to repeal any necessary clauses of other employment regulations in order to do so. New clause 81 concerns the minimum service levels provided across the NHS. There are staff who provide an important and valuable service but whose jobs may not be clinical; for example, services may be able to run with slightly fewer porters if they want to go on strike.

I hope that no member of NHS staff would want to go on strike. I hope they would want to make sure that patients were getting care, and I hope they would recognise that, in a universal service, they are essentially causing harm to the patients around them, who are their friends, their neighbours, the people who live on their street and the people who would look after them. However, the evidence suggests that that is happening, so I am afraid that these new clauses are necessary. We need to put a minimum number of staff in place to support the doctors, and doctors should be at work to make sure that patients are safe.

[Karin Smyth]

There have been interesting discussions on these new clauses. I recognise that the intention behind them is to reduce the impact on patients and NHS budgets when doctors take industrial action. That is an objective that we all support, but I do not agree that the new clauses are the best way to achieve it.

I respect the shadow Minister’s professional background and the strong moral case she set out to explain why she does not feel it is appropriate. For a long time, as she says, doctors did not go on strike, but something changed in the industrial relations landscape roughly 10 years ago to start that process, that change of culture and that frustration that led doctors to strike. I listened with interest to the former Health and Social Care Secretary, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), reflecting on this issue recently—we’re all subject to podcasts these days, aren’t we? He spoke about those relationships at the time, and I think we should learn from that; it is very helpful to have those recollections. But something changed, and this has been the result.

I pay tribute to my hon. Friend the Member for Bury St Edmunds and Stowmarket and many others of his vintage, if I can say that—

[Dr Prinsley]

A fine vintage.

[Karin Smyth]

Indeed. They wanted to work with resident doctors to talk through a way to make progress without resorting to strike action, because that is a sign of failure in any system.

On new clause 81, we are committed to reforming trade union legislation to bring it into the 21st century. We want to create an industrial relations framework that is fit for a modern economy, and workplaces that work for everyone. That is why the Employment Rights Act 2025 repealed the Strikes (Minimum Service Level) Act 2023. The previous legislation created a hostile environment, which was not conducive to good partnership working with trade unions or to settling disputes.

On new clause 82, although strikes are hugely disruptive, a ban on a doctor’s right to strike is not the answer.

--- Later in debate ---

[Dr Johnson]

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

Advice and guidance services were an improvement. Previously, if a general practitioner wanted to refer someone to hospital, a consultant would triage the referral. Sometimes, the referral was not needed, so a message would be written to the GP saying, “I wonder if you’ve tried this” or “Could you give more information, please?” Improving that process was the advice and guidance service, which in many ways is beneficial.

I am, however, concerned by the suggestion earlier in the year that advice and guidance will become a compulsory feature, and that only after advice and guidance has been received will there be potential for referral. Instead of a GP being able to refer to a consultant and a consultant being able to accept that referral, advice and guidance will have to be sought first. That will cause a delay in patient pathways and flow. It may mean that the date on which the person is added to the waiting list for an appointment is a couple of days later. That may slow things down and improve the figures, but I cannot see any clinical benefit from mandating it.

There is also a concern that there would be what is called a diversion rate of at least 25% by March 2027 for at least 10 high-volume specialties. I am concerned about that. If someone gets to the point of being given a hospital appointment, that is because the clinician who saw them in primary care used their clinical judgment to decide that the patient needed that appointment, and the consultant triaging the referral used their clinical judgment to decide that the patient needed to be seen.

[Dr Prinsley]

I wonder whether the hon. Member’s experience mirrors mine. Many years ago, it seemed to be easy for general practitioners to ring me up. I often received telephone calls from general practitioners asking for advice about patients. As time went on, general practitioners became busier and busier and seemed to have less time to telephone consultants. When I started my consultant career, I spoke often to general practitioners, and by the time I got elected to Parliament and had to stop, I found that was a very unusual thing. Has her experience been similar?

[Dr Johnson]

I think we are all getting busier. As such, it is harder for clinicians in primary care to phone the consultant and speak to them, because both are busy and potentially seeing patients. I am not criticising the ability to have an advice and guidance service, because it is helpful. We do the same with specialists in tertiary centres, for example. One might send them a message asking a question. Advice and guidance is a good principle. My concern is that it would remove the ability for consultants to refer directly, introducing an unnecessary delay in the system. Are we questioning the judgment of clinicians? Why do we want to reduce the number of patients who get put on the list by a quarter?

I recognise, as I am sure the hon. Member for Bury St Edmunds and Stowmarket does, that sometimes referrals could be better directed. There is a mechanism already for doing that, but new clause 86 reflects the fact that general practitioners should still be able to refer patients using their clinical judgment to a consultant. That may be someone who the patient has chosen to see or who the GP believes is right for the patient’s condition.

[Dr Prinsley]

The other important fact is that more and more hospital referrals were not coming from general practitioners at all, but from other people working in the general practice such as nurses and physician associates, who are less confident in forming a clinical judgment.

[Dr Johnson]

If they are, they can use the advice and guidance service. The point is that when a general practitioner wants to refer his or her patient to a consultant on the basis of their clinical need, they should be able to. That is the purpose of the new clause.

--- Later in debate ---

[Dr Johnson]

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

Under the Government’s preference-informed allocation scheme, when a doctor is applying for a foundation post, they are allocated randomly to a job. They get to express a preference, but there is no work they can do to make them more likely to get where they want to be; there are no certificates they can earn, there is no research they can do, and there are no exam results they can get that would improve their chances. That is fundamentally wrong.

The Government say that many people get their first choice, which is true. That is great for them, but it is not great for the people who do not get their choice and have no control over their future. We had a very good debate on this subject, attended by many people in this room, in January, and there was widespread agreement on both sides of the House that it was the wrong thing to do. The Minister said at the time that the Government would keep the system under review. Has the Minister reviewed the system? Does she believe that we should prioritise medical graduates with the most relevant qualifications, clinical experience and skills? Does she think that doctors should have the opportunity to have control over where in the country they work and what jobs they do? Should doctors be able to work harder, aim for better results or do additional activities in order to get themselves the job they want, or does she think it should all be done by a computer?

I would be interested to hear the Minister’s thoughts. The new clause makes clear our position that meritocracy should prevail and people should be rewarded for the work they do and the results they get, and that we should be hiring the best clinicians who apply for the jobs.

[Dr Prinsley]

I think the new clause refers specifically to the foundation programme—

[Dr Johnson]

Correct.

[Dr Prinsley]

Does it actually say that in the new clause?