Health Bill 2026-27

None 98A

Clause 25, page 18, line 17, at end insert—
“(2B) In preparing a neighbourhood health plan, the responsible local authority and each of its partner integrated care boards must—
(a) consider the effects on health and development, and the risks of harm, of children’s digital environment for children of all ages in the authority’s area, and in particular for children aged 0 to 5, and
(b) where the assessment of relevant needs identifies needs relating to those effects or risks, set out in the plan how those needs are to be met.
(2C) Guidance issued under subsection (4) must include guidance on how authorities should discharge their duties under subsection (2B), including how to involve health visitors, school nurses and family hubs.
(2D) In subsection (2B)—
“children’s digital environment” means the devices, services, content and platforms with which children interact, including screens, online services, social media, games, messaging services and artificial intelligence tools;
“effects on health and development” includes effects on—
(a) language, cognitive, and social and emotional development,
(b) sleep, physical activity and healthy weight,
(c) eyesight, and
(d) mental health and wellbeing;
“risks of harm” means risks of harm to children’s health and development arising from harmful or age-inappropriate online content, online contact with adults or other children, online conduct and online advertising.”

None 279F

After Clause 84, insert the following new Clause—
“Children’s digital environment: guidance and training for health professionals in England
(1) The Secretary of State must, within six months of the day on which this Act is passed, publish guidance for health professionals on the effects on health and development, and the risks of harm, of children’s digital environment.
(2) The guidance must apply to children of all ages and must in particular address children aged 0 to 5.
(3) The guidance must draw on advice from health professionals, researchers and academics, must be consistent with any guidance for parents and carers on screen use published by the Secretary of State, and must address—
(a) the effects of children’s digital environment on health and development at different ages, including for children with special educational needs or disabilities,
(b) recommended limits on screen time, screen-free times and places to promote children’s health,
(c) the effect of parents’ and carers’ own use of devices on children’s health, and
(d) how to raise these matters with children, parents and carers in a supportive, non-judgemental way, and where to refer or signpost them for further support.
(4) The Secretary of State must exercise functions under section 1F of the National Health Service Act 2006 (duty as to education and training) with a view to ensuring that education and training on the guidance is available to health professionals who work with children and their families, including health visitors, general practitioners, practice nurses, midwives, school nurses, speech and language therapists, community paediatricians, optometrists and staff of family hubs.
(5) Before publishing or revising the guidance, the Secretary of State must consult such persons as the Secretary of State considers appropriate, including relevant professional bodies and royal colleges.
(6) The Secretary of State must review the guidance at least every three years.
(7) The Secretary of State must, within two years of the day on which this Act is passed, lay before Parliament a report on the availability and uptake of the education and training under subsection (4).
(8) In this section—
“children’s digital environment” means the devices, services, content and platforms with which children interact, including screens, online services, social media, games, messaging services and artificial intelligence tools;
“effects on health and development” includes effects on—
(a) language, cognitive, and social and emotional development,
(b) sleep, physical activity and healthy weight,
(c) eyesight, and
(d) mental health and wellbeing;
“risks of harm” means risks of harm to children’s health and development arising from harmful or age-inappropriate online content, online contact with adults or other children, online conduct and online advertising.”

None 279G

After Clause 84, insert the following new Clause—
“Children’s digital environment: universal health reviews in England
(1) The Secretary of State must, within six months of the day on which this Act is passed, ensure that the Healthy Child Programme guidance, and any successor to it, includes provision on the effects on health and development, and the risks of harm, of children’s digital environment.
(2) The guidance must provide that, as part of the universal health and development reviews offered to children aged 0 to 5 and their parents and carers, health professionals offer—
(a) information on guidance for parents and carers on screen use and online safety published by the Secretary of State;
(b) an opportunity to discuss—
(i) the child’s use of screens and digital technology,
(ii) parents’ and carers’ own use of devices,
(iii) screen-free routines, and
(iv) the risks of harm to the child’s health and development of their digital environment;
(c) where appropriate, further support or signposting.
(3) The guidance must make provision of a similar kind, appropriate to their age, for the health and development contacts offered to school-age children under the Healthy Child Programme.
(4) The Secretary of State must ensure that information on the matters in subsection (2)(b) is included in the personal child health record, in whatever form it is provided.
(5) In this section—
“children’s digital environment” means the devices, services, content and platforms with which children interact, including screens, online services, social media, games, messaging services and artificial intelligence tools;
“effects on health and development” includes effects on—
(a) language, cognitive, and social and emotional development,
(b) sleep, physical activity and healthy weight,
(c) eyesight, and
(d) mental health and wellbeing;
“risks of harm” means risks of harm to children’s health and development arising from harmful or age-inappropriate online content, online contact with adults or other children, online conduct and online advertising.”

None 279H

After Clause 84, insert the following new Clause—
“Report on dementia care
(1) Within 12 months of the day on which this Act is passed and every 12 months thereafter, the Secretary of State must publish and lay before both Houses of Parliament a report on—
(a) the provision of NHS care in relation to dementia;
(b) the provision of social care in relation to dementia.
(2) A report under subsection (1) must have regard to—
(a) any targets or standards set out in any national plan, guidance or framework relating to dementia services, and
(b) any other information the Secretary of State considers appropriate.
(3) A report under subsection (1) must include—
(a) an assessment of variation in dementia services and outcomes between integrated care board areas,
(b) information on workforce capacity, capability and training standards relevant to dementia care,
(c) information on access to ongoing post-diagnostic support services, including support for unpaid carers of dementia patients,
(d) information on continuity and coordination of care for people living with dementia, including access to a named professional responsible for coordinating support across services,
(e) outcomes and experiences for people living with dementia and unpaid carers, including crisis prevention, carer wellbeing, and experiences of joined-up care,
(f) progress on dementia prevention and risk reduction, and
(g) dementia research activity in the NHS.”

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

None 279J

After Clause 84, insert the following new Clause—
“Review of continued professional development for nurses and midwives
(1) Within six months of the day on which this Act is passed, the Secretary of State must carry out a review of continued professional development for nurses and midwives.
(2) The review must in particular assess—
(a) the level of funding available for continued professional development for nurses and midwives, and
(b) the protected time available to nurses and midwives for continued professional development.
(3) The Secretary of State must publish a report of the findings of the review.”

None 279K

After Clause 84, insert the following new Clause—
“Oversight of funeral service provider premises and practices connected to the storage, preparation and movement of human remains
(1) The Secretary of State may by regulations made by statutory instrument establish a body corporate, or confer functions on an existing public authority (“the regulator”), to provide oversight of the premises and practices connected to the storage, preparation and movement of human remains by funeral service providers in England.
(2) The purpose of the regulator is to ensure that the activities undertaken under subsection (1) are consistent with the protection of public health.
(3) The regulator is independent in the exercise of its functions and is not to be regarded as a servant or agent of the Crown.
(4) Regulations under this section may, in particular, make provision for—
(a) a scheme for the registration of funeral service providers,
(b) the inspection of premises, vehicles and other facilities used by registered providers for the storage, preparation, care or transportation of deceased persons, or from which funeral services are arranged or conducted,
(c) the publication and enforcement of a code of practice for the funeral services sector, and
(d) the imposition of sanctions, including suspension or removal from the register, for breach of that code.
(5) Before making regulations under this section, the Secretary of State must consult—
(a) providers of funeral services,
(b) such persons representing the interests of bereaved people as the Secretary of State considers appropriate, and
(c) such other persons as the Secretary of State considers appropriate.
(6) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

None 279L

After Clause 84, insert the following new Clause—
“Remit of the Human Tissue Authority
(1) The Secretary of State must, within six months of the day on which this Act is passed, by order under section 14(4) of the Human Tissue Act 2004, amend the remit of the Human Tissue Authority to include the regulation of funeral directors, private mortuaries, direct cremation services and other organisations which transport or hold the bodies of deceased persons for the purposes of ensuring that the carrying out of their functions is consistent with the protection of public health.
(2) The Authority must establish and maintain a register of the bodies subject to its oversight under subsection (1).
(3) The Secretary of State may by regulations made by statutory instrument make further provision regarding the establishment and operation of the register under subsection (2).
(4) A statutory instrument containing regulations under subsection (3) may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

None 172B

After Clause 56, insert the following new Clause—
“Termination of the NHS Federated Data Platform contract
(1) The Secretary of State must take all necessary steps to ensure that the contract with Palantir Technologies UK Limited (“Palantir”) for the provision of the NHS Federated Data Platform is not extended beyond its initial contractual term ending on 15 February 2027.
(2) The Secretary of State must ensure that the first available contractual right to terminate or decline to extend that contract is exercised.
(3) The Secretary of State must not enter into, or permit any relevant NHS body to enter into, a replacement agreement with Palantir Technologies UK Limited or an associated undertaking for the provision of substantially the same national NHS data infrastructure.
(4) Within three months of the day on which this Act is passed, the Secretary of State must publish a plan for the transfer of the functions of the Federated Data Platform to infrastructure under public control.
(5) The plan must include arrangements to ensure continuity of NHS services, the secure transfer of data and the termination of the access to NHS systems and data of Palantir and its subcontractors, subject only to access strictly necessary for a time-limited transition.
(6) The Secretary of State must report to Parliament every three months on progress in implementing the plan until the transfer is complete.”

This amendment requires the Government to end the NHS Federated Data Platform contract with Palantir at the first available contractual opportunity, prevents substantially equivalent replacement arrangements, and requires a transition to publicly controlled infrastructure.

None 279R

After Schedule 11, insert the following new Schedule—
“SCHEDULE
AMENDMENTS TO THE HUMAN FERTILISATION AND EMBRYOLOGY ACT 1990
Introduction
1 The Human Fertilisation and Embryology Act 1990 is amended in accordance with this Schedule.
Duties
2 For section 8ZA, substitute—
“8ZA Duties in relation to carrying out its functions
(1) In exercising its functions under this Act, the Authority must have regard to the need to protect the health, safety, welfare and interests of—
(a) persons receiving, or considering receiving, treatment services;
(b) persons providing gametes or embryos for use in activities governed by this Act;
(c) persons who may be born as a result of treatment services;
(d) any other persons whose health, safety, welfare or interests may be materially affected by activities governed by this Act.
(2) In discharging its functions, the Authority must have regard, in particular, to the need to—
(a) promote safe and evidence-based treatment;
(b) protect persons from avoidable harm arising from treatment services;
(c) ensure that persons receiving or considering treatment services are provided with accurate and comprehensible information about the nature, risks, benefits and limitations of those services;
(d) promote compliance with the requirements of this Act and any regulations or licence conditions made under it.
(3) The Authority must exercise its regulatory functions effectively, proportionately, efficiently and economically having regard to the—
(a) nature and seriousness of any actual or potential risk to persons referred to in subsection (1);
(b) likelihood of that risk materialising;
(c) steps reasonably available to prevent or mitigate that risk;
(d) need to avoid imposing unnecessary regulatory burdens on persons carrying on activities governed by this Act.”
Enforcement
3 After section 19C, insert—
“19D Enforcement notices
(1) Where the Authority is satisfied that a person has failed, or is failing, as described in section 18(2) (revocation of licence), the Authority may give the person a written notice (an “enforcement notice”) which requires the person to—
(a) take steps specified in the notice, or
(b) refrain from taking steps specified in the notice,
or both (see also section 19E).
(2) An enforcement notice specified under subsection (1) may only impose requirements which the Authority considers appropriate having regard to the failure (whether or not for the purpose of remedying the failure).
19E Enforcement notices: supplementary
(1) An enforcement notice must—
(a) state what the person has failed or is failing to do, and
(b) give the Authority’s reasons for reaching that opinion.
(2) In deciding whether to provide an enforcement notice specified under section 19D(1), the Authority must consider whether the failure has caused, or is likely to cause, any person damage or distress.
(3) An enforcement notice may specify the time or times at which, or period or periods within which, a requirement imposed by the notice must be complied with, subject to the restrictions in subsections (5) to (7).
(4) An enforcement notice must provide information about the—
(a) consequences of failure to comply with it, and
(b) rights under sections 21 (appeal on a point of law).
(5) An enforcement notice must not specify a time for compliance with a requirement in the notice which falls before the end of the period within which an appeal can be brought against the notice.
(6) If an appeal is brought against an enforcement notice, a requirement in the notice need not be complied with pending the determination or withdrawal of the appeal.
(7) If an enforcement notice—
(a) states that, in the Authority’s opinion, it is necessary for a requirement to be complied with urgently, and
(b) gives the Authority’s reasons for reaching that opinion,
subsections (5) and (6) do not apply but the notice must not require the requirement to be complied with before the end of the period of 24 hours beginning when the notice is given.
(8) In this section, “specified” means specified in an enforcement notice.
19F Enforcement notices: cancellation and variation
(1) The Authority may cancel or vary an enforcement notice by giving written notice to the person to whom it was given.
(2) A person to whom an enforcement notice is given may apply in writing to the Authority for the cancellation or variation of the notice.
(3) An application under subsection (2) may be made only—
(a) after the end of the period within which an appeal can be brought against the notice, and
(b) on the ground that, by reason of a change of circumstances, one or more of the provisions of that notice need not be complied with in order to remedy the failure identified in the notice.”
“Penalties
19G Penalty notices
(1) If the Authority is satisfied that a person has—
(a) failed or is failing as described in section 19D(1) (enforcement notices), or
(b) failed to comply with an enforcement notice,
the Authority may, by written notice (a “penalty notice”), require the person to pay the Authority an amount in sterling specified in the notice.
(2) When deciding whether to give a penalty notice to a person and determining the amount of the penalty, the Authority must have regard to the following, so far as relevant to the extent that the notice concerns another matter, matters listed in subsection (3).
(3) Matters which the Authority must have regard to in issuing a penalty notice include—
(a) the nature, gravity and duration of the failure;
(b) the intentional or negligent character of the failure;
(c) any action taken by the person to mitigate the damage or distress suffered by persons;
(d) any relevant previous failures by the person;
(e) the degree of co-operation with the Authority, in order to remedy the failure and mitigate the possible adverse effects of the failure;
(f) the categories of the failure in regards to licensable activities;
(g) the manner in which the infringement became known to the Authority, including whether, and if so to what extent, the person notified the Authority of the failure;
(h) the extent to which the person has complied with previous enforcement notices or penalty notices;
(i) adherence to approved codes of conduct or certification mechanisms;
(j) any other aggravating or mitigating factor applicable to the case, including financial benefits gained, or losses avoided, as a result of the failure (whether directly or indirectly);
(k) whether the penalty would be effective, proportionate and dissuasive.
(4) Schedule 4AZA makes further provision about penalty notices, including provision requiring the Authority to give a notice of intent to impose a penalty and provision about payment, variation, cancellation and enforcement.
(5) The Secretary of State may by regulations—
(a) confer power on the Authority to give a penalty notice in respect of other failures to comply with the requirements of licensable activities, and
(b) provide for the maximum penalty that may be imposed in relation to such failures to be either the standard maximum amount or the higher maximum amount.
(6) Regulations under this section may—
(a) make provision about the giving of penalty notices in respect of the failure, and
(b) amend this section and section 19H (maximum amount of penalty).
(7) In this section, “higher maximum amount” and “standard maximum amount” have the same meaning as in section 19H.
19H Maximum amount of penalty
(1) In relation to a failure to comply with an enforcement notice, the maximum amount of the penalty that may be imposed by a penalty notice is the higher maximum amount.
(2) In relation to an infringement of a provision of this Act where subsection (1) does not apply the maximum amount of the penalty that may be imposed by a penalty notice is the standard maximum amount.
(3) The “higher maximum amount” is—
(a) in the case of an undertaking, £17,500,000 or 4% of the undertaking's total annual worldwide turnover in the preceding financial year, whichever is higher, or
(b) in any other case, £17,500,000.
(4) The “standard maximum amount” is—
(a) in the case of an undertaking, £8,700,000 or 2% of the undertaking's total annual worldwide turnover in the preceding financial year, whichever is higher, or
(b) in any other case, £8,700,000.
(5) The Secretary of State may by regulations—
(a) provide that a person of a description specified in the regulations is or is not an undertaking, and
(b) make provision about how an undertaking’s turnover is to be determined.
(6) The Secretary of State may by regulations provide that a period is or is not a financial year.”
4 Before section 20 insert—
“Appeals etc”
5 In section 20 (right to reconsideration of licensing decisions), in subsections (1), (2) and (4), for “require” substitute “request”.
6 For section 21, substitute—
“21 Rights of appeal
(1) A person aggrieved by a decision on reconsideration in pursuance of a notice under section 20 (right to reconsideration of licensing decisions) may appeal to the court.
(2) A person who is given any of the following notices may appeal to the court—
(a) an enforcement notice;
(b) a penalty notice;
(c) a penalty variation notice.
21A Determination of appeals
(1) Subsections (2) to (4) apply where a person appeals to the court under section 21(1) or (2).
(2) The court may review any determination of fact on which the notice or decision against which the appeal is brought was based.
(3) If the court considers—
(a) that the notice or decision against which the appeal is brought is not in accordance with the law, or
(b) to the extent that the notice or decision involved an exercise of discretion by the Authority, that the Authority ought to have exercised the discretion differently,
the court must allow the appeal or substitute another notice or decision which the Authority could have given or made.
(4) Otherwise, the court must dismiss the appeal.
21B Applications in respect of urgent notices
(1) This section applies where an enforcement notice given to a person contains an urgency statement.
(2) The person may apply to the court for either or both of the following—
(a) the disapplication of the urgency statement in relation to some or all of the requirements of the notice;
(b) a change to the time at which, or the period within which, a requirement of the notice must be complied with.
(3) On an application under subsection (2), the court may do any of the following—
(a) direct that the notice is to have effect as if it did not contain the urgency statement;
(b) direct that the inclusion of the urgency statement is not to have effect in relation to a requirement of the notice;
(c) vary the notice by changing the time at which, or the period within which, a requirement of the notice must be complied with;
(d) vary the notice by making other changes required to give effect to a direction under paragraph (a) or (b) or in consequence of a variation under paragraph (c).
(4) The decision of the court on an application under this section is final.
(5) In this section, “urgency statement” means a statement under section 19E(7)(a).
21C Jurisdiction
(1) The jurisdiction conferred on a court by section 21 (rights of appeal) is exercisable—
(a) in England and Wales, by the High Court or the county court,
(b) in Scotland, by the Court of Session or the sheriff,
(c) in Northern Ireland, by the High Court or a county court,
subject to subsection (2).
(2) The jurisdiction conferred on a court by section 21B (applications in respect of urgent notices) is exercisable only by the High Court or, in Scotland, the Court of Session.”
7 In section 45(4A) (regulations), insert at the appropriate place— “sections 19G (penalty notices) and 19H (maximum amount of penalty);”.
8 After Schedule 3A insert—
“Schedule 3AZASection 19G
PENALTIES
Meaning of “penalty”
1 In this Schedule, “penalty” means a penalty imposed by a penalty notice.
Notice of intent to impose penalty
2 Before giving a person a penalty notice, the Authority must, by written notice (a “notice of intent”) inform the person that the Authority intends to give a penalty notice.
Contents of notice of intent
3 (1)A notice of intent must contain the following information—
(a)the name and address of the person to whom the Authority proposes to give a penalty notice;
(b)the reasons why the Authority proposes to give a penalty notice (see sub-paragraph (2));
(c)an indication of the amount of the penalty the Authority proposes to impose, including any aggravating or mitigating factors that the Authority proposes to take into account.
(2)The information required under sub-paragraph (1)(b) includes—
(a)a description of the circumstances of the failure, and
(b)the nature, gravity and duration of the failure.
(3)A notice of intent must also—
(a)state that the person may make written representations about the Authority’s intention to give a penalty notice, and
(b)specify the period within which such representations may be made.
(4)The period specified for making written representations must be a period of not less than 21 days beginning when the notice of intent is given.
(5)If the Authority considers that it is appropriate for the person to have an opportunity to make oral representations about the Authority’s intention to give a penalty notice, the notice of intent must also—
(a)state that the person may make such representations, and
(b)specify the arrangements for making such representations and the time at which, or the period within which, they may be made.
Giving a penalty notice
4 (1)This paragraph applies where the Authority gives a notice of intent to a person.
(2)Within the period of six months beginning when the notice is given, or as soon as reasonably practicable thereafter, the Authority must give to the person—
(a)a penalty notice, or
(b)written notice that the Authority has decided not to give a penalty notice to the person.
(3)The Authority may not give a penalty notice to the person before a time, or before the end of a period, specified in the notice of intent for making oral or written representations.
(4)When deciding whether to give a penalty notice to the person and determining the amount of the penalty, the Authority must consider any oral or written representations made by the person in accordance with the notice of intent.
Contents of a penalty notice
5 (1)A penalty notice must contain the following information—
(a)the name and address of the person to whom it is addressed;
(b)details of the notice of intent given to the person;
(c)whether the Authority received oral or written representations in accordance with the notice of intent;
(d)the reasons why the Authority proposes to impose the penalty (see sub-paragraph (2));
(e)the reasons for the amount of the penalty, including any aggravating or mitigating factors that the Authority has taken into account;
(f)details of how the penalty is to be paid;
(g)details of the rights of appeal under section 21;
(h)details of the Authority’s enforcement powers under this Schedule.
(2)The information required under sub-paragraph (1)(d) includes—
(a)a description of the circumstances of the failure, and
(b)the nature, gravity and duration of the failure.
Period for payment of penalty
6 (1)A penalty must be paid to the Authority within the period specified in the penalty notice.
(2)The period specified must be a period of not less than 28 days beginning when the penalty notice is given.
Variation of penalty
7 (1)The Authority may vary a penalty notice by giving written notice (a “penalty variation notice”) to the person to whom it was given.
(2)A penalty variation notice must specify—
(a)the penalty notice concerned, and
(b)how it is varied.
(3)A penalty variation notice may not—
(a)reduce the period for payment of the penalty;
(b)increase the amount of the penalty;
(c)otherwise vary the penalty notice to the detriment of the person to whom it was given.
(4)If—
(a)a penalty variation notice reduces the amount of the penalty, and
(b)when that notice is given, an amount has already been paid that exceeds the amount of the reduced penalty,
the Authority must repay the excess.
Cancellation of penalty
8 (1)The Authority may cancel a penalty notice by giving written notice to the person to whom it was given.
(2)If a penalty notice is cancelled, the Authority—
(a)may not take any further action under section 19G or this Schedule in relation to the failure to which that notice relates, and
(b)must repay any amount that has been paid in accordance with that notice.
Enforcement of payment
9 (1)The Authority must not take action to recover a penalty unless—
(a)the period specified in accordance with paragraph 6 has ended,
(b)any appeals against the penalty notice have been decided or otherwise ended,
(c)if the penalty notice has been varied, any appeals against the penalty variation notice have been decided or otherwise ended, and
(d)the period for the person to whom the penalty notice was given to appeal against the penalty, and any variation of it, has ended.
(2)In England and Wales, a penalty is recoverable—
(a)if the county court so orders, as if it were payable under an order of that court;
(b)if the High Court so orders, as if it were payable under an order of that court.
(3)In Scotland, a penalty may be enforced in the same manner as an extract registered decree arbitral bearing a warrant for execution issued by the sheriff court of any sheriffdom in Scotland.
(4)In Northern Ireland, a penalty is recoverable—
(a)if a county court so orders, as if it were payable under an order of that court;
(b)if the High Court so orders, as if it were payable under an order of that court.”
9 (1)Schedule 3B is amended in accordance with this paragraph.
(2)In paragraph 2, after sub-paragraph (1) insert—
(1A)If requested to do so by the Secretary of State, the Authority must arrange for a duly authorised person to inspect any of the premises mentioned in sub-paragraph (3).
(1B)The Authority may arrange for a duly authorised person to inspect any of the premises referred to in sub-paragraph (3) in circumstances where it is not required to do so by sub-paragraph (1) or (1A).”
(3)After paragraph 2 insert—
“Considerations relating to inspection frequency
2A (1)In determining the frequency, timing and scope of inspections, the Authority must have regard to the risks associated with the activities authorised by the licence.
(2)The matters to which the Authority must have regard include—
(a)the nature and seriousness of any incident or suspected breach of a licence condition;
(b)complaints or concerns received from patients, donors, persons born as a result of treatment, or staff;
(c)the history of compliance by the licence holder;
(d)the adequacy of action taken in response to previous inspection findings;
(e)the risks to the health, safety or welfare of persons receiving or providing treatment, and to the security and integrity of gametes and embryos.
(3)The Authority must maintain and periodically review a database for assessing the risks referred to in this paragraph.
(4)The Secretary of State may by regulations make further provision about the contents and information standards of the database.”
(4)After paragraph 8 insert—
“Action following an inspection”
(5)In paragraph 9 for sub-paragraph (5), substitute—
(5)The Authority must give a copy of the report or information to—
(a)the person requesting it, unless the Authority considers that it would be inappropriate to do so in the particular circumstances of the case, and
(b)the Secretary of State.
(6)The Authority must include in its annual report information about the exercise of its inspection and enforcement functions.
(7)The Secretary of State may by regulations make further provision about the contents of reports under this paragraph.”
(6)After paragraph 9 insert—
“9A (1)Where an inspection identifies a material deficiency in the operation of licensed activities, the Authority must determine what further action is necessary and proportionate.
(2)The Authority may require the licence holder to submit and implement a corrective action plan within a specified period.
(3)A corrective action plan must specify—
(a)he deficiency to be addressed;
(b)the steps to be taken to address it;
(c)the person responsible for each step;
(d)the date by which each step to be complied.
(e)any other condition as may be specified in regulations made by the Secretary of State.
(4)A corrective action plan must be sent to the Authority by such period as the Authority may specify.
(5)After receiving the corrective action plan, the Authority must within 28 days consider whether a further inspection is necessary under paragraph 2 to determine whether the deficiency has been remedied.
9BThe Secretary of State may by regulations make provision for the contents of an inspection report.”
10 In section 7 (reports to the Secretary of State), after subsection (2), insert—
“(2A) A report prepared under this section must include information about—
(a) inspections carried out by the Authority,
(b) a corrective action plan in place under paragraph 9A of Schedule 3B, and
(c) the improvements made to remedy any deficiencies in relation to such corrective action plan.”
Complaints
11 After section 8D, insert—
“8DA Complaints relating to licensed activities
(1) The Authority must establish and maintain procedures for receiving, assessing and investigating complaints relating to activities governed by this Act.
(2) The Authority must investigate a complaint where it has reasonable grounds to suspect—
(a) a serious breach of a requirement imposed by or under this Act;
(b) a material failure to comply with a licence condition;
(c) conduct presenting a significant risk to the health, safety or welfare of a person;
(d) a systemic failure affecting patients, donors or other persons materially affected by activities governed by this Act.
(3) The Authority must, as soon as reasonably practicable after receiving a complaint, determine whether any of the circumstances in subsection (2) apply.
(4) Where the Authority decides not to investigate a complaint, it must give the complainant a statement of reasons for that decision.
(5) Where the Authority investigates a complaint, it must—
(a) conduct the investigation as soon as reasonably practicable;
(b) keep the complainant reasonably informed of the progress of the investigation;
(c) notify the complainant of the outcome;
(d) give reasons for its findings and any regulatory action taken, subject to any lawful restriction on disclosure.
(6) The Authority may decline to investigate, or may suspend an investigation, where it considers that doing so is necessary and proportionate having regard to—
(a) the availability of a more appropriate procedure for determining the matter;
(b) ongoing civil or criminal proceedings;
(c) the vexatious or excessive use of the complaints procedure.
(7) The Authority must give a statement of reasons for a decision under subsection (6).”
Reporting in relation to licensable activities
12 (1)Section 17 (the person responsible) is amended in accordance with this paragraph.
(2)In subsection (1)(g), at end insert “; and of any prescribed near miss which indicates a material risk to the health, safety or welfare of a person or to the security or integrity of gametes or embryos.”
(3)After subsection (2) insert—
(2A)In subsection (1)(g) “prescribed” means prescribed in regulations made by the Secretary of State.””
13 After section 31B, insert—
“31C Reporting and investigation of serious adverse events
(1) The Authority must issue a code of practice establishing requirements governing the notification, recording and investigation of serious adverse events, serious adverse reactions and prescribed near misses arising in connection with licensable activities.
(2) The requirements must include provision about—
(a) the circumstances in which an incident or near miss must be notified to the Authority;
(b) the period within which notification must be given;
(c) the information to be included in a notification;
(d) the investigation and analysis of the causes of an incident or near miss;
(e) the identification and implementation of measures to prevent recurrence;
(f) the preservation of relevant records and electronic audit trails.
(3) The Authority must monitor notifications received under this section for the purpose of identifying recurring incidents, systemic failures and emerging risks.
(4) The Authority must publish information about significant trends identified under subsection (3), subject to the protection of personal data and confidential information.
(5) Requirements under this section must be proportionate to the seriousness and nature of the incident or near miss.
(6) The Authority may revise or revoke a code issued under this section.
(7) The Authority must send a copy of the code to the Secretary of State.
(8) The Secretary of State must lay a copy of the code before each House of Parliament.”
14 In section 12 (general conditions), in subsection (1), after paragraph (g), insert—
“(h) that the responsible person will comply with any requirements of a code of practice issued under section 31C.”
Continuity plans
15 In Schedule 2, after paragraph 4, insert—
“Continuity plans
4A (1)The Authority must ensure that the conditions of a licence authorising the storage of gametes or embryos require the licence holder to maintain a continuity plan.
(2)A continuity plan must make provision for the safe and lawful management, transfer or disposal of gametes and embryos where—
(a)the licence expires or is revoked;
(b)the licence holder ceases to carry on the licensed activities;
(c)the licence holder becomes unable to carry on those activities safely;
(d)the Authority determines that urgent arrangements are necessary to protect persons or stored gametes or embryos.
(3)A continuity plan must also include provision for—
(a)the identification of an appropriately licensed facility to which storage activities may be transferred;
(b)the preservation and transfer of records, consent documentation and information necessary to maintain traceability;
(c)the notification of affected persons, so far as reasonably practicable;
(d)the maintenance of appropriate storage conditions pending transfer or other lawful disposition;
(e)the allocation of responsibility for implementing the plan.
(4)The Authority must assess the adequacy of a continuity plan when considering an application for a licence or its renewal and may require the plan to be revised.
(5)The Authority may require a licence holder to implement a continuity plan, in whole or in part, where it considers that this is necessary to protect the health, safety or welfare of persons or to secure the safe and lawful management of stored gametes or embryos.
(6)The Secretary of State may by regulations make further provision in relation to the contents or requirements of continuity plans.””

This new Schedule amends the Human Fertilisation and Embryology Act 1990 to make provision about the Human Fertilisation and Embryology Authority.

None 279M

After Clause 84, insert the following new Clause—
“Amendments to the Human Fertilisation and Embryology Act 1990
Schedule (Amendments to the Human Fertilisation and Embryology Act 1990) amends the Human Fertilisation and Embryology Act 1990 to make provision about the Human Fertilisation and Embryology Authority.”

This amendment is consequential to others in the name of Baroness Deech.

Opposition Amendment 279N

After Clause 84, insert the following new Clause—
“NHS-funded in vitro fertilisation
(1) Within six months of the day on which this Act is passed, the Secretary of State must by regulations make arrangements for the standardised provision of NHS-funded in vitro fertilisation (IVF).
(2) Provision under this section must, in accordance with any existing NICE guidelines, set requirements for all integrated care boards in England relating to NHS-funded IVF.
(3) Requirements under subsection (2) must include—
(a) standardisation of the minimum number of rounds of IVF available to one individual, and
(b) standardisation of the maximum and minimum age at which an individual can access IVF.”

This new clause would require the Secretary of State to make regulations standardising NHS-funded IVF provision across all integrated care boards in England, in accordance with existing NICE guidelines, including the number of rounds available to an individual and the age limits for access.

None 288A

Clause 87, page 65, line 11, at the end insert—
“(ga) section (Amendments to the Human Fertilisation and Embryology Act 1990) (Amendments to the Human Fertilisation and Embryology Act 1990) and Schedule (Amendments to the Human Fertilisation and Embryology Act 1990) (Amendments to the Human Fertilisation and Embryology Act 1990);”

This amendment is consequential to others in the name of Baroness Deech.

None 290A

Clause 88, page 65, line 25, at the end insert—
“(c) section (Amendments to the Human Fertilisation and Embryology Act 1990) (Amendments to the Human Fertilisation and Embryology Act 1990) and Schedule (Amendments to the Human Fertilisation and Embryology Act 1990) (Amendments to the Human Fertilisation and Embryology Act 1990).”

This amendment is consequential to others in the name of Baroness Deech.

None 279P

After Clause 84, insert the following new Clause— “Safety of digital health technologies provided to children (1) An NHS body may only provide, prescribe or recommend a digital health technology for use by a child where it is satisfied that there is evidence that the technology is effective and safe for use by children of the relevant age, having regard to any relevant standards or guidance issued by the National Institute for Health and Care Excellence. (2) Before an NHS body provides, prescribes or recommends a digital health technology for use by a child, it must carry out an assessment of the risks of harm to that child arising from the use of the device on which the technology operates. (3) An assessment under subsection (2) must consider, in particular— (a) the extent to which use of the technology requires or encourages access to a digital technology device (especially during the night), (b) the risk that the device gives the child access to social media, messaging services, the internet or other content or services not needed for the technology to work, and (c) the age and needs of the child. (4) Where an NHS body provides, prescribes or recommends a digital health technology for use by a child, it must give the child’s parent or carer written advice on its safe use, including— (a) how to restrict access to other functions and content on the device, (b) the safe management of overnight use and alerts, and (c) the risks to children’s wellbeing associated with unrestricted digital technology device use. (5) Where the child is under the age of 16, the NHS body must take reasonable steps to ensure that the digital health technology is made available on— (a) a device dedicated solely to the use of that technology, or (b) a device configured so that access is restricted to that technology and to functions needed for the child’s safety, such as emergency calls. (6) Subsection (5) does not apply where— (a) a responsible clinician considers that compliance would be clinically inappropriate or would compromise the effective operation of the technology, or (b) the child’s parent or carer, having received the advice described in subsection (4), declines the arrangements described in subsection (5). (7) A decision under subsection (6) must be recorded in the child’s health record. (8) The Secretary of State must, within 12 months of the day on which this section comes into force, issue guidance to NHS bodies on the discharge of their duties under this section, having consulted such persons as the Secretary of State considers appropriate, including representatives of children, parents and clinicians. (9) Subsection (1) does not apply, for a period of two years beginning with the day on which this section comes into force, to a digital health technology that was being provided, prescribed or recommended for use by children by an NHS body immediately before that day, provided that during that period the NHS body— (a) informs the child’s parent or carer that evidence of the technology’s effectiveness and safety for children of the relevant age has not yet been established, and (b) keeps the use of the technology under review. (10) In this section— “child” means a person under the age of 18; “digital health technology” means software, including a mobile application, provided for the purpose of monitoring, managing, diagnosing or treating a physical or mental health condition, including but not limited to continuous glucose monitoring and insulin management applications and mental health applications; “NHS body” has the meaning given in section 275 of the National Health Service Act 2006.”

None 279Q

After Clause 84, insert the following new Clause— “Neural data The UK GDPR (Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data) is amended as follows— (a) in paragraph 1 of Article 4 (definitions), after subparagraph (14) insert— “(14A) “neural data” means personal data generated by measuring the activity of the central or peripheral nervous system of a natural person, including any inferences from that data, including information that can be used to provide information about the thoughts or health of that person;”; (b) in Article 9 (processing of special categories of personal data), paragraph 1, after “person,” insert “neural data,”.”

After Clause 56, insert the following new Clause— “Termination of the NHS Federated Data Platform contract (1) The Secretary of State must take all necessary steps to ensure that the contract with Palantir Technologies UK Limited (“Palantir”) for the provision of the NHS Federated Data Platform is not extended beyond its initial contractual term ending on 15 February 2027. (2) The Secretary of State must ensure that the first available contractual right to terminate or decline to extend that contract is exercised. (3) The Secretary of State must not enter into, or permit any relevant NHS body to enter into, a replacement agreement with Palantir Technologies UK Limited or an associated undertaking for the provision of substantially the same national NHS data infrastructure. (4) Within three months of the day on which this Act is passed, the Secretary of State must publish a plan for the transfer of the functions of the Federated Data Platform to infrastructure under public control. (5) The plan must include arrangements to ensure continuity of NHS services, the secure transfer of data and the termination of the access to NHS systems and data of Palantir and its subcontractors, subject only to access strictly necessary for a time-limited transition. (6) The Secretary of State must report to Parliament every three months on progress in implementing the plan until the transfer is complete.”

After Schedule 11, insert the following new Schedule— “SCHEDULE AMENDMENTS TO THE HUMAN FERTILISATION AND EMBRYOLOGY ACT 1990 Introduction 1 The Human Fertilisation and Embryology Act 1990 is amended in accordance with this Schedule. Duties 2 For section 8ZA, substitute— “8ZA Duties in relation to carrying out its functions (1) In exercising its functions under this Act, the Authority must have regard to the need to protect the health, safety, welfare and interests of— (a) persons receiving, or considering receiving, treatment services; (b) persons providing gametes or embryos for use in activities governed by this Act; (c) persons who may be born as a result of treatment services; (d) any other persons whose health, safety, welfare or interests may be materially affected by activities governed by this Act. (2) In discharging its functions, the Authority must have regard, in particular, to the need to— (a) promote safe and evidence-based treatment; (b) protect persons from avoidable harm arising from treatment services; (c) ensure that persons receiving or considering treatment services are provided with accurate and comprehensible information about the nature, risks, benefits and limitations of those services; (d) promote compliance with the requirements of this Act and any regulations or licence conditions made under it. (3) The Authority must exercise its regulatory functions effectively, proportionately, efficiently and economically having regard to the— (a) nature and seriousness of any actual or potential risk to persons referred to in subsection (1); (b) likelihood of that risk materialising; (c) steps reasonably available to prevent or mitigate that risk; (d) need to avoid imposing unnecessary regulatory burdens on persons carrying on activities governed by this Act.” Enforcement 3 After section 19C, insert— “19D Enforcement notices (1) Where the Authority is satisfied that a person has failed, or is failing, as described in section 18(2) (revocation of licence), the Authority may give the person a written notice (an “enforcement notice”) which requires the person to— (a) take steps specified in the notice, or (b) refrain from taking steps specified in the notice, or both (see also section 19E). (2) An enforcement notice specified under subsection (1) may only impose requirements which the Authority considers appropriate having regard to the failure (whether or not for the purpose of remedying the failure). 19E Enforcement notices: supplementary (1) An enforcement notice must— (a) state what the person has failed or is failing to do, and (b) give the Authority’s reasons for reaching that opinion. (2) In deciding whether to provide an enforcement notice specified under section 19D(1), the Authority must consider whether the failure has caused, or is likely to cause, any person damage or distress. (3) An enforcement notice may specify the time or times at which, or period or periods within which, a requirement imposed by the notice must be complied with, subject to the restrictions in subsections (5) to (7). (4) An enforcement notice must provide information about the— (a) consequences of failure to comply with it, and (b) rights under sections 21 (appeal on a point of law). (5) An enforcement notice must not specify a time for compliance with a requirement in the notice which falls before the end of the period within which an appeal can be brought against the notice. (6) If an appeal is brought against an enforcement notice, a requirement in the notice need not be complied with pending the determination or withdrawal of the appeal. (7) If an enforcement notice— (a) states that, in the Authority’s opinion, it is necessary for a requirement to be complied with urgently, and (b) gives the Authority’s reasons for reaching that opinion, subsections (5) and (6) do not apply but the notice must not require the requirement to be complied with before the end of the period of 24 hours beginning when the notice is given. (8) In this section, “specified” means specified in an enforcement notice. 19F Enforcement notices: cancellation and variation (1) The Authority may cancel or vary an enforcement notice by giving written notice to the person to whom it was given. (2) A person to whom an enforcement notice is given may apply in writing to the Authority for the cancellation or variation of the notice. (3) An application under subsection (2) may be made only— (a) after the end of the period within which an appeal can be brought against the notice, and (b) on the ground that, by reason of a change of circumstances, one or more of the provisions of that notice need not be complied with in order to remedy the failure identified in the notice.” “Penalties 19G Penalty notices (1) If the Authority is satisfied that a person has— (a) failed or is failing as described in section 19D(1) (enforcement notices), or (b) failed to comply with an enforcement notice, the Authority may, by written notice (a “penalty notice”), require the person to pay the Authority an amount in sterling specified in the notice. (2) When deciding whether to give a penalty notice to a person and determining the amount of the penalty, the Authority must have regard to the following, so far as relevant to the extent that the notice concerns another matter, matters listed in subsection (3). (3) Matters which the Authority must have regard to in issuing a penalty notice include— (a) the nature, gravity and duration of the failure; (b) the intentional or negligent character of the failure; (c) any action taken by the person to mitigate the damage or distress suffered by persons; (d) any relevant previous failures by the person; (e) the degree of co-operation with the Authority, in order to remedy the failure and mitigate the possible adverse effects of the failure; (f) the categories of the failure in regards to licensable activities; (g) the manner in which the infringement became known to the Authority, including whether, and if so to what extent, the person notified the Authority of the failure; (h) the extent to which the person has complied with previous enforcement notices or penalty notices; (i) adherence to approved codes of conduct or certification mechanisms; (j) any other aggravating or mitigating factor applicable to the case, including financial benefits gained, or losses avoided, as a result of the failure (whether directly or indirectly); (k) whether the penalty would be effective, proportionate and dissuasive. (4) Schedule 4AZA makes further provision about penalty notices, including provision requiring the Authority to give a notice of intent to impose a penalty and provision about payment, variation, cancellation and enforcement. (5) The Secretary of State may by regulations— (a) confer power on the Authority to give a penalty notice in respect of other failures to comply with the requirements of licensable activities, and (b) provide for the maximum penalty that may be imposed in relation to such failures to be either the standard maximum amount or the higher maximum amount. (6) Regulations under this section may— (a) make provision about the giving of penalty notices in respect of the failure, and (b) amend this section and section 19H (maximum amount of penalty). (7) In this section, “higher maximum amount” and “standard maximum amount” have the same meaning as in section 19H. 19H Maximum amount of penalty (1) In relation to a failure to comply with an enforcement notice, the maximum amount of the penalty that may be imposed by a penalty notice is the higher maximum amount. (2) In relation to an infringement of a provision of this Act where subsection (1) does not apply the maximum amount of the penalty that may be imposed by a penalty notice is the standard maximum amount. (3) The “higher maximum amount” is— (a) in the case of an undertaking, £17,500,000 or 4% of the undertaking's total annual worldwide turnover in the preceding financial year, whichever is higher, or (b) in any other case, £17,500,000. (4) The “standard maximum amount” is— (a) in the case of an undertaking, £8,700,000 or 2% of the undertaking's total annual worldwide turnover in the preceding financial year, whichever is higher, or (b) in any other case, £8,700,000. (5) The Secretary of State may by regulations— (a) provide that a person of a description specified in the regulations is or is not an undertaking, and (b) make provision about how an undertaking’s turnover is to be determined. (6) The Secretary of State may by regulations provide that a period is or is not a financial year.” 4 Before section 20 insert— “Appeals etc” 5 In section 20 (right to reconsideration of licensing decisions), in subsections (1), (2) and (4), for “require” substitute “request”. 6 For section 21, substitute— “21 Rights of appeal (1) A person aggrieved by a decision on reconsideration in pursuance of a notice under section 20 (right to reconsideration of licensing decisions) may appeal to the court. (2) A person who is given any of the following notices may appeal to the court— (a) an enforcement notice; (b) a penalty notice; (c) a penalty variation notice. 21A Determination of appeals (1) Subsections (2) to (4) apply where a person appeals to the court under section 21(1) or (2). (2) The court may review any determination of fact on which the notice or decision against which the appeal is brought was based. (3) If the court considers— (a) that the notice or decision against which the appeal is brought is not in accordance with the law, or (b) to the extent that the notice or decision involved an exercise of discretion by the Authority, that the Authority ought to have exercised the discretion differently, the court must allow the appeal or substitute another notice or decision which the Authority could have given or made. (4) Otherwise, the court must dismiss the appeal. 21B Applications in respect of urgent notices (1) This section applies where an enforcement notice given to a person contains an urgency statement. (2) The person may apply to the court for either or both of the following— (a) the disapplication of the urgency statement in relation to some or all of the requirements of the notice; (b) a change to the time at which, or the period within which, a requirement of the notice must be complied with. (3) On an application under subsection (2), the court may do any of the following— (a) direct that the notice is to have effect as if it did not contain the urgency statement; (b) direct that the inclusion of the urgency statement is not to have effect in relation to a requirement of the notice; (c) vary the notice by changing the time at which, or the period within which, a requirement of the notice must be complied with; (d) vary the notice by making other changes required to give effect to a direction under paragraph (a) or (b) or in consequence of a variation under paragraph (c). (4) The decision of the court on an application under this section is final. (5) In this section, “urgency statement” means a statement under section 19E(7)(a). 21C Jurisdiction (1) The jurisdiction conferred on a court by section 21 (rights of appeal) is exercisable— (a) in England and Wales, by the High Court or the county court, (b) in Scotland, by the Court of Session or the sheriff, (c) in Northern Ireland, by the High Court or a county court, subject to subsection (2). (2) The jurisdiction conferred on a court by section 21B (applications in respect of urgent notices) is exercisable only by the High Court or, in Scotland, the Court of Session.” 7 In section 45(4A) (regulations), insert at the appropriate place— “sections 19G (penalty notices) and 19H (maximum amount of penalty);”. 8 After Schedule 3A insert— “SCHEDULE 3AZA Section 19G PENALTIES Meaning of “penalty” 1 In this Schedule, “penalty” means a penalty imposed by a penalty notice. Notice of intent to impose penalty 2 Before giving a person a penalty notice, the Authority must, by written notice (a “notice of intent”) inform the person that the Authority intends to give a penalty notice. Contents of notice of intent 3 (1) A notice of intent must contain the following information— (a) the name and address of the person to whom the Authority proposes to give a penalty notice; (b) the reasons why the Authority proposes to give a penalty notice (see sub-paragraph (2)); (c) an indication of the amount of the penalty the Authority proposes to impose, including any aggravating or mitigating factors that the Authority proposes to take into account. (2) The information required under sub-paragraph (1)(b) includes— (a) a description of the circumstances of the failure, and (b) the nature, gravity and duration of the failure. (3) A notice of intent must also— (a) state that the person may make written representations about the Authority’s intention to give a penalty notice, and (b) specify the period within which such representations may be made. (4) The period specified for making written representations must be a period of not less than 21 days beginning when the notice of intent is given. (5) If the Authority considers that it is appropriate for the person to have an opportunity to make oral representations about the Authority’s intention to give a penalty notice, the notice of intent must also— (a) state that the person may make such representations, and (b) specify the arrangements for making such representations and the time at which, or the period within which, they may be made. Giving a penalty notice 4 (1) This paragraph applies where the Authority gives a notice of intent to a person. (2) Within the period of six months beginning when the notice is given, or as soon as reasonably practicable thereafter, the Authority must give to the person— (a) a penalty notice, or (b) written notice that the Authority has decided not to give a penalty notice to the person. (3) The Authority may not give a penalty notice to the person before a time, or before the end of a period, specified in the notice of intent for making oral or written representations. (4) When deciding whether to give a penalty notice to the person and determining the amount of the penalty, the Authority must consider any oral or written representations made by the person in accordance with the notice of intent. Contents of a penalty notice 5 (1) A penalty notice must contain the following information— (a) the name and address of the person to whom it is addressed; (b) details of the notice of intent given to the person; (c) whether the Authority received oral or written representations in accordance with the notice of intent; (d) the reasons why the Authority proposes to impose the penalty (see sub-paragraph (2)); (e) the reasons for the amount of the penalty, including any aggravating or mitigating factors that the Authority has taken into account; (f) details of how the penalty is to be paid; (g) details of the rights of appeal under section 21; (h) details of the Authority’s enforcement powers under this Schedule. (2) The information required under sub-paragraph (1)(d) includes— (a) a description of the circumstances of the failure, and (b) the nature, gravity and duration of the failure. Period for payment of penalty 6 (1) A penalty must be paid to the Authority within the period specified in the penalty notice. (2) The period specified must be a period of not less than 28 days beginning when the penalty notice is given. Variation of penalty 7 (1) The Authority may vary a penalty notice by giving written notice (a “penalty variation notice”) to the person to whom it was given. (2) A penalty variation notice must specify— (a) the penalty notice concerned, and (b) how it is varied. (3) A penalty variation notice may not— (a) reduce the period for payment of the penalty; (b) increase the amount of the penalty; (c) otherwise vary the penalty notice to the detriment of the person to whom it was given. (4) If— (a) a penalty variation notice reduces the amount of the penalty, and (b) when that notice is given, an amount has already been paid that exceeds the amount of the reduced penalty, the Authority must repay the excess. Cancellation of penalty 8 (1) The Authority may cancel a penalty notice by giving written notice to the person to whom it was given. (2) If a penalty notice is cancelled, the Authority— (a) may not take any further action under section 19G or this Schedule in relation to the failure to which that notice relates, and (b) must repay any amount that has been paid in accordance with that notice. Enforcement of payment 9 (1) The Authority must not take action to recover a penalty unless— (a) the period specified in accordance with paragraph 6 has ended, (b) any appeals against the penalty notice have been decided or otherwise ended, (c) if the penalty notice has been varied, any appeals against the penalty variation notice have been decided or otherwise ended, and (d) the period for the person to whom the penalty notice was given to appeal against the penalty, and any variation of it, has ended. (2) In England and Wales, a penalty is recoverable— (a) if the county court so orders, as if it were payable under an order of that court; (b) if the High Court so orders, as if it were payable under an order of that court. (3) In Scotland, a penalty may be enforced in the same manner as an extract registered decree arbitral bearing a warrant for execution issued by the sheriff court of any sheriffdom in Scotland. (4) In Northern Ireland, a penalty is recoverable— (a) if a county court so orders, as if it were payable under an order of that court; (b) if the High Court so orders, as if it were payable under an order of that court.” 9 (1) Schedule 3B is amended in accordance with this paragraph. (2) In paragraph 2, after sub-paragraph (1) insert— “(1A) If requested to do so by the Secretary of State, the Authority must arrange for a duly authorised person to inspect any of the premises mentioned in sub-paragraph (3). (1B) The Authority may arrange for a duly authorised person to inspect any of the premises referred to in sub-paragraph (3) in circumstances where it is not required to do so by sub-paragraph (1) or (1A).” (3) After paragraph 2 insert— “Considerations relating to inspection frequency 2A (1) In determining the frequency, timing and scope of inspections, the Authority must have regard to the risks associated with the activities authorised by the licence. (2) The matters to which the Authority must have regard include— (a) the nature and seriousness of any incident or suspected breach of a licence condition; (b) complaints or concerns received from patients, donors, persons born as a result of treatment, or staff; (c) the history of compliance by the licence holder; (d) the adequacy of action taken in response to previous inspection findings; (e) the risks to the health, safety or welfare of persons receiving or providing treatment, and to the security and integrity of gametes and embryos. (3) The Authority must maintain and periodically review a database for assessing the risks referred to in this paragraph. (4) The Secretary of State may by regulations make further provision about the contents and information standards of the database.” (4) After paragraph 8 insert— “Action following an inspection” (5) In paragraph 9 for sub-paragraph (5), substitute— “(5) The Authority must give a copy of the report or information to— (a) the person requesting it, unless the Authority considers that it would be inappropriate to do so in the particular circumstances of the case, and (b) the Secretary of State. (6) The Authority must include in its annual report information about the exercise of its inspection and enforcement functions. (7) The Secretary of State may by regulations make further provision about the contents of reports under this paragraph.” (6) After paragraph 9 insert— “9A (1) Where an inspection identifies a material deficiency in the operation of licensed activities, the Authority must determine what further action is necessary and proportionate. (2) The Authority may require the licence holder to submit and implement a corrective action plan within a specified period. (3) A corrective action plan must specify— (a) he deficiency to be addressed; (b) the steps to be taken to address it; (c) the person responsible for each step; (d) the date by which each step to be complied. (e) any other condition as may be specified in regulations made by the Secretary of State. (4) A corrective action plan must be sent to the Authority by such period as the Authority may specify. (5) After receiving the corrective action plan, the Authority must within 28 days consider whether a further inspection is necessary under paragraph 2 to determine whether the deficiency has been remedied. 9B The Secretary of State may by regulations make provision for the contents of an inspection report.” 10 In section 7 (reports to the Secretary of State), after subsection (2), insert— “(2A) A report prepared under this section must include information about— (a) inspections carried out by the Authority, (b) a corrective action plan in place under paragraph 9A of Schedule 3B, and (c) the improvements made to remedy any deficiencies in relation to such corrective action plan.” Complaints 11 After section 8D, insert— “8DA Complaints relating to licensed activities (1) The Authority must establish and maintain procedures for receiving, assessing and investigating complaints relating to activities governed by this Act. (2) The Authority must investigate a complaint where it has reasonable grounds to suspect— (a) a serious breach of a requirement imposed by or under this Act; (b) a material failure to comply with a licence condition; (c) conduct presenting a significant risk to the health, safety or welfare of a person; (d) a systemic failure affecting patients, donors or other persons materially affected by activities governed by this Act. (3) The Authority must, as soon as reasonably practicable after receiving a complaint, determine whether any of the circumstances in subsection (2) apply. (4) Where the Authority decides not to investigate a complaint, it must give the complainant a statement of reasons for that decision. (5) Where the Authority investigates a complaint, it must— (a) conduct the investigation as soon as reasonably practicable; (b) keep the complainant reasonably informed of the progress of the investigation; (c) notify the complainant of the outcome; (d) give reasons for its findings and any regulatory action taken, subject to any lawful restriction on disclosure. (6) The Authority may decline to investigate, or may suspend an investigation, where it considers that doing so is necessary and proportionate having regard to— (a) the availability of a more appropriate procedure for determining the matter; (b) ongoing civil or criminal proceedings; (c) the vexatious or excessive use of the complaints procedure. (7) The Authority must give a statement of reasons for a decision under subsection (6).” Reporting in relation to licensable activities 12 (1) Section 17 (the person responsible) is amended in accordance with this paragraph. (2) In subsection (1)(g), at end insert “; and of any prescribed near miss which indicates a material risk to the health, safety or welfare of a person or to the security or integrity of gametes or embryos.” (3) After subsection (2) insert— “(2A) In subsection (1)(g) “prescribed” means prescribed in regulations made by the Secretary of State.”” 13 After section 31B, insert— “31C Reporting and investigation of serious adverse events (1) The Authority must issue a code of practice establishing requirements governing the notification, recording and investigation of serious adverse events, serious adverse reactions and prescribed near misses arising in connection with licensable activities. (2) The requirements must include provision about— (a) the circumstances in which an incident or near miss must be notified to the Authority; (b) the period within which notification must be given; (c) the information to be included in a notification; (d) the investigation and analysis of the causes of an incident or near miss; (e) the identification and implementation of measures to prevent recurrence; (f) the preservation of relevant records and electronic audit trails. (3) The Authority must monitor notifications received under this section for the purpose of identifying recurring incidents, systemic failures and emerging risks. (4) The Authority must publish information about significant trends identified under subsection (3), subject to the protection of personal data and confidential information. (5) Requirements under this section must be proportionate to the seriousness and nature of the incident or near miss. (6) The Authority may revise or revoke a code issued under this section. (7) The Authority must send a copy of the code to the Secretary of State. (8) The Secretary of State must lay a copy of the code before each House of Parliament.” 14 In section 12 (general conditions), in subsection (1), after paragraph (g), insert— “(h) that the responsible person will comply with any requirements of a code of practice issued under section 31C.” Continuity plans 15 In Schedule 2, after paragraph 4, insert— “Continuity plans 4A (1) The Authority must ensure that the conditions of a licence authorising the storage of gametes or embryos require the licence holder to maintain a continuity plan. (2) A continuity plan must make provision for the safe and lawful management, transfer or disposal of gametes and embryos where— (a) the licence expires or is revoked; (b) the licence holder ceases to carry on the licensed activities; (c) the licence holder becomes unable to carry on those activities safely; (d) the Authority determines that urgent arrangements are necessary to protect persons or stored gametes or embryos. (3) A continuity plan must also include provision for— (a) the identification of an appropriately licensed facility to which storage activities may be transferred; (b) the preservation and transfer of records, consent documentation and information necessary to maintain traceability; (c) the notification of affected persons, so far as reasonably practicable; (d) the maintenance of appropriate storage conditions pending transfer or other lawful disposition; (e) the allocation of responsibility for implementing the plan. (4) The Authority must assess the adequacy of a continuity plan when considering an application for a licence or its renewal and may require the plan to be revised. (5) The Authority may require a licence holder to implement a continuity plan, in whole or in part, where it considers that this is necessary to protect the health, safety or welfare of persons or to secure the safe and lawful management of stored gametes or embryos. (6) The Secretary of State may by regulations make further provision in relation to the contents or requirements of continuity plans.””

After Clause 78, insert the following new Clause— “Reusing medication in care homes and hospices (1) If a resident in a care home or hospice has been prescribed medication and that resident no longer needs that medication, the medication can be reused for the symptom control or treatment of another patient, providing that— (a) the medicine is suitable for reuse; (b) the medicine is in an unopened pack or blister that has not been tampered with; (c) the medicine is in date; (d) the medicine has been stored appropriately, including refrigeration if required; (e) the medicine is a licensed medicine that has been prescribed by a registered healthcare professional with prescribing rights; (f) the medicine is being administered on the advice of the prescriber with a valid written prescription; (g) the medicine has been stored in a locked cupboard; (h) consent has been given by the patient for whom the medicine was originally prescribed, or the next of kin if the patient has died; (i) the patient to whom the medication is now to be given is informed that a returned medicine is being used. (2) When the medicine is a controlled drug, it must be entered as a reused medication in the controlled drugs register. (3) All such medication must be entered in a “reused medication register”, recording the— (a) date; (b) name of the original owner; (c) details of the medicine; (d) generic name of the medicine; (e) strength of the medicine; (f) formulation of the medicine; (g) expiry date of the medicine; (h) quantity of the medicine. (4) When a controlled drug is reused, the controlled drug reused register must be updated to record the— (a) date; (b) patient’s name; (c) dose and quantity of the medicine; (d) reason for reusing. (5) All records must be available for all inspecting bodies. (6) Any clinical adverse effects must be recorded using the yellow card scheme, via national reporting and learning systems, and to the Integrated Commissioning Board.”

After Clause 84, insert the following new Clause— “Amendments to the Human Fertilisation and Embryology Act 1990 Schedule (Amendments to the Human Fertilisation and Embryology Act 1990) amends the Human Fertilisation and Embryology Act 1990 to make provision about the Human Fertilisation and Embryology Authority.”

After Clause 84, insert the following new Clause— “NHS-funded in vitro fertilisation (1) Within six months of the day on which this Act is passed, the Secretary of State must by regulations make arrangements for the standardised provision of NHS-funded in vitro fertilisation (IVF). (2) Provision under this section must, in accordance with any existing NICE guidelines, set requirements for all integrated care boards in England relating to NHS-funded IVF. (3) Requirements under subsection (2) must include— (a) standardisation of the minimum number of rounds of IVF available to one individual, and (b) standardisation of the maximum and minimum age at which an individual can access IVF.”

Clause 87, page 65, line 11, at the end insert— “(ga) section (Amendments to the Human Fertilisation and Embryology Act 1990) (Amendments to the Human Fertilisation and Embryology Act 1990) and Schedule (Amendments to the Human Fertilisation and Embryology Act 1990) (Amendments to the Human Fertilisation and Embryology Act 1990);”

Clause 88, page 65, line 25, at the end insert— “(c) section (Amendments to the Human Fertilisation and Embryology Act 1990) (Amendments to the Human Fertilisation and Embryology Act 1990) and Schedule (Amendments to the Human Fertilisation and Embryology Act 1990) (Amendments to the Human Fertilisation and Embryology Act 1990).”

After Clause 11, insert the following new Clause— “Duty as to a smoke-free England In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert— “1CD Duty as to a smoke-free England (1) In exercising functions in relation to the health service, the Secretary of State must act with a view to England becoming smoke-free as defined in section 7(1) of the Health Act 2006 (offence of smoking in smoke-free place). (2) The Secretary of State must, within 12 months of the day on which the Health Act 2026 is passed, publish a roadmap setting out how the health service will contribute to England becoming smoke-free, including interim targets and the stop smoking services to be commissioned by integrated care boards. (3) The Secretary of State must lay before Parliament an annual report on progress against the roadmap.””

Clause 25, page 18, line 17, at end insert— “(2B) In preparing a neighbourhood health plan, the responsible local authority and each of its partner integrated care boards must— (a) consider the effects on health and development, and the risks of harm, of children’s digital environment for children of all ages in the authority’s area, and in particular for children aged 0 to 5, and (b) where the assessment of relevant needs identifies needs relating to those effects or risks, set out in the plan how those needs are to be met. (2C) Guidance issued under subsection (4) must include guidance on how authorities should discharge their duties under subsection (2B), including how to involve health visitors, school nurses and family hubs. (2D) In subsection (2B)— “children’s digital environment” means the devices, services, content and platforms with which children interact, including screens, online services, social media, games, messaging services and artificial intelligence tools; “effects on health and development” includes effects on— (a) language, cognitive, and social and emotional development, (b) sleep, physical activity and healthy weight, (c) eyesight, and (d) mental health and wellbeing; “risks of harm” means risks of harm to children’s health and development arising from harmful or age-inappropriate online content, online contact with adults or other children, online conduct and online advertising.”

After Clause 84, insert the following new Clause— “Children’s digital environment: guidance and training for health professionals in England (1) The Secretary of State must, within six months of the day on which this Act is passed, publish guidance for health professionals on the effects on health and development, and the risks of harm, of children’s digital environment. (2) The guidance must apply to children of all ages and must in particular address children aged 0 to 5. (3) The guidance must draw on advice from health professionals, researchers and academics, must be consistent with any guidance for parents and carers on screen use published by the Secretary of State, and must address— (a) the effects of children’s digital environment on health and development at different ages, including for children with special educational needs or disabilities, (b) recommended limits on screen time, screen-free times and places to promote children’s health, (c) the effect of parents’ and carers’ own use of devices on children’s health, and (d) how to raise these matters with children, parents and carers in a supportive, non-judgemental way, and where to refer or signpost them for further support. (4) The Secretary of State must exercise functions under section 1F of the National Health Service Act 2006 (duty as to education and training) with a view to ensuring that education and training on the guidance is available to health professionals who work with children and their families, including health visitors, general practitioners, practice nurses, midwives, school nurses, speech and language therapists, community paediatricians, optometrists and staff of family hubs. (5) Before publishing or revising the guidance, the Secretary of State must consult such persons as the Secretary of State considers appropriate, including relevant professional bodies and royal colleges. (6) The Secretary of State must review the guidance at least every three years. (7) The Secretary of State must, within two years of the day on which this Act is passed, lay before Parliament a report on the availability and uptake of the education and training under subsection (4). (8) In this section— “children’s digital environment” means the devices, services, content and platforms with which children interact, including screens, online services, social media, games, messaging services and artificial intelligence tools; “effects on health and development” includes effects on— (a) language, cognitive, and social and emotional development, (b) sleep, physical activity and healthy weight, (c) eyesight, and (d) mental health and wellbeing; “risks of harm” means risks of harm to children’s health and development arising from harmful or age-inappropriate online content, online contact with adults or other children, online conduct and online advertising.”

After Clause 84, insert the following new Clause— “Children’s digital environment: universal health reviews in England (1) The Secretary of State must, within six months of the day on which this Act is passed, ensure that the Healthy Child Programme guidance, and any successor to it, includes provision on the effects on health and development, and the risks of harm, of children’s digital environment. (2) The guidance must provide that, as part of the universal health and development reviews offered to children aged 0 to 5 and their parents and carers, health professionals offer— (a) information on guidance for parents and carers on screen use and online safety published by the Secretary of State; (b) an opportunity to discuss— (i) the child’s use of screens and digital technology, (ii) parents’ and carers’ own use of devices, (iii) screen-free routines, and (iv) the risks of harm to the child’s health and development of their digital environment; (c) where appropriate, further support or signposting. (3) The guidance must make provision of a similar kind, appropriate to their age, for the health and development contacts offered to school-age children under the Healthy Child Programme. (4) The Secretary of State must ensure that information on the matters in subsection (2)(b) is included in the personal child health record, in whatever form it is provided. (5) In this section— “children’s digital environment” means the devices, services, content and platforms with which children interact, including screens, online services, social media, games, messaging services and artificial intelligence tools; “effects on health and development” includes effects on— (a) language, cognitive, and social and emotional development, (b) sleep, physical activity and healthy weight, (c) eyesight, and (d) mental health and wellbeing; “risks of harm” means risks of harm to children’s health and development arising from harmful or age-inappropriate online content, online contact with adults or other children, online conduct and online advertising.”

After Clause 84, insert the following new Clause— “Report on dementia care (1) Within 12 months of the day on which this Act is passed and every 12 months thereafter, the Secretary of State must publish and lay before both Houses of Parliament a report on— (a) the provision of NHS care in relation to dementia; (b) the provision of social care in relation to dementia. (2) A report under subsection (1) must have regard to— (a) any targets or standards set out in any national plan, guidance or framework relating to dementia services, and (b) any other information the Secretary of State considers appropriate. (3) A report under subsection (1) must include— (a) an assessment of variation in dementia services and outcomes between integrated care board areas, (b) information on workforce capacity, capability and training standards relevant to dementia care, (c) information on access to ongoing post-diagnostic support services, including support for unpaid carers of dementia patients, (d) information on continuity and coordination of care for people living with dementia, including access to a named professional responsible for coordinating support across services, (e) outcomes and experiences for people living with dementia and unpaid carers, including crisis prevention, carer wellbeing, and experiences of joined-up care, (f) progress on dementia prevention and risk reduction, and (g) dementia research activity in the NHS.”

After Clause 84, insert the following new Clause— “Review of continued professional development for nurses and midwives (1) Within six months of the day on which this Act is passed, the Secretary of State must carry out a review of continued professional development for nurses and midwives. (2) The review must in particular assess— (a) the level of funding available for continued professional development for nurses and midwives, and (b) the protected time available to nurses and midwives for continued professional development. (3) The Secretary of State must publish a report of the findings of the review.”

After Clause 84, insert the following new Clause— “Oversight of funeral service provider premises and practices connected to the storage, preparation and movement of human remains (1) The Secretary of State may by regulations made by statutory instrument establish a body corporate, or confer functions on an existing public authority (“the regulator”), to provide oversight of the premises and practices connected to the storage, preparation and movement of human remains by funeral service providers in England. (2) The purpose of the regulator is to ensure that the activities undertaken under subsection (1) are consistent with the protection of public health. (3) The regulator is independent in the exercise of its functions and is not to be regarded as a servant or agent of the Crown. (4) Regulations under this section may, in particular, make provision for— (a) a scheme for the registration of funeral service providers, (b) the inspection of premises, vehicles and other facilities used by registered providers for the storage, preparation, care or transportation of deceased persons, or from which funeral services are arranged or conducted, (c) the publication and enforcement of a code of practice for the funeral services sector, and (d) the imposition of sanctions, including suspension or removal from the register, for breach of that code. (5) Before making regulations under this section, the Secretary of State must consult— (a) providers of funeral services, (b) such persons representing the interests of bereaved people as the Secretary of State considers appropriate, and (c) such other persons as the Secretary of State considers appropriate. (6) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

After Clause 84, insert the following new Clause— “Remit of the Human Tissue Authority (1) The Secretary of State must, within six months of the day on which this Act is passed, by order under section 14(4) of the Human Tissue Act 2004, amend the remit of the Human Tissue Authority to include the regulation of funeral directors, private mortuaries, direct cremation services and other organisations which transport or hold the bodies of deceased persons for the purposes of ensuring that the carrying out of their functions is consistent with the protection of public health. (2) The Authority must establish and maintain a register of the bodies subject to its oversight under subsection (1). (3) The Secretary of State may by regulations made by statutory instrument make further provision regarding the establishment and operation of the register under subsection (2). (4) A statutory instrument containing regulations under subsection (3) may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

None 172A

After Clause 56, insert the following new Clause— “Guidance on anonymisation and pseudonymisation of patient information Within 12 months of the day on which this Act is passed, the Information Commission must publish guidance applicable to health services in England, Wales, Scotland and Northern Ireland on the anonymisation and pseudonymisation of patient information.”

None 183A

Clause 62, page 45, leave out lines 2 to 10 and insert— “Omit section 298 of the Health and Social Care Act 2012.”

None 183B

Clause 62, page 45, line 10, at end insert— “(3) All such advice or assistance is subject to the Freedom of Information Act 2000 with no exemptions. (4) A register of advice or assistance provided must be published annually within three months of the end of each calendar year. (5) The register of advice under subsection (4) must also include the amount charged to the recipient of such advice or assistance.”

None 279A

After Clause 84, insert the following new Clause— “Procurement objectives: medical devices, consumables and services (1) The Secretary of State must lay before each House of Parliament an annual report on the extent to which procurement by the NHS and the social care sector in England of medical devices, consumables and services has adhered to the objectives set out in section 12(1) of the Procurement Act 2023 (covered procurement: objectives). (2) The report under subsection (1) must be limited to the objectives specified in section 12(1) of the Procurement Act 2023 and must not report on any procurement objective not provided for in that section. (3) Nothing in this section applies to a procurement contract or framework agreement to which the Defence and Security Public Contracts Regulations 2011 (S.I. 2011/1848), Public Contracts Regulations 2015 (S.I. 2015/102), Concession Contract Regulations 2016 (S.I. 2016/273) or Utilities Contracts Regulations 2016 (S.I. 2016/274) continue to apply under the Procurement Act 2023 (Commencement No. 3 and Transitional and Saving Provisions) Regulations 2024 (S.I. 2024/716).”

None 279B

After Clause 84, insert the following new Clause— “Specialist palliative care (1) Each integrated care board must commission sufficient specialist palliative care services to meet the needs of their population. (2) Such services specified in subsection (1) must include the provision of access to— (a) specialist palliative care support, working with local clinical teams, in all relevant settings, including private homes, care homes, hospitals, hospices and other community settings, (b) specialist level in-patient palliative care beds when required, including admission on an urgent basis, (c) specialist palliative care advice, available at all times, to support health and social care professionals who are providing care to the person and their family, to include face to face specialist palliative care review between 9 am and 5 pm on each day of the week, (d) support to ensure the appropriate workforce, equipment and medication is available to deliver specialist palliative care, (e) a single point of contact, available for people with palliative and end of life care in the community, for advice, access to equipment and to rapid response nursing, (f) appropriate systems to share information about the person’s needs with all professionals involved in their care, provided they give consent for this, (g) support to ensure patients are able to have open conversations about their personal needs and concerns, and that these are documented in the single patient record to the extent that the patient desires, (h) support for the education and training of the health and social care workforce regarding palliative care, (i) support to enable staff to participate in relevant research and to disseminate evidence-based innovations in palliative care, and (j) agreed outcomes data for national level benchmarking.”

Opposition Amendment 279C

After Clause 84, insert the following new Clause— “De-registration of doctors and health care professionals found to have expressed antisemitic behaviour or speech (1) The Secretary of State must make regulations made by statutory instrument requiring a statutory regulator of a health or care profession to immediately remove from its register any person found to have expressed antisemitic behaviour or speech. (2) Regulations under subsection (1) must provide that removal from the register is the mandatory sanction and may not be replaced by a lesser sanction. (3) In this section, “antisemitic behaviour or speech” means behaviour or speech which expresses a certain perception of Jews, which may be hatred toward Jews, and which is directed toward Jewish or non-Jewish individuals or their property or Jewish community institutions and religious facilities, including but not limited to— (a) calling for, aiding, or justifying the killing or harming of Jews in the name of a radical ideology or an extremist view of religion, (b) making mendacious, dehumanizing, demonizing or stereotypical allegations about Jews as such or the power of Jews as collective, such as, especially but not exclusively, the myth about a world Jewish conspiracy or of Jews controlling the media, economy, government or other societal institutions, (c) accusing Jews as a people of being responsible for real or imagined wrongdoing committed by a single Jewish person or group, or even for acts committed by non-Jews, (d) denying the fact, scope, mechanisms (e.g. gas chambers) or intentionality of the genocide of the Jewish people at the hands of Nazi Germany and its supporters and accomplices during World War II (the Holocaust), (e) accusing the Jews as a people, or Israel as a State, of inventing or exaggerating the Holocaust, (f) using the symbols and images associated with classic antisemitism (e.g. claims of Jews killing Jesus or blood libel) to characterize Israel or Israelis, (g) using derogatory terms for Jewish people (such as “kike” or “yid”), (h) using stereotypical and negative physical depictions or descriptions or character traits for Jewish people, such as references to wealth or avarice or, in the political arena, equating Jews with capitalists or the ruling class, or (i) holding Jews collectively responsible for actions of the State of Israel. (4) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

None 279D

After Clause 84, insert the following new Clause— “Community equipment services: national data collection and reporting (1) The Secretary of State must make arrangements to ensure that consistent national information is collected and published in relation to the assessment for and supply of community equipment services in England. (2) The information collected under subsection (1) must include— (a) the number of people assessed as requiring community equipment, (b) waiting times for assessment for and supply of community equipment, (c) the number of people awaiting community equipment, and (d) the number of people receiving community equipment. (3) The information must, so far as reasonably practicable, distinguish between— (a) provision for adults and children, (b) different local authority areas, and (c) referrals originating from hospital and community settings. (4) The Secretary of State must ensure that information collected under this section includes community equipment services commissioned or arranged by NHS bodies and local authorities, including through joint arrangements. (5) The Secretary of State must publish the information collected under this section at least annually. (6) For the purposes of this section, “community equipment services” means the assessment for and supply of equipment, aids or appliances to support a person's independence, safety, care or daily living at home or in the community but does not include specialist NHS wheelchair services.”

None 279E

After Clause 84, insert the following new Clause— “Community equipment services: annual report to Parliament (1) The Secretary of State must lay before both Houses of Parliament an annual report on the provision of community equipment services in England. (2) The report must include— (a) available information on community equipment provision and waiting times, (b) variation in provision and waiting times between local areas, (c) differences in provision for adults and children, (d) gaps in the national information available on community equipment services, and (e) steps taken or proposed to improve national monitoring and accountability for community equipment services. (3) The report must cover community equipment services commissioned or arranged by NHS bodies and local authorities, including through joint arrangements. (4) For the purposes of this section, “community equipment services” means the assessment for and supply of equipment, aids or appliances to support a person's independence, safety, care or daily living at home or in the community but does not include specialist NHS wheelchair services.”

Opposition Amendment 118

After Clause 49, insert the following new Clause—
“Primary care investment standard
(1) The Secretary of State must by regulations made by statutory instrument establish a primary care investment standard for integrated care boards.
(2) The primary care investment standard must require each integrated care board to increase its spending on primary care services, in each financial year, by at least the same proportion as any increase in the level of its total programme funding for that year.
(3) Regulations under this section may make provision about—
(a) the description of services that constitute “primary care services” for the purposes of this section;
(b) how compliance with the primary care investment standard is to be measured, monitored and enforced;
(c) circumstances in which the standard may be varied or disapplied.
(4) A statutory instrument containing regulations under this section may not be may unless a draft has been approved by resolution of both Houses of Parliament.”

This new clause would require the Secretary of State to establish, by regulations, a primary care investment standard requiring integrated care boards to increase spending on primary care services at least in line with the growth in their total programme funding, with such regulations subject to the affirmative procedure.

None 161

After Clause 56, insert the following new Clause—
“Retention of NHS number on following adoption
(1) The Secretary of State must secure ensure that, where a person is the subject of an adoption order, the person’s NHS number is not changed by reason only of the making of that order.
(2) The Secretary of State must secure ensure that a person’s health record is maintained as a single and continuous record under that NHS number after the making of an adoption order, to the same extent as it was maintained immediately before the order was made.
(3) The duties in subsections (1) and (2) apply in relation to—
(a) an adoption order made in public law proceedings, and
(b) an adoption order made in private law proceedings, including an order made in favour of a step-parent or the partner of a parent.
(4) In this section—
“adoption order” has the meaning given by section 46 of the Adoption and Children Act 2002;
“health record” has the meaning given by section 205 of the Data Protection Act 2018;
“NHS number” has the same meaning as “consistent identifier” in section 251A of the Health and Social Care Act 2012.”

Opposition Amendment 197

LORD PATEL

After Clause 71, insert the following new Clause—
“Healthwatch funding
(1) The Secretary of State must, within 12 months of the day on which this Act is passed, bring forward a scheme to fund Healthwatch England and Local Healthwatch organisations for the 2027/2028 financial year to the level estimated by the Department for Health and Social Care in 2013/14.
(2) The Secretary of State must consider uprating this funding in line with 2026/2027 inflation rates.”

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

None 206

After Clause 84, insert the following new Clause—
“Fracture prevention services: implementation plan and reporting
(1) The Secretary of State must, within six months of the passing of this Act, publish and lay before Parliament an implementation plan for securing universal access in England by 2030 to services for the prevention of secondary fragility fractures.
(2) The implementation plan must include—
(a) a baseline assessment of current access to, and quality of, such services in each integrated care board area,
(b) the minimum standards expected of such services,
(c) measurable annual milestones towards universal access by 2030, including milestones relating to the identification, assessment, treatment and follow-up of people who have sustained a fragility fracture,
(d) the steps the Secretary of State proposes to take to reduce unwarranted variation in access to, and quality of, such services, and
(e) the outcomes by reference to which the effectiveness of implementation will be assessed, including the incidence of further fragility fractures and hip fractures.
(3) The Secretary of State must, within six months of the publication of the implementation plan under subsection (1), and at intervals of no more than 12 months thereafter until 2030, lay before Parliament a report setting out—
(a) progress against the milestones in the implementation plan,
(b) changes in access to services for the prevention of secondary fragility fractures, and
(c) the number and proportion of eligible people identified, assessed, treated and followed up through such services, including variation between integrated care board areas.
(4) In this section, “services for the prevention of secondary fragility fractures” means services which provide for the systematic identification, assessment, treatment and follow-up of people who have sustained a fragility fracture, including services commonly known as fracture liaison services.”

This new clause would require the Secretary of State to publish an implementation plan for securing universal access in England by 2030 to services which systematically identify, assess, treat and follow up people who have sustained a fragility fracture, including fracture liaison services, and to report annually to Parliament on progress.

None 208

After Clause 84, insert the following new Clause—
“Standards of care for NHS transplant patients’ services
(1) Within twelve months of the day on which this Act is passed, the Secretary of State must publish a review on the standards of NHS care for transplant patients.
(2) The review under subsection (1) may cover the following matters—
(a) analysis of the comparative performance, outcomes, waiting times and organ utilisation, including variation between transplant centres and international comparisons in relation to lung transplants; hearts transplants; kidney transplants liver transplants and other appropriate transplants;
(b) analysis of workforce requirements and funding for 24/7 on call teams and centres providing transplant services;
(c) such other matters as may be specified by the Secretary of State.
(3) The review under subsection (1) must be taken in collaboration with patients, and families of patients together with practising clinicians in transplant services.
(4) The review under subsection (1) must be laid before both Houses of Parliament.”

This new clause would require the Secretary of State to undertake a review of NHS transplantation services.

None 214

After Clause 84, insert the following new Clause—
“5A Health and care partners
(1) After section 242A National Health Service Act 2006 insert—
“242B Involvement of health and care partners
(1) A service user has a right to personal contact, without physical barriers or time limits, including contact in private, and to be accompanied in person by at least one health and care partner.
(2) Each health and care provider must make arrangements, as respects health or care services for which it is responsible, which secure that users of those services may be accompanied by at least one health and care partner during any period during which health or care services are provided to the service user or the service user is under the care or supervision of the health and care provider.
(3) For the purposes of this section a “health and care partner” is a named person chosen by the service user who provides care and support whether unpaid or paid to the service user.
(4) The following are “health and care providers” for the purposes of this section—
(a) an NHS Trust or NHS Foundation Trust,
(b) an integrated care board,
(c) an English local authority,
(d) a care home in England within the meaning of section 8 (3) Care Act 2014,
(e) a person or company providing health care or care services registered with the Care Quality Commission, or
(f) a person or company who provides care services to another person in return for payment.””

This amendment is aimed at offering all users of health and care services the opportunity to nominate someone close to them as their health and care partner. This would be a purely voluntary role, distinct from the role of visitor. The access of the health and care partner would be protected and their opinion respected when health and care decisions are being made.

None 173

Clause 57, page 42, line 9, after “the” insert “physical access to the individual,”

This amendment, and another in the name of Lord Hunt of Kings Heath, seeks to ensure that people who are asked to help with discussion and decision-making during someone’s care have direct personal access to that individual.

None 174

Clause 57, page 42, line 17, at end insert—
“(fc) the importance of the individual having physical access to others including health and care partners;”.”

This amendment, and another in the name of Lord Hunt of Kings Heath, seeks to ensure that people who are asked to help with discussion and decision-making during someone’s care have direct personal access to that individual.

None 18

After Clause 4, insert the following new Clause—
“Health inequalities: strategy and annual report
(1) The Secretary of State must, within 12 months of the day on which this Act is passed, publish a cross-government strategy for reducing health inequalities in England, setting out the steps to be taken by the Secretary of State and other Ministers of the Crown.
(2) The Secretary of State must lay before Parliament, at least once in each calendar year, a report on progress in reducing health inequalities in England and in implementing the strategy.”

This new clause would require the Secretary of State to produce a cross-government health inequalities strategy and an annual progress report to Parliament.

None 71

After Clause 17, insert the following new Clause—
“Prescribed specialised services
(1) The Secretary of State must by regulations made by statutory instrument specify, based on clearly defined criteria, the services provided as part of the health service in England which are to be treated as specialised services (“prescribed specialised services”), and must publish the full list of such services.
(2) Prescribed specialised services include both—
(a) services for which commissioning responsibility is exercised by the Secretary of State, and
(b) services for which commissioning responsibility is exercised by one or more integrated care boards.
(3) The Secretary of State must make arrangements to ensure that all prescribed specialised services are informed by clinical involvement in the—
(a) planning of the commissioning arrangements;
(b) design of services and arrangements for service delivery;
(c) monitoring of the performance of specialised services.
(4) The Secretary of State is accountable for national oversight of all prescribed specialised services and must exercise functions in relation to those services with a view to securing equitable access for patients across England.
(5) Within 12 months of the day on which this Act is passed, and every 12 months thereafter, the Secretary of State must publish a report on the performance of all prescribed specialised services.
(6) A report under subsection (5) must include information relating to—
(a) patient outcomes,
(b) access to services,
(c) waiting times,
(d) workforce capacity,
(e) service sustainability,
(f) geographical variation in services,
(g) compliance with national service specifications, and
(h) arrangements for the coordination of specialist, community and neighbourhood care.
(7) A report under subsection (5) must be laid before both Houses of Parliament.
(8) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

This new clause would require all specialised services, whether commissioned by the Secretary of State or by integrated care boards, to be specified in regulations and make the Secretary of State accountable for national oversight and equitable access across England.

None 90

After Clause 22, insert the following new Clause—
“Integrated care boards: prisons and probation
After section 14Z44 of the National Health Service Act 2006 insert—
“14Z44A Duty as to prisons and probation etc
(1) Each integrated care board must, in the exercise of its functions, comply with the conditions of this section.
(2) The first condition is that they have due regard to the need to improve health outcomes for—
(a) people in custody of the Prison Service, and
(b) people under the supervision of the probation service in the community.
(3) The second condition is that they take reasonable steps to ensure continuity of care for people—
(a) sentenced to a custodial sentence,
(b) moved between prisons,
(c) moved between areas pursuant to a community sentence imposed by a court,
(d) released from secure custody and remaining under the supervision of the probation service, or
(e) leaving the supervision of the probation service.
(4) The third condition is that they take reasonable steps to ensure that people mentioned in subsection (2) have access, in addition to any services commissioned by local authorities, to—
(a) mental health support, including but not limited to acute mental health services and psychiatric treatment,
(b) substance misuse support, including but not limited to opiate and non-opiate and alcohol recovery services,
(c) addiction services, including but not limited to smoking cessation, and gambling disorder services, and
(d) other specialised services determined appropriate by assessment of local community needs or delivered by local providers.
(5) When complying with the conditions set out in this section, an integrated care board must have regard to any guidance issued by the Secretary of State.
(6) The Secretary of State may issue guidance on specific services which must be commissioned by integrated care boards in order to comply with this section.””

This amendment would require ICBs to have particular regard to improving the provision of healthcare for people in prison, serving community sentences, or under post-release supervision. It would also require that specialist services for these groups be commissioned where needed, and that continuity of care be protected where possible as people move in and out of custody.

None 7

Clause 4, page 3, line 24, leave out “have regard to the need to”

None 13

Clause 4, page 3, line 29, at end insert—
“(c) reduce inequalities between the people of England in respect of life expectancy or general state of health which are wholly or partly the result of differences in respect of general health determinants.”

None 19

After Clause 4, insert the following new Clause—
“Health inequalities strategy—
(1) The Secretary of State must, within six months of the day on which this Act is passed, publish a health inequalities strategy.
(2) In preparing the strategy under subsection (1), the Secretary of State must consult such persons as the Secretary of State considers appropriate.
(3) A Minister of the Crown must, in exercising the Minister’s functions, have regard to the strategy.”

None 47

After Clause 11, insert the following new Clause—
“Duty of Secretary of State to obtain appropriate advice
The Secretary of State must obtain advice appropriate for enabling the Secretary of State to discharge effectively the Secretary of State’s functions in relation to the health service from persons who (taken together) have a broad range of professional expertise in—
(a) the prevention, diagnosis or treatment of illness, and
(b) the protection or improvement of public health.”

This new clause would place on the Secretary of State an equivalent statutory duty to that currently imposed on NHS England by section 13J of the National Health Service Act 2006, requiring appropriate professional advice to be obtained in the discharge of the Secretary of State’s functions.

None 162

After Clause 56, insert the following new Clause—
“Protection of confidential psychological therapy records
(1) The Secretary of State must by regulations made by statutory instrument provide for safeguards governing the inclusion of information relating to psychotherapy, counselling or other psychological therapies in the single patient record.
(2) The regulations must provide that detailed narrative records of psychotherapy, counselling or other psychological therapies may not be routinely disclosed through the single patient record to health or social care professionals unless the patient has given explicit and informed consent to the disclosure.
(3) Subsection (2) does not apply where disclosure is necessary to address an immediate risk to the life, safety or wellbeing of the patient or another person.
(4) Any disclosure under subsection (3) must be limited to the information reasonably necessary for that purpose, and the reasons for the disclosure must be recorded.
(5) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

None 114

Clause 48, page 33, line 10, at end insert—
“(2A) A direction under subsection (1) may relate only to—
(a) conditions subject to which sums are paid to the board under section 223G,
(b) limits on expenditure or resource use by the board,
(c) requirements that sums be used only for specified purposes (including requirements of the kind mentioned in section 223GB), and
(d) the payment or repayment of sums to the Secretary of State,
and may not specify how the board is to exercise its commissioning functions (within the meaning given by section 5A(2)).”

This amendment, consequential on the amendment in the name of Lord Scriven to replace clause 11, stops financial directions being used to direct how an ICB commissions services.

None 117

Clause 49, page 34, line 27, at end insert—
“(2A) Any objectives set under subsection (1) for an integrated care board form part of its ICB outcomes (see section 14Z61), and the Secretary of State must publish them.”

This amendment, consequential on the amendment in the name of Lord Scriven to replace clause 11, makes joint financial objectives part of each ICB’s published outcomes.

Baroness Merron gives notice of her intention to oppose the Question that Schedule 9 be the Ninth Schedule to the Bill.

This leaves out Schedule 9. Schedule 9 transfers the Health Services Safety Investigations Body’s functions to the Care Quality Commission.

None 26

LORD PATEL

Clause 6, page 4, line 20, at end insert—
“(5) The Secretary of State must establish a transformational fund, within a year of the date on which the Health Act 2026 is passed, to enable improvements in access to specialist palliative care and its support to generalist services.”

This amendment would require the Secretary of State to create a dedicated palliative and end of life care transformation fund to support service redesign by scaling proven models of care that help deliver the government’s intended shift from hospital to community care for people at the end of life.

None 66

Clause 16, page 12, line 10, at end insert—
“(3) Regulations must impose duties on integrated care boards with respect to waiting times for treatments or other services provided to children which they arrange in the exercise of their commissioning functions.
(4) Regulations under subsection (3) must include provision as to the arrangements integrated care boards must make where a specified treatment or other specified service for a child is not provided within a specified period.
(5) The first regulations under subsection (3) must be made before the end of the period of 12 months beginning with the day on which section 16 of the Health Act 2026 comes into force.
(6) In this section “child” means a person under the age of 18.”

This amendment would require the Secretary of State to make regulations imposing waiting-time duties on integrated care boards in respect of children including a requirement on integrated care boards to take action where a child does not receive a specified treatment or service within the specified period.

None 99

Clause 25, page 18, line 22, at end insert—
“(4A) Any guidance issued by the Secretary of State under subsection (4) must include provision about—
(a) supporting effective management within primary and neighbourhood care, including through appropriate clinical capability and arrangements for escalation where clinically necessary,
(b) assessing the workforce and service capacity required to implement a neighbourhood health plan,
(c) allocating lead responsibility between partner organisations, and
(d) assessing progress against locally selected indicators using information already collected or published in the exercise of statutory functions.”

This amendment seeks to require guidance on neighbourhood health plans to cover clinical leadership and escalation arrangements in primary and neighbourhood care, assessing the workforce and service capacity needed for delivery, the clear allocation of lead responsibility between partner organisations, and the monitoring of progress using existing statutory data and locally selected indicators.

Opposition Amendment 148

After Clause 52, insert the following new Clause—
“Single patient record: sexual and reproductive health information
(1) Regulations under section 250E of the National Health Service Act 2006 (as inserted by section 52 of this Act) must not require or authorise information relating to the provision of sexual and reproductive health services to a patient to be made available through the system established under those regulations, unless the patient has given explicit consent.
(2) A patient may withdraw consent given under subsection (1) at any time.
(3) In this section “sexual and reproductive health services” includes—
(a) testing for and treatment of HIV and other sexually transmitted infections,
(b) contraception, and
(c) the termination of pregnancy.”

This amendment would exclude HIV, sexual health and abortion care information from the single patient record unless the patient gives explicit consent.

Opposition Amendment 163

After Clause 52, insert the following new Clause—
“Right to receive sexual health services anonymously
(1) A person seeking testing for, or treatment of, HIV or any other sexually transmitted infection from a sexual health service must not be required, as a condition of receiving that service, to give their name or any other information which identifies them.
(2) Information identifying a person who receives a service under subsection (1) must not be disclosed without that person’s consent, except where necessary to prevent a serious risk of harm to the person or to others.”

This amendment would put on a statutory footing the existing right to use sexual health services anonymously.

None 177

After Clause 57, insert the following new Clause—
“Cap on care costs
(1) Sections 15 (cap on care costs) and 16 (cap on care costs: annual adjustment) of the Care Act 2014 come into force at the end of the period of two months beginning with the day on which this Act is passed.
(2) The Secretary of State must make regulations under section 15(4) of the Care Act 2014 to take effect no later than 12 months after the entry into force of sections 15 and 16 of the Care Act 2014.”

This amendment would bring into force the cap on care costs which was recommended by the Dilnot Commission in 2011 and passed into law in the Care Act 2014, but which has not been brought into force.

None 178

After Clause 57, insert the following new Clause—
“Integrated personal health and care budgets
(1) The National Health Service Act 2006 is amended as follows.
(2) After section 12DB (inserted by Schedule 12 to this Act) insert—
“12DC Right to an integrated personal health and care budget
(1) This section applies where—
(a) The Secretary of State or an integrated care board (‘the relevant NHS body’) is responsible for arranging the provision to an adult of one or more community-based health services,
(b) the relevant NHS body has identified an amount which is sufficient to secure the provision of those services in accordance with an agreed care plan, and
(c) a local authority is required, or has decided, to meet needs of that adult under Part 1 of the Care Act 2014 and the adult has a personal budget under section 26 of that Act.
(2) The adult, or an authorised representative acting on the adult’s behalf, may request that the amounts available from the relevant NHS body and the local authority be provided as an integrated personal health and care budget.
(3) Where a request is made under subsection (2), the relevant NHS body and the local authority must—
(a) grant the request unless one of the grounds in subsection (8) applies;
(b) prepare, with the adult or authorised representative, a single personalised health and care plan;
(c) identify in that plan—
(i) the adult’s assessed health needs and care and support needs;
(ii) the outcomes which the arrangements are intended to achieve;
(iii) the amount to be provided by the relevant NHS body;
(iv) the amount to be provided by the local authority;
(v) any amount which the adult is required to pay following a financial assessment under the Care Act 2014; and
(vi) the total amount of the integrated personal health and care budget;
(d) designate one of them as the lead body responsible for administering the budget; and
(e) establish a single system for payment, management, monitoring and review of the budget.
(4) An integrated personal health and care budget may be managed by—
(a) a direct payment to the adult or an authorised representative,
(b) a direct payment to a person nominated by the adult or authorised representative,
(c) a managed account administered by a person or body independent of the relevant NHS body and the local authority,
(d) a notional budget administered by the lead body in accordance with the personalised health and care plan, or
(e) a combination of the arrangements in paragraphs (a) to (d).
(5) The relevant NHS body and the local authority must give effect to the adult’s preferred method of management under subsection (4), except to the extent that a ground in subsection (8) applies.
(6) Amounts comprised in an integrated personal health and care budget may be applied to any service, support, item or arrangement specified in the personalised health and care plan where the bodies are satisfied that it will contribute to meeting one or more of the needs or outcomes specified in that plan.
(7) Expenditure under subsection (6) need not be classified exclusively as expenditure on health care or on care and support, but the personalised health and care plan must make provision sufficient to meet all the needs which the relevant NHS body and the local authority are respectively required to meet.
(8) A request, or a preferred method of managing the budget, may be refused only where—
(a) the proposed arrangement would be unlawful,
(b) it would give rise to a material risk to the health, safety or welfare of the adult or another person which cannot reasonably be mitigated,
(c) the adult, authorised representative or nominee would be unable to manage the arrangement safely or effectively notwithstanding any support which could reasonably be provided,
(d) the requested arrangement relates to a service which regulations expressly exclude from integrated personal budgets, or
(e) the proposed expenditure would not contribute to meeting a need or outcome specified in the personalised health and care plan.
(9) Where a request is refused in whole or in part, the relevant NHS body and the local authority must—
(a) give the adult and any authorised representative written reasons,
(b) identify any alternative arrangement which they propose,
(c) inform them of the right to require a review, and
(d) continue to secure the services required to meet the adult’s assessed needs while the review is determined.
(10) A review under subsection (9) must—
(a) be undertaken by a person who was not involved in the original decision,
(b) involve the adult and any authorised representative,
(c) be completed within the prescribed period, and
(d) result in a written decision with reasons.
(11) Nothing in this section—
(a) transfers from the relevant NHS body or the local authority responsibility for any function or duty for which that body is otherwise responsible,
(b) permits a charge to be imposed for any service which must be provided free of charge as part of the health service,
(c) permits an amount payable by the relevant NHS body to be taken into account as resources of the adult for the purposes of a financial assessment under the Care Act 2014,
(d) permits either body to reduce the amount it would otherwise be required to provide solely because the other body is contributing to the integrated budget, or
(e) affects the right of the adult to have services arranged directly instead of receiving or managing a personal budget.
(12) To the extent that an integrated personal health and care budget consists of—
(a) NHS funding, a payment made under this section is to be treated as a direct payment under section 12A;
(b) money payable by a local authority to meet needs under Part 1 of the Care Act 2014, the payment is to be treated as a direct payment under section 31 or 32 of that Act, as appropriate.
(13) In this section “authorised representative” means—
(a) where the adult has capacity to make the relevant decision, a person whom the adult has authorised to act on the adult’s behalf,
(b) a donee of a lasting power of attorney, or a deputy appointed by the Court of Protection, who has authority to make the relevant decision,
(c) a person nominated by the adult before the adult lost capacity to make the relevant decision, or
(d) where there is no person within paragraphs (b) or (c), a suitable person approved jointly by the relevant NHS body and the local authority to act in the adult’s best interests.
(14) An authorised representative may nominate a person or organisation to administer a managed account where the authorised representative does not have authority, or does not wish, personally to receive and manage the money.
(15) In this section “community-based health services” means health services arranged for an adult in the adult’s home or in a community setting, including—
(a) NHS Continuing Healthcare,
(b) community nursing, therapy, rehabilitation and mental-health services,
(c) equipment and other support required to enable the adult to live in the community, and
(d) such other services as may be prescribed.
(16) The Secretary of State must make regulations providing for—
(a) the period within which a request must be determined and implemented,
(b) the calculation and sufficiency of the NHS contribution,
(c) support for adults and authorised representatives in preparing and managing a budget,
(d) monitoring, review, audit and recovery of payments,
(e) resolution of disputes between responsible bodies without interruption to the adult’s care, and
(f) the limited descriptions of service which may be excluded under subsection (8)(d).”
(3) In section 75 of the National Health Service Act 2006, after subsection (3) insert—
“(3A) Regulations under this section must make provision enabling NHS bodies and local authorities to discharge their duties under section 12DC.
(3B) The absence of arrangements under this section does not relieve an NHS body or local authority of a duty imposed by section 12DC.””

This amendment and another in the name of Lord Lansley integrate funding after NHS and Care Act eligibility have been determined. They would give a statutory right to one plan, one total budget and one administrative arrangement, but do not merge the statutory responsibilities of the NHS body and local authority.

None 179

After Clause 57, insert the following new Clause—
“Consequential amendments to the Care Act 2014
(1) The Care Act 2014 is amended as follows.
(2) In section 25, after subsection (2) insert—
“(2A) Where section 12DC of the National Health Service Act 2006 applies, the requirements of this section may be satisfied by a single personalised health and care plan prepared under that section.”
(3) For section 26(3) substitute—
“(3) Where section 12DC of the National Health Service Act 2006 applies, the personal budget must—
(a) specify the amount of NHS money available in the adult’s case,
(b) form part of the integrated personal health and care budget prepared under that section, and
(c) identify separately the amounts provided by the local authority, the relevant NHS body and the adult.
(3A) In any other case, a personal budget may specify other amounts of public money available in the adult’s case, including amounts relating to housing, healthcare or welfare.”
(4) In sections 31 and 32, after subsection (3) insert—
“(3A) Where a direct payment forms part of an integrated personal health and care budget under section 12DC of the National Health Service Act 2006, the local authority must coordinate the payment, account, conditions and review arrangements with the relevant NHS body and must not require a separate account or administrative process unless this is necessary for the protection of the adult.””

This amendment and another in the name of Lord Lansley integrate funding after NHS and Care Act eligibility have been determined. They would give a statutory right to one plan, one total budget and one administrative arrangement, but do not merge the statutory responsibilities of the NHS body and local authority.

None 200

After Clause 71, insert the following new Clause—
“Powers for coroners and medical examiners to review suspected failings in obstetric, neonatal and paediatric care
(1) The Secretary of State must, by regulations made by statutory instrument, establish a standard mechanism whereby coroners and medical examiners must review cases of deaths, bought to them by patients, medical staff or other relevant whistleblowers, where there are suspected failings in the provision of obstetric, neonatal and paediatric care.
(2) A coroner or a medical examiner has a duty to review cases using the mechanism established under subsection (1) if, in the course of their duties, there are reasonable grounds to suspect that a death or incident involved systemic failings or clinical negligence in a health care setting.
(3) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

This new clause would require the Secretary of State to establish a standard mechanism for coroners and medical examiners to review cases involving suspected failings in obstetric, neonatal and paediatric care.

None 204

After Clause 78, insert the following new Clause—
“Infant feeding bottles: materials
(1) A relevant NHS body must, when procuring or supplying infant feeding bottles for use by infants in its care, procure or supply bottles which are not made wholly or partly of plastic.
(2) The duty in subsection (1) does not apply where the responsible clinician considers that the use of a bottle not made of plastic would be contrary to the clinical interests of a particular infant.
(3) A relevant NHS body satisfies the duty in subsection (1) by procuring or supplying bottles the container of which is made of a safe alternative material.
(4) The Secretary of State may by regulations specify a material as a safe alternative material, or remove a material previously so specified, but may only specify a material where satisfied, on the basis of the best available scientific and clinical evidence and applying a precautionary approach, that in normal conditions of use the material does not release into the contents of the bottle—
(a) microplastic particles,
(b) bisphenols or their derivatives,
(c) phthalates or other plasticisers, or
(d) any other substance having endocrine-disrupting properties,
in quantities which may pose a risk to the health of an infant.
(5) In subsection (4), “normal conditions of use” includes sterilisation, the preparation of feed with water at temperatures used in clinical and domestic settings, repeated washing, and the expected service life of the bottle.
(6) The Secretary of State must make the first regulations under subsection (4) within 12 months of the day on which this section comes into force.
(7) Before making regulations under subsection (4), the Secretary of State must consult—
(a) the United Kingdom Health Security Agency,
(b) the Food Standards Agency,
(c) the Health and Safety Executive,
(d) such organisations representing paediatric, neonatal and maternity clinicians as the Secretary of State considers appropriate, and
(e) such other persons as the Secretary of State considers appropriate.
(8) The Secretary of State must issue guidance to relevant NHS bodies about the discharge of the duty in subsection (1), including guidance on cleaning, sterilisation and safe handling, and a relevant NHS body must have regard to that guidance.
(9) Within 12 months of the day on which this section comes into force, and annually thereafter, the Secretary of State must lay before Parliament a report on compliance with the duty in subsection (1), including an estimate of the number of infant feeding bottles procured or supplied by relevant NHS bodies in the reporting period and the materials of which they were made.
(10) In this section—
“infant” means a child under the age of 24 months;
“infant feeding bottle” means the container from which an infant is fed, and does not include the teat, valve or collar;
“relevant NHS body” means—
(a) an integrated care board,
(b) an NHS trust, or
(c) an NHS foundation trust;
“responsible clinician” means the registered medical practitioner or registered nurse with responsibility for the care of the infant”

Opposition Amendment 20

After Clause 4, insert the following new Clause—
“Urban health equity
(1) The Secretary of State must, within 12 months of the day on which this Act is passed, publish a strategy for reducing health inequalities in urban areas in England.
(2) The strategy must address the effect on health of deprivation, air quality, housing and access to health services.
(3) The Secretary of State must lay before Parliament an annual report on progress in implementing the strategy.”

This amendment would require the Secretary of State to publish a strategy for reducing health inequalities in urban areas and report annually on progress.

Opposition Amendment 59

After Clause 12, insert the following new Clause—
“Specialised commissioning: children and young people
(1) Before any decision to delegate, transfer or otherwise devolve responsibility for commissioning specialised services, the Secretary of State must have regard to—
(a) the need for age-appropriate specialised services for children and young people,
(b) the need for equitable access to those services across England,
(c) the impact of the decision on the quality, safety, sustainability and clinical effectiveness of those services,
(d) the effect of the small and geographically dispersed population of children and young people requiring those services,
(e) the impact on patients from Wales, Scotland and Northern Ireland who use those services in England, and
(f) the benefits of retaining national commissioning or oversight where this supports sufficient patient volumes, clinical expertise, service standards or equitable access.
(2) Before making a decision under subsection (1) that relates to specialised services for children and young people, the Secretary of State must publish an impact assessment setting out the likely effect on—
(a) access to services,
(b) clinical outcomes and patient experience,
(c) health inequalities,
(d) clinical expertise and service sustainability,
(e) service integration and continuity of care,
(f) patients, families and carers, and
(g) the quality, consistency and equity of services.
(3) In preparing an impact assessment under subsection (2), the Secretary of State must consult such persons as the Secretary of State considers appropriate, including children and young people who use specialised services, their families and carers, clinicians, and relevant provider and support organisations.
(4) The Secretary of State must lay before Parliament an annual report on the provision, accessibility, quality and outcomes of specialised services for children and young people.
(5) In this section—
“children and young people” means persons under the age of 25;
“specialised services” means services commissioned under regulations made under section 3B of the National Health Service Act 2006 (regulation-making power to require Secretary of State to commission services).”

This amendment would require the Secretary of State to consider the needs of children and young people before devolving specialised commissioning, publish an impact assessment, and report annually to Parliament.

None 60

After Clause 14, insert the following new Clause—
“Sight tests: people with learning disabilities
In regulation 3(1) of the Primary Ophthalmic Services Regulations 2008 (S.I. 2008/1186) (sight tests: eligibility)—
(a) at the end of paragraph (h), omit “or”,
(b) at the end of paragraph (i), for the full stop substitute “; or”, and
(c) after paragraph (i) insert—
“(j) who is eligible for registration as having a learning disability with their GP or is already registered as having a learning disability with their GP.””

This amendment would make people with a learning disability eligible for a free NHS sight test, in the same way as people with diabetes or a family history of glaucoma.

Opposition Amendment 61

Schedule 1, page 72, line 30, at end insert—
(5)After subsection (2) insert—
(2A)Eligibility for, and the scope of, the sight-testing service mentioned in subsection (2), and the fees payable for it, must be set nationally by the Secretary of State, and an integrated care board may not vary them in its area.””

This amendment would ensure that access to NHS sight tests remains nationally protected and is not subject to local variation once integrated care boards take on commissioning of primary ophthalmic services.

None 62

Schedule 1, page 73, line 6, at end insert—
“116C Primary ophthalmic services for people with learning disabilities
The Secretary of State must—
(a) assess, or make arrangements for the assessment of, the need for primary ophthalmic services among people with learning disabilities,
(b) direct integrated care boards to commission primary ophthalmic services to meet those needs, and
(c) monitor and evaluate the effectiveness of those services.”

This amendment would require the Secretary of State to assess the eye care needs of people with learning disabilities and direct integrated care boards to commission services to meet them.

Opposition Amendment 67

Clause 16, page 12, line 22, at end insert—
“(3) Regulations under subsection (1) must make provision for enabling people to choose the provider of appropriate non-consultant-led community services, including—
(a) optometry-led monitoring and management of low-risk glaucoma, and
(b) community urgent eye care services.
(4) The Secretary of State must keep under review the services to which regulations under subsection (1) apply, with a view to extending patient choice for care in the community.”

This amendment would extend patient choice to non-consultant-led community services, including optometry-led glaucoma care and community urgent eye care services.

Opposition Amendment 70

After Clause 16, insert the following new Clause—
“Reservation and prioritisation of contracts for the voluntary, community and social enterprise sector
(1) In exercising their commissioning functions, integrated care boards must take reasonable steps to secure the participation of voluntary, community and social enterprise organisations in the provision of services.
(2) The Secretary of State must by regulations made by statutory instrument enable integrated care boards to reserve and prioritise contracts to be delivered by voluntary, community and social enterprise organisations as part of their commissioning process.
(3) Circumstances in which contracts may be appropriate to be reserved and prioritised under subsection (2) include—
(a) services that are, or could be, community-based,
(b) services that are intended to reach populations that are underserved, marginalised, or experiencing health inequalities, or
(c) where voluntary, community and social enterprise organisations are best placed to deliver person-centred or culturally competent care.
(4) In exercising functions under this section, integrated care boards must have regard to—
(a) the need to reduce health inequalities,
(b) the importance of securing equitable access to services across different areas, and
(c) the sustainability of voluntary, community and social enterprise provision.
(5) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

This new clause would require integrated care boards to take reasonable steps to secure the participation of voluntary, community and social enterprise organisations in the provision of services through the ICB commissioning process.

Opposition Amendment 23

After Clause 17, insert the following new Clause—
“Patient choice: onward referrals by virtual and integrated health services
(1) The Secretary of State must by regulations made by statutory instrument make provision to ensure that a patient who is referred onward by a designated health service body to a provider for elective care or treatment is offered the same choices in respect of that referral as would apply if the referral had been made by a general practitioner, dentist or optometrist.
(2) Regulations under subsection (1) must in particular ensure that a designated health service body—
(a) does not maintain a closed list of preferred providers for onward referrals which excludes providers that would otherwise be available to patients under the NHS choice framework,
(b) does not direct a patient to a particular provider for elective care without first offering the patient the opportunity to exercise their right to choice, and
(c) has access to the NHS e-Referral Service, or any successor system, for the purpose of facilitating patient choice in respect of onward referrals.
(3) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.
(4) In this section—
“designated health service body” means—
(a) an NHS trust or NHS foundation trust,
(b) a body designated by the Secretary of State as providing virtual care or triage services to NHS patients in England, or
(c) a body designated by the Secretary of State as an integrated healthcare organisation or organisation of equivalent description;
“onward referral” means a referral made by a designated health service body to another provider for the purposes of the patient receiving further investigation, treatment or care.”

This amendment would ensure that patients referred onward by NHS trusts and virtual or integrated health services have the same choice of provider as those referred by a GP, dentist or optometrist.

Opposition Amendment 82

Clause 22, page 16, line 19, at end insert—
“(2A) The constitution must also provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include at least one member nominated jointly by providers of primary care services in the integrated care board’s area, including providers of primary ophthalmic services, and must set out the process for that nomination.”

This amendment would ensure that primary care, including optometry, is represented on each integrated care board.

None 93

After Clause 22, insert the following new Clause—
“Quality and outcomes for people living with inflammatory bowel disease
(1) Each integrated care board must monitor and assess variation in the quality of care, access to services and outcomes for people living with inflammatory bowel disease within its area.
(2) In carrying out an assessment under subsection (1), an integrated care board must assess its performance against the national standards and measures established under section (National strategy for inflammatory bowel disease).
(3) For each financial year, an integrated care board must publish a report on its performance against the national standards and measures established under section (National strategy for inflammatory bowel disease), including any unwarranted variation identified within its area and the action taken or proposed to reduce it.
(4) In this section, “inflammatory bowel disease” includes Crohn’s disease, ulcerative colitis and such related conditions as the Secretary of State may specify in regulations made under section (National strategy for inflammatory bowel disease).
(5) The first report under this section must be published within 12 months of the day on which this section comes into force, and subsequent reports must be published annually.”

The amendment would require all ICBs to assess and report against the same national framework for inflammatory bowel disease.

None 120

Clause 52, page 36, line 16, after "received", insert "publicly funded"

This amendment together with others in the name of Baroness Noakes probe the extent to which private health and social care falls within the patient record system.

None 121

Clause 52, page 36, line 17, after "received", insert "publicly funded"

This amendment together with others in the name of Baroness Noakes probe the extent to which private health and social care falls within the patient record system.

None 122

Clause 52, page 36, line 18, after "of" insert "publicly funded"

This amendment together with others in the name of Baroness Noakes probe the extent to which private health and social care falls within the patient record system.

Opposition Amendment 129

Clause 52, page 36, line 37, at end insert—
“(2A) The regulations must make provision for—
(a) persons providing optometry services to have access to relevant patient information through the system,
(b) the system to be interoperable with the digital systems used by such persons, and
(c) persons providing optometry services to be represented in the governance and implementation of the system.”

This amendment would ensure that optometrists have access to the single patient record, interoperable digital systems and a role in its governance and implementation.

None 130

Clause 52, page 36, line 37, at end insert—
“(2A) The regulations must provide that any patient may opt out of all or any information relating to them being included in the system.”

This amendment allows patients to opt out of being included in the single patient record system.

Opposition Amendment 139

Clause 52, page 37, line 14, after “condition” insert “, and includes optometry services, including primary ophthalmic services”

This amendment would make explicit that optometry is included within the single patient record framework.

None 140

Clause 52, page 37, line 23, at end insert—
““publicly funded” care includes care which is partly funded out of public funds;”

This amendment together with others in the name of Baroness Noakes probe the extent to which private health and social care falls within the patient record system.

None 149

After Clause 52, insert the following new Clause—
“Single patient record: review of data minimisation
(1) Before making regulations under section 250E of the National Health Service Act 2006 (single patient record), the Secretary of State must undertake a review of—
(a) the patient information to be provided to or processed through the system established under that section,
(b) the identifiable patient information to be held by suppliers, contractors, partners and service providers whose information or services will be used to establish, populate or operate the system,
(c) whether that identifiable patient information can be anonymised, pseudonymised or processed using a unique identifier before it is disclosed to or processed by those persons,
(d) the periods for which identifiable patient information will be retained by those persons,
(e) whether the establishment of the system will result in unnecessary duplication of identifiable patient information, and
(f) the cybersecurity risks of the unnecessary retention, disclosure or duplication of identifiable patient information.
(2) The review must make recommendations for reducing the amount of identifiable patient information held by persons participating in the system and increasing the use of anonymisation, pseudonymisation and unique identifiers.
(3) The Secretary of State must lay before Parliament a report setting out the findings and recommendations of the review.”

This new clause would require a review of data minimisation in relation to the single patient record, including identifiable information held by suppliers, partners, contractors, diagnostic laboratories and other service providers, and whether greater use could be made of anonymisation, pseudonymisation and unique identifiers.

None 252

After Clause 84, insert the following new Clause—
“NHS mental health workforce plan
(1) Within 12 months of the publication of the first NHS workforce plan since the 2023 NHS workforce plan, the Secretary of State must publish a follow-up mental health workforce plan.
(2) The plan should include but not be limited to detail on—
(a) how the mental health workforce will be effectively retained and recruited to meet the scale of the mental health demand, including for people with learning disabilities and autistic people;
(b) investment required to achieve the commitments in the plan.
(3) The Secretary of State must produce an annual report to Parliament on the achievements made in delivering the plan.”

The amendment requires the Government to publish a follow-up mental health workforce plan within 12 months of the publication of the next NHS workforce plan.

Opposition Amendment 253

After Clause 84, insert the following new Clause—
“Health and care workforce strategy
(1) The Secretary of State must, within 12 months of the day on which this Act is passed, publish a health and care workforce strategy for England.
(2) The strategy must set out—
(a) an assessment of the number of staff, including registered nurses and primary care practitioners, needed to meet current and projected demand for health and care services, and
(b) a funded plan to close any gap between that number and the staff available.
(3) In this section “primary care practitioners” includes general practitioners, dentists, optometrists and pharmacists.
(4) The Secretary of State must lay before Parliament an annual report on progress in implementing the strategy.”

This amendment would require the Secretary of State to assess health and care staffing needs, including for nursing and primary care, publish a funded plan to close any gaps, and report annually to Parliament.

None 254

After Clause 84, insert the following new Clause—
“Autism, ADHD and learning disabilities: responsibility following abolition of NHS England
(1) No regulations may be made under section 88 (commencement) bringing section 1 into force unless the Secretary of State has published, and laid before Parliament, a statement under this section.
(2) A statement under this section must set out—
(a) how each function exercised by NHS England in relation to the assessment, diagnosis, treatment and support of autistic people and people with ADHD will be exercised following the abolition of NHS England, and by which person or body,
(b) how the functions exercised by NHS England in connection with its national programme for people with a learning disability and autistic people will be exercised following that abolition, and by which person or body,
(c) the senior officer of the Department of Health and Social Care with lead responsibility for the matters in paragraphs (a) and (b), and
(d) how the Secretary of State will monitor, and report to Parliament on, waiting times for autism and ADHD assessment.
(3) In this section—
“ADHD” means attention deficit hyperactivity disorder;
“autistic people” includes people with any autism spectrum condition.”

This new clause would prevent NHS England from being abolished until the Government has published who will be responsible for its autism, ADHD and learning disability functions, and how assessment waiting times will be monitored.

None 255

After Clause 84, insert the following new Clause—
“Autism and ADHD: publication of information and prevalence surveys
(1) The Secretary of State must publish information about the assessment of autism and ADHD in England, including—
(a) the number of people referred for an autism assessment, and the number of people referred for an ADHD assessment, who are waiting for that assessment,
(b) the length of time for which those people have been waiting, and
(c) information disaggregated by integrated care board area, age group and sex.
(2) Information under subsection (1) must be published—
(a) at intervals no longer than those at which equivalent information was published by NHS England immediately before the day on which section 1 comes into force, and
(b) in a form which allows comparison with the information published by NHS England before that day.
(3) The Secretary of State must arrange for surveys to be carried out to estimate the prevalence of autism and ADHD among children and adults in England.
(4) The first survey under subsection (3) must be commissioned within two years of the day on which this Act is passed and further surveys must be commissioned at intervals of not more than five years.
(5) The Secretary of State must publish the results of each survey under subsection (3) and lay a copy before Parliament.
(6) In this section "ADHD" means attention deficit hyperactivity disorder, and “autism” includes any autism spectrum condition.”

This new clause would ensure that published statistics on autism and ADHD assessment waiting lists continue, on the same timetable and in comparable form, after NHS England's information functions transfer to the Secretary of State, and would require regular surveys of the prevalence of autism and ADHD.

None 256

After Clause 84, insert the following new Clause—
“Treatment at sporting and cultural events
(1) The Secretary of State must, within six months of the day on which this Act is passed, by regulations made by statutory instrument establish an exception from registration under Chapter 2 of Part 1 of the Health and Social Care Act 2008 (registration in respect of provision of health or social care) for the provision of treatment of disease, disorder or injury by a listed healthcare professional where—
(a) the treatment is provided to—
(i) an athlete or performer, or
(ii) a person providing essential support to an athlete or performer,
(b) the treatment is provided in connection with preparation for, travel to or from, or participation in a sporting competition, sporting event or cultural performance,
(c) the healthcare professional is registered with the professional regulator relevant to their profession,
(d) the treatment is provided in accordance with relevant quality and clinical governance standards recognised by the Secretary of State, and
(e) the healthcare professional has notified the Care Quality Commission that they intend to operate under the exception.
(2) For the purposes of this section, “athlete” includes—
(a) a professional or elite athlete;
(b) an amateur athlete;
(c) a child or young person participating in sport;
(d) a person participating in a grassroots, community, school or recreational sporting competition or event.
(3) Regulations under subsection (1) must make provision in relation to—
(a) elite and professional competitions and performances,
(b) amateur and non-elite competitions and performances,
(c) grassroots and community sporting events,
(d) school and youth sporting events, and
(e) competitions and events involving disabled athletes or performers.
(4) The standards recognised under subsection (1)(d) must include standards relating to—
(a) safeguarding, including the safeguarding of children and vulnerable adults,
(b) clinical governance,
(c) professional competence,
(d) indemnity,
(e) medicines management,
(f) record keeping, and
(g) emergency escalation.
(5) The Care Quality Commission must maintain a register of listed healthcare professionals who have notified it under subsection (1)(e).
(6) Entry in the register under subsection (5)—
(a) does not constitute registration under Chapter 2 of Part 1 of the Health and Social Care Act 2008, and
(b) may be suspended or removed where the Care Quality Commission is satisfied that the professional no longer meets the conditions in subsection (1).
(7) Before making regulations under this section, the Secretary of State must consult—
(a) the Care Quality Commission,
(b) relevant professional regulators,
(c) national governing bodies for sport and cultural activities,
(d) bodies representing sport and exercise medicine and pre-hospital care, and
(e) bodies representing grassroots, community, school and youth sport.
(8) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

None 291

Clause 88, page 65, line 27, at end insert “, subject to the provisions of section (Autism, ADHD and learning disabilities: responsibility following abolition of NHS England) (autism, ADHD and learning disabilities: responsibility following abolition of NHS England).”

This amendment is consequential on another amendment in the name of Baroness Leaman.

None 6

Clause 4, page 3, leave out lines 22 to 29 and insert—
“1C Duty to improve public health and reduce health inequalities
(1) The Secretary of State must, in exercising functions in relation to the health service—
(a) take all reasonable steps to improve the health of the people of England and prevent illness,
(b) reduce health inequalities between the people of England,
(c) take all reasonable steps to reduce inequalities in the ability to access health services and in the outcomes achieved through the provision of health services, and
(d) address the social, economic and environmental determinants of health, including in relation to housing, education, employment, income and environmental conditions.
(2) In discharging the duties under subsection (1), the Secretary of State must take account of the need to prevent ill health by addressing its causes, as well as by providing services for the treatment of illness.”

This amendment strengthens the Secretary of State’s duties to improve public health and reduce health inequalities, including by addressing the social, economic and environmental determinants of health and preventing illness rather than relying on treatment alone.

None 15

Clause 4, page 3, line 29, at end insert—
“(c) ensure that national health data systems collect, analyse and publish data sufficient to identify and monitor health inequalities affecting inclusion health groups, including Gypsy, Roma and Traveller communities.”

This amendment would require national health data systems to collect, analyse and publish data sufficient to identify and monitor health inequalities affecting inclusion health groups, including Gypsy, Roma and Traveller communities, to improve the evidence base for reducing health inequalities.

None 16

Clause 4, page 3, line 29, at end insert—
“(2) In exercising the duty under this section, the Secretary of State must have regard to the need to reduce inequalities in access to health services and health outcomes experienced by inclusion health groups, including Gypsy, Roma and Traveller communities.”

This amendment would require the Secretary of State, when exercising the statutory duty to reduce health inequalities, to have regard to the particular barriers to healthcare access and health outcomes experienced by inclusion health groups, including Gypsy, Roma and Traveller communities.

None 17

Clause 4, page 3, line 29, at end insert—
“(2) The Secretary of State must, within 12 months of the day on which this Act is passed and annually thereafter, publish a report setting out—
(a) the steps taken to improve the identification of inclusion health groups within national health data systems,
(b) progress in reducing inequalities in access to health services and health outcomes experienced by those groups, and
(c) actions taken in relation to Gypsy, Roma and Traveller communities.”

This amendment would require the Secretary of State to publish regular reports on progress in identifying inclusion health groups in national health data and reducing health inequalities experienced by those groups, strengthening transparency and accountability.

Opposition Amendment 24

After Clause 5, insert the following new Clause—
“Patient choice: onward referrals by virtual and integrated health services
(1) The Secretary of State must by regulations make provision to ensure that a patient who has been accepted by an NHS provider organisation (including an NHS Trust, an NHS Foundation Trust, an Integrated Healthcare Organisation or a service accessed via NHS Online) and is referred onward by that body or service to a provider for elective care or treatment is offered the same choices in respect of that referral as would apply if the referral had been made by a general practitioner, dentist or optometrist.
(2) For the purposes of this section, “designated health service body” means—
(a) any body designated by the Secretary of State as providing virtual care or triage services to NHS patients in England;
(b) any body designated by the Secretary of State as an integrated healthcare organisation or organisation of equivalent description.
(3) Regulations under subsection (1) must in particular make provision designed to ensure that a designated health service body—
(a) does not restrict a patient’s choice of provider by reference to a closed list of preferred providers without first offering the patient the opportunity to exercise their right to choose from all providers available to provide the elective care concerned;
(b) has access to the NHS e-Referral Service, or any successor system, for the purpose of facilitating patient choice in respect of onward referrals.
(4) In this section, “onward referral” means a referral made by a designated health service body to another provider for the purposes of the patient receiving further investigation, treatment or care.
(5) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

This amendment seeks to probe into the Secretary of State's duty to make provisions for up to five independent healthcare providers to assist with NHS care in order to lessen the burden across services and reduce travel time for patients.

Opposition Amendment 27

After Clause 6, insert the following new Clause—
“Access to health innovation networks
(1) The Secretary of State must make arrangements for a wide single national point of access to the health innovation networks in England.
(2) The arrangements must enable a person to—
(a) make a single request for support,
(b) be directed to the appropriate health innovation network or networks, and
(c) receive coordinated support where an innovation has potential application in more than one region.
(3) The Secretary of State must publish information about the operation and performance of the arrangements.”

This new clause would require a single national point of access through which innovators and other organisations could obtain coordinated support from the health innovation networks in England.

None 29

Clause 7, page 4, line 31, at end insert—
“(1A) In discharging the duty in subsection (1), the Secretary of State must ensure that education and training for persons employed in the health service in England includes training on recognising, preventing and responding to antisemitism and other forms of racism.”

This amendment seeks to ensure that the workforce education and training duty transferred from NHS England will include training on antisemitism and racism, as recommended by the Lord Mann review (recommendations 32 to 36).

None 33

Clause 10, page 6, leave out lines 14 to 21 and insert—
“12E Presumption in favour of public provision of health services
(1) In exercising functions in relation to the health service, the Secretary of State must secure, so far as reasonably practicable, that health services are provided by public bodies.
(2) A health service may be provided by a private-sector body only where the Secretary of State or other relevant public authority is satisfied that—
(a) no reasonable alternative is available for the provision of that service by a public body within a clinically appropriate timeframe, and
(b) the use of a private-sector body is necessary to ensure the provision of the service or to meet the healthcare needs of patients.
(3) A decision to arrange for a health service to be provided by a private-sector body under subsection (2) must—
(a) be supported by a published assessment of the available alternatives,
(b) explain why provision by a public body is not reasonably practicable, and
(c) be limited to the extent and duration necessary to meet the need identified.”

This amendment establishes a presumption that NHS services should be provided by public bodies and restricts private-sector provision to cases where no reasonable public-sector alternative is available within a clinically appropriate timeframe and private provision is necessary to meet patients’ needs.

Opposition Amendment 35

Clause 10, page 6, line 21, leave out “the health service” and insert “patients, where the Secretary of State is satisfied that the variation is necessary to improve patient outcomes”

This amendment would permit the Secretary of State deliberately to vary the balance between public, independent providers of health services only where the variation is necessary to improve patient outcomes. Its purpose is to prevent changes to the provider mix being made for ideological or political reasons.

None 36

After Clause 10, insert the following new Clause—
“Review of existing private-sector provision of health services
(1) The Secretary of State must, within 12 months of the day on which this Act is passed, undertake and publish a review of existing arrangements under which health services are provided by private-sector bodies.
(2) The review must assess—
(a) whether each arrangement remains necessary having regard to the presumption in favour of public provision of health services,
(b) the feasibility of providing the service through a public body,
(c) the financial, clinical and workforce implications of returning the service to public provision, and
(d) the steps and timescale for bringing the service into public provision where private-sector provision is no longer necessary.
(3) Following the review, the Secretary of State must publish and lay before Parliament a plan for the progressive return to public provision of services for which private-sector provision is not necessary.
(4) The Secretary of State must publish an annual report on the implementation of the plan under subsection (3).”

This amendment requires the Secretary of State to review existing arrangements for the provision of NHS services by private-sector bodies, assess whether those arrangements remain necessary and identify opportunities to return services to public provision.

None 39

Clause 11, page 7, line 33, at end insert—
“(5) A direction under section 14Z61 may not be given for the purpose of determining an individual decision by an integrated care board concerning the commissioning, organisation or provision of a particular local health service, including a decision concerning—
(a) the opening, closure or relocation of a particular NHS service or facility,
(b) the location at which a particular NHS service is provided,
(c) the selection of a particular provider to provide NHS services, or
(d) the allocation of resources to a particular local service.
(6) A direction under section 14Z61 in relation to specialised services may be given only for the purpose of—
(a) determining which services are to be commissioned as specialised services,
(b) securing compliance with national standards, service specifications or commissioning policies relating to those services, or
(c) requiring collaboration between integrated care boards in commissioning those services.
(7) Nothing in subsections (5) and (6) prevents the Secretary of State from exercising the powers conferred by section 14Z62A where the conditions in that section are met.”

This amendment would prevent the Secretary of State from using the general power of direction to determine individual local commissioning decisions, while limiting directions on specialised services to defined national purposes. It would preserve the separate intervention powers that apply where an integrated care board has significantly failed, or is at significant risk of significantly failing, to discharge its functions.

None 49

After Clause 11, insert the following new Clause—
“Promoting access to dentistry equitably
In the National Health Service Act 2006, after section 1C insert—
“1CA Duty to promote access to dentistry equitably
In exercising functions in relation to the health service, the Secretary of State must have regard to the need to ensure provision of dentistry across England accessible to all regardless of wealth or geography.””

None 50

After Clause 11, insert the following new Clause—
“Promoting access to ambulance services equitably
In the National Health Service Act 2006, after section 1C insert—
“1CA Duty to promote access to ambulance services equitably
In exercising functions in relation to the health service, the Secretary of State must have regard to the need to ensure provision of ambulance services across England accessible to all regardless of wealth or geography.””

None 51

After Clause 11, insert the following new Clause—
“Duty to provide NHS services publicly
In section 1 of the National Health Service Act 2006 (Secretary of State's duty to promote comprehensive health service) for subsection (2) substitute—
“(2) The Secretary of State must discharge the duty under subsection (1) by ensuring that services forming part of the health service in England are provided by public bodies.
(2A) For the purposes of subsection (2), a service is not provided by a public body where its provision is contracted or otherwise arranged to be carried out by a private body.
(2B) In this section, “public body” means the Secretary of State, an integrated care board, an NHS trust, an NHS foundation trust, a local authority or another body established by or under an enactment to perform public functions.””

This amendment places a duty on the Secretary of State to ensure that NHS services are provided publicly, rather than arranging for their provision by other bodies.

None 52

After Clause 11, insert the following new Clause—
“Duties as to climate change etc
In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert—
“1CD Duties as to climate change etc
(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the need to—
(a) contribute towards compliance with—
(i) section 1 of the Climate Change Act 2008 (UK net zero emissions target), and
(ii) section 5 of the Environment Act 2021 (environmental targets: effects), and
(b) adapt to any current or predicted impacts of climate change identified in the most recent report under section 56 of the Climate Change Act 2008.
(2) The Secretary of State may publish guidance about the discharge of—
(a) the duty imposed on the Secretary of State by subsection (1) of this section;
(b) the duty imposed on integrated care boards by section 14Z44 (duties as to climate change etc);
(c) the duty imposed on NHS trusts by section 26B (duties in relation to climate change etc);
(d) the duty imposed on NHS foundation trusts by section 63B (duties in relation to climate change etc).
(3) In discharging their duty under section 14Z44, integrated care boards must have regard to guidance published under subsection (2).
(4) In discharging the duty under subsection (1), the Secretary of State must have regard to guidance published under subsection (2).””

None 53

After Clause 11, insert the following new Clause—
“Duty as to UK suppliers and sovereign capability
In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert—
“1CD Duty as to UK suppliers and sovereign capability
(1) The Secretary of State must take into account the matters mentioned in subsection (2)—
(a) in setting the award criteria for a relevant contract under section 23 of the Procurement Act 2023, so far as those matters relate to the subject matter of the contract, and
(b) in having regard, under section 12(1)(a) of that Act, to the importance of delivering value for money in connection with the award of a relevant contract.
(2) The matters are—
(a) the extent to which the data, control and support of the system concerned will remain within the jurisdiction of the United Kingdom,
(b) the risks to the security and resilience of the health service arising from any respect in which they will not, including the risk that access to NHS patient data could be compelled under the law of a country or territory outside the United Kingdom, and
(c) so far as consistent with the international obligations of the United Kingdom, the contribution of the contract to developing and maintaining capability within the United Kingdom to design, deliver and support technology and information systems which handle NHS patient data.
(3) Subsections (4) and (5) apply to a material relevant contract under which—
(a) the data, control or support of the system concerned will not remain wholly within the jurisdiction of the United Kingdom, or
(b) the supplier, or any subcontractor with access to NHS patient data, is subject to the law of a country or territory outside the United Kingdom under which access to such data could be compelled,
(a “jurisdiction-risk contract”).
(4) Before entering into a jurisdiction-risk contract, the Secretary of State must consult—
(a) the National Cyber Security Centre,
(b) persons representing the interests of patients, and
(c) trade unions representing health service staff,
on the proposed contract, and must, before, or as soon as reasonably practicable after, entering into the contract, lay before Parliament a report on that consultation.
(5) As soon as reasonably practicable after entering into a jurisdiction-risk contract, the Secretary of State must lay before Parliament a statement setting out—
(a) the reasons for the award, including how the matters in subsection (2) were taken into account, and
(b) whether the Government is taking, or is planning to take, steps to develop or support long-term domestic alternatives to the systems provided under the contract.
(6) The Secretary of State must, at least once in every period of 12 months, lay before Parliament a report setting out—
(a) the number and total value of relevant contracts entered into during that period, the proportion of each awarded to UK suppliers, and the number and total value of jurisdiction-risk contracts entered into during that period; and
(b) how the award of those contracts has contributed to the objectives of any NHS Digital Sovereignty Strategy published under section (NHS Digital Sovereignty Strategy) of the Health Act 2026 (NHS Digital Sovereignty Strategy).
(7) A report or statement under this section may omit information the publication of which would be reasonably likely to prejudice national security or the commercial interests of any person, but must state that information has been omitted.
(8) This section is without prejudice to the national security exemption under paragraph 25 of Schedule 2 to the Procurement Act 2023.
(9) In this section—
“material relevant contract” means a relevant contract with an estimated value, determined in accordance with Schedule 3 to the Procurement Act 2023, of more than the threshold amount that applies under Schedule 1 to that Act to a contract of that kind awarded by a central government authority, including a contract awarded under a framework and a renewal or extension of a relevant contract;
“NHS patient data” means patient information (within the meaning given in section 250E(7)) relating to persons who have received health care or social care in England;
“relevant contract” means a contract entered into by the Secretary of State for the provision of technology or information systems which—
(a) form part of the single patient record, or hold or process patient information for its purposes, or
(b) are provided for use across the health service in England as national systems and hold, process or provide access to NHS patient data;
“the single patient record” means the system for making patient information available referred to in section 250E(1), whether or not established by regulations under that section;
“UK supplier” means a company incorporated in the United Kingdom which either has no parent undertaking or each of whose parent undertakings (within the meaning of section 1162 of the Companies Act 2006) is incorporated, and has its head office, in the United Kingdom.””

This new clause would require procurement of the single patient record and national systems handling NHS patient data to weigh UK jurisdiction over data, control and support, and UK capability, with consultation and statements to Parliament for higher-value contracts outside UK jurisdiction, and an annual report on the UK share.

None 57

Clause 12, page 9, leave out lines 33 to 39 and insert—
“(2) Before prescribing a service or facility under subsection (1)(b), the Secretary of State must publish an assessment of the likely impact of such a prescription on—
(a) patient safety,
(b) clinical outcomes,
(c) equality of access to services,
(d) workforce capacity and specialist expertise,
(e) service sustainability, and
(f) geographical variation in access to, and outcomes from, services.
(2A) The Secretary of State must lay the assessment under subsection (2) before both Houses of Parliament.
(2B) In deciding whether it would be appropriate to prescribe a service or facility under subsection (1)(b), the Secretary of State must have regard to the assessment published under subsection (2).
(2C) Where regulations made under subsection (1)(b) prescribe a service or facility for commissioning other than by the Secretary of State, the Secretary of State must publish and maintain a national service framework for that service or facility.
(2D) A framework under subsection (2C) must include provision relating to—
(a) service standards,
(b) care pathways,
(c) workforce requirements,
(d) rehabilitation and long-term follow-up,
(e) collection and publication of outcome data,
(f) coordination between specialist, community and neighbourhood services, and
(g) coordination of care for persons receiving treatment through multiple clinical pathways.”

This amendment would require the Secretary of State to publish an impact assessment before they make a decision to prescribe a service or facility under subsection (1)(b) of section 3B of the National Health Service Act 2006 and maintain a national service framework for any specialised service no longer commissioned directly by the Secretary of State.

Opposition Amendment 68

Clause 16, page 12, line 22, at end insert—
“14Z45BA Patient choice: community services substituting for consultant-led elective care
(1) Regulations under section 14Z45B(1) must make provision to enable patients to make choices in respect of non-consultant-led community services where those services are commissioned as a direct substitute for, or to prevent a referral to, consultant-led elective services.
(2) For the purposes of subsection (1), a service is to be regarded as a direct substitute for, or intended to prevent a referral to, consultant-led elective services if it—
(a) provides assessment, diagnosis, treatment or management for a condition that would otherwise be referred to a secondary care specialist, or
(b) is commissioned by an integrated care board for the purpose of reducing or managing demand on secondary or elective care.
(3) Services to which this section applies include but are not limited to—
(a) community adult audiology services,
(b) community glaucoma management and monitoring services,
(c) Minor Eye Conditions Services, and
(d) Community Urgent Eyecare Services.
(4) Regulations made by virtue of this section must make provision designed to ensure that—
(a) patients are offered a choice of any clinically appropriate provider commissioned under a qualifying NHS contract for the relevant service,
(b) no limitation on the number of providers from which a patient may choose is imposed solely on the grounds of cost or demand management, and
(c) patients are provided with information enabling them to make an informed choice, including information about waiting times and quality.
(5) An integrated care board must not commission a community service of a kind falling within subsection (2) in a manner which has the effect of restricting patient choice below the standard that would apply to an equivalent consultant-led elective service.”

This amendment seeks to probe the choices open to patients of community services provided by non-NHS healthcare providers and whether patients have the choice of up to five providers for hospital care.

None 73

After Clause 17, insert the following Clause—
“Annual report on specialised services
(1) Within 12 months of the day on which this Act is passed, and every 12 months thereafter, the Secretary of State must publish a report on the commissioning and performance of all specialised services.
(2) A report under subsection (1) must include information relating to—
(a) patient outcomes,
(b) access to services,
(c) waiting times,
(d) workforce capacity,
(e) service sustainability,
(f) geographical variation in services,
(g) compliance with national service specifications, and
(h) arrangements for the coordination of specialist, community and neighbourhood care.
(3) A report under subsection (1) must be laid before both Houses of Parliament.”

This new clause would require the Secretary of State to publish an annual report on all commissioned specialised services.

None 74

After Clause 17, insert the following new Clause—
“Clinical leadership in specialised commissioning
The Secretary of State must make arrangements to ensure that all specialised commissioning, including specialised commissioning at Integrated Board Level, is informed by national clinical leadership and specialist clinical advice in the—
(a) planning of the commissioning arrangements,
(b) design of services and arrangements for service delivery, and
(c) monitoring of the performance of specialist services.”

This new clause requires clinical leadership in the commissioning of specialised services, whether commissioned by the Secretary of State or Integrated Care Boards. This could include, but is not limited to, maintaining NHS England’s existing infrastructure of Clinical Reference Groups, National Clinical Directors and National Speciality Advisers.

None 75

After Clause 17, insert the following new Clause—
“Adult gender services: service specification, data and reporting
(1) This section applies to gender dysphoria services for adults which, immediately before the abolition of NHS England, were commissioned by NHS England as specialised services.
(2) The Secretary of State must—
(a) maintain a national service specification for the services described in subsection (1), founded on the principles of evidence-based medicine,
(b) ensure that every provider of such services submits, as a condition of its contract, complete quarterly data to the specialised services quality dashboard or its successor, including outcome and complication measures, and
(c) maintain a single national waiting list for such services.
(3) The Secretary of State must, within 12 months of the day on which this Act is passed, and annually thereafter, lay before Parliament a report on—
(a) implementation of each recommendation of the Operational and Delivery Review of NHS Adult Gender Dysphoria Clinics led by Dr David Levy (published December 2025), including the identity of the body accountable for each recommendation following the abolition of NHS England,
(b) compliance by each provider with the data duty in subsection (2)(b), identifying any provider that has failed to submit complete data, and
(c) waiting times, referral volumes and discharge outcomes for the services described in subsection (1).”

This new clause seeks to preserve, on the abolition of NHS England, national accountability for adult gender dysphoria services, by requiring an evidence-based national specification, mandatory outcome data as a contractual condition, and annual reporting to Parliament on implementation of the Levy recommendations.

None 79

Clause 21, page 16, line 5, at end insert—
“(4) A performance assessment must include an assessment of how well the integrated care board has discharged its duty under section (Antisemitism, racism and extremism: duties of NHS bodies and annual report) of the Health Act 2026.”

This amendment would require the Secretary of State’s annual performance assessment of each integrated care board to cover how well it has prevented and responded to antisemitism, other forms of racism and support for proscribed organisations that affects patients and staff.

None 80

Clause 21, page 16, line 5, at end insert—
“(4) In conducting a performance assessment under this section, the Secretary of State must assess the discharge by an integrated care board of any functions relating to specialised services.
(5) An assessment under subsection (4) must consider—
(a) patient outcomes,
(b) access to services,
(c) compliance with national service specifications,
(d) workforce capacity,
(e) service sustainability, and
(f) geographical variation in access to, and outcomes from, services.
(6) The report published under subsection (3) must include a summary of the assessments undertaken under subsections (4) and (5).”

This amendment would require the Secretary of State to undertake and publish a national assessment of the performance of integrated care boards in relation to specialised services.

None 94

After Clause 22, insert the following new Clause—
“Duty of integrated care boards to promote collaboration
(1) An integrated care board must, in exercising its functions, promote collaboration and integration between NHS bodies and other relevant health and care organisations.
(2) The duty under subsection (1) includes a duty to—
(a) plan services in collaboration with NHS providers, primary care providers, local authorities and relevant voluntary and community organisations,
(b) consider the effect of commissioning decisions on the integration, continuity and long-term provision of NHS services,
(c) seek opportunities for NHS bodies to provide services collaboratively, rather than through arrangements that unnecessarily fragment service provision, and
(d) have regard to the benefits of cooperation between providers in improving population health and reducing health inequalities.
(3) An integrated care board must publish an assessment of how it has fulfilled the duties under this section in its annual report.”

This new clause requires integrated care boards to promote collaboration across NHS, primary care, local authority, voluntary and community services, supporting a bottom-up approach to decision-making that reflects local needs and encourages joined-up service planning and delivery.

Baroness Bennett of Manor Castle gives notice of her intention to oppose the Question that Clause 24 stand part of the Bill.

None 100

Clause 25, page 18, line 26, at end insert—
“(5A) In preparing a plan under this section, the responsible local authority and each of its partner integrated care boards must take reasonable steps to reduce health inequalities in the area resulting from differences in respect of general health determinants, including through ensuring the meaningful involvement of communities who face disproportionate barriers to participation.”

This amendment seeks to create a specific requirement for local authorities and ICBs to meaningfully reduce health inequalities arising from the wider determinants of health as part of their neighbourhood health plans. The amendment seeks to ensure that individuals are involved in developing the plans, especially those most affected by health inequalities.

Opposition Amendment 102

After Clause 25, insert the following new Clause—
“Joint local health and wellbeing strategies
(1) The Local Government and Public Involvement in Health Act 2007 is amended as set out in subsections (2) and (3).
(2) After section 116A of the insert—
“116AA Joint local health and wellbeing strategies
(1) Where an assessment of relevant needs is prepared under section 116 by a responsible local authority, the responsible local authority and each of its partner integrated care boards must prepare a joint local health and wellbeing strategy setting out priorities for meeting those needs, improving health and wellbeing and reducing health inequalities in the authority’s area, including in relation to the wider determinants of health.
(2) A neighbourhood health plan prepared under section 116A must be consistent with any joint local health and wellbeing strategy for that area.
(3) A neighbourhood health plan may form part of a joint local health and wellbeing strategy.”
(3) In section 116B (as substituted by section 25 of this Act), after paragraph (b) insert—
“(c) any joint local health and wellbeing strategy prepared under section 116AA.”
(4) In section 196(1) of the Health and Social Care Act 2012 (functions of Health and Wellbeing Boards), for “sections 116 and 116A” substitute “sections 116, 116A and 116AA”.”

This amendment would retain joint local health and wellbeing strategies as the democratically owned strategic framework for local health and wellbeing, require neighbourhood health plans to be consistent with them, restore the duty on local authorities and integrated care boards to have regard to them, and keep preparing them a function of the Health and Wellbeing Board.

Opposition Amendment 105

Schedule 3, page 99, line 18, at end insert—
“(6) The Secretary of State may appoint a person as chair or another non-executive director only following a recommendation made by an independent appointments panel.
(7) The Secretary of State must by regulations make provision about the composition and operation of independent appointments panels under this paragraph.
(8) Regulations under this paragraph must provide that each panel must include persons with knowledge of, and a connection to, the area principally served by the NHS foundation trust.
(9) Before making regulations under this paragraph, the Secretary of State must consult NHS foundation trusts, persons who are or have been members of councils of governors, patients and such other persons as the Secretary of State considers appropriate.
(10) Regulations under this paragraph must be made by statutory instrument and may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.”

This amendment would require appointments of chairs and non-executive directors of NHS foundation trusts to be made following recommendations by independent appointments panels with local representation. Its purpose is to probe how the Government will prevent the centralisation and politicisation of appointments, and how the Department will manage the practical burden of making appointments across all foundation trusts.

None 111

After Clause 44, insert the following new Clause—
“Hospices: supply and disposal of medicines and medical supplies
(1) The Secretary of State must by regulations made by statutory instrument enable qualifying voluntary hospices providing palliative or end of life care to obtain medicines and medical supplies through the pharmaceutical supply arrangements of the health service.
(2) Regulations under subsection (1) may make provision about—
(a) the meaning of “qualifying hospices”, and
(b) the medicines and supplies that may be obtained.
(3) The Secretary of State must by regulations make provision for the disposal of expired, unwanted or surplus medicines and medical supplies by qualifying hospices.
(4) Regulations under subsection (3) may make provision about—
(a) the collection, return and destruction of medicines, and
(b) the meaning of “qualifying hospices”.
(5) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

NHS patients in NHS hospitals or at home in the community are eligible for NHS prescribed medications at no additional cost. However, in some hospices, the hospice itself has to purchase the medications for these same patients as the hospice does not have a contract covering NHS supply of medications.

None 112

After Clause 44, insert the following new Clause—
“Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing
(1) The Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing may be ratified only if—
(a) a Minister of the Crown has laid before the House of Commons a copy of the Arrangement, and
(b) the Arrangement has been approved by a resolution of the House of Commons on a motion moved by a Minister of the Crown.
(2) Before tabling a motion under subsection (1)(b) the Secretary of State must publish and lay before the House of Commons an impact assessment on the potential effects on the health service of implementation of the Arrangement.”

This new clause would require the Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing to be brought before the House for a vote.

None 126

Clause 52, page 36, line 33, at end insert—
“(ca) enabling a patient, following diagnosis of a health condition, to consent to the sharing of such information as is necessary for the purpose of enabling an approved voluntary, community or charitable organisation to offer or provide condition-specific support services to the patient;
(cb) facilitating referral, where consent has been provided, to such an organisation under subsection (ca);”

This amendment would ensure that regulations establishing the single patient record may include provision enabling patients, following diagnosis, to consent to referral and information sharing with approved voluntary, community and charitable organisations providing condition-specific support services.

Opposition Amendment 127

Clause 52, page 36, line 37, at end insert—
“(e) requiring any electronic health records which contribute patient information to, or interoperate with, the system to support interoperable data standards and secure integration through application programming interfaces, so that clinical information, including clinical documentation generated with the assistance of artificial intelligence, can be exchanged securely between systems.”

This amendment would allow regulations establishing the single patient record to require all electronic health record systems contributing to or interoperating with it to support open, standards-based application programming interface (API) integration.

Opposition Amendment 131

Clause 52, page 36, line 37, at end insert—
“(2A) Regulations under subsection (1) must require the establishment and maintenance of an electronic register of each occasion on which patient information made available through the system is accessed.
(2B) The register must record—
(a) the identity, organisation and role of the person accessing the information,
(b) the date and time of the access,
(c) the information accessed, and
(d) the purpose of the access.
(2C) Regulations under subsection (1) must provide for a patient—
(a) to inspect, without charge, entries in the register relating to their information, and
(b) to request an investigation of any access which the patient believes was unauthorised or improper.
(2D) The register must record access undertaken for the provision of care and access undertaken for research, planning, commissioning or any other purpose.”

This amendment would require every access to information through the single patient record to be recorded in an electronic register and would give patients the right to inspect the entries relating to their information and challenge potentially improper access.

Opposition Amendment 135

Clause 52, page 37, line 3, at end insert—
“(4A) Regulations under subsection (1) must make provision securing that sensitive patient information may not be made available through the system to a person involved in the provision of health care or social care unless—
(a) the patient has given explicit consent to the information being made available to that person or to a specified description of persons, and
(b) that consent remains in force at the time at which the information is accessed.
(4B) Regulations made for the purposes of subsection (4A) must provide for a patient to—
(a) specify the persons, or descriptions of persons, to whom sensitive patient information may be made available,
(b) give, vary or withdraw consent easily and without charge,
(c) restrict consent to specified information, specified purposes or a specified period, and
(d) obtain a record of each occasion on which sensitive patient information relating to the patient has been accessed, including the identity or description of the person accessing it and the date and purpose of the access.
(4C) Regulations under subsection (1) may provide for sensitive patient information to be made available without the consent required by subsection (4A) only where—
(a) access to the information is necessary to prevent death or serious harm to the patient or another person,
(b) it is not reasonably practicable to obtain the patient’s consent, and
(c) the access is limited to the information strictly necessary for that purpose.
(4D) Where sensitive patient information is accessed by virtue of subsection (4C)—
(a) the access and the reasons for it must be recorded,
(b) the patient must be notified as soon as reasonably practicable, unless notification would create a serious risk of harm to the patient or another person, and
(c) the access must be subject to subsequent review in accordance with provision made by the regulations.
(4E) In this section, “sensitive patient information” means patient information relating to—
(a) sexual or reproductive health,
(b) termination of pregnancy,
(c) fertility treatment,
(d) mental health diagnosis or treatment,
(e) substance misuse diagnosis or treatment,
(f) genetic information, or
(g) any other description of information prescribed by regulations as requiring enhanced protection by reason of its particularly private or sensitive character.
(4F) Consent for the purposes of this section must be freely given, specific, informed and unambiguous, and must be indicated by a clear affirmative action.
(4G) A patient must not be denied or disadvantaged in the provision of health care or social care solely because the patient has not given consent under subsection (4A).”

This amendment would require regulations establishing the single patient record to provide enhanced protection for particularly sensitive health information. Such information could ordinarily be viewed only by persons, or descriptions of persons, expressly authorised by the patient. A limited exception would permit access without consent where strictly necessary.

Opposition Amendment 136

Clause 52, page 37, line 3, at end insert—
“(4A) Before making regulations under this section, the Secretary of State must lay before Parliament a report setting out—
(a) the person or persons who will be the controller of patient information processed through the system,
(b) the respective responsibilities of any controllers, joint controllers and processors,
(c) the arrangements for the custody, stewardship and security of patient information,
(d) the location of the servers on which patient information will principally be stored and processed,
(e) the circumstances in which patient information may be stored, processed or accessed outside the United Kingdom,
(f) the legal jurisdictions to which the information and the persons processing it may be subject, and
(g) the safeguards that will prevent patient information from being accessed under the law of another jurisdiction in a manner incompatible with the law of the United Kingdom.
(4B) The Secretary of State must consult the Information Commissioner before laying the report required by this subsection.”

This amendment would require the Secretary of State to clarify the governance, control, stewardship, location and legal jurisdiction of data used in the single patient record before making regulations establishing the system.

Opposition Amendment 137

Clause 52, page 37, line 3, at end insert—
“(4A) Regulations under this section must make provision for patient information generated in connection with health care provided—
(a) as part of the health service, or
(b) otherwise than as part of the health service, including health care provided by independent healthcare providers.
to be made available through the system to persons providing health care in either setting, where the information is relevant and necessary for the direct care of the patient.”

This amendment would ensure that relevant patient information generated in both NHS and independent healthcare settings can be included in the single patient record and made available to NHS and independent healthcare providers where it is necessary for the patient’s direct care.

None 142

Clause 52, page 38, line 16, at end insert—
“250G Duty to bring forward reform of scientific research in the public interest
(1) Before the end of the period mentioned in subsection (2), the Secretary of State must publish a draft of regulations under section 251 making provision for—
(a) the use of confidential patient information held in connection with the single patient record established under section 250E for the purposes of scientific research in the public interest, and
(b) the protection of patient privacy and confidentiality in connection with such use, including respect for any objection by a patient to such use.
(2) The period is 12 months beginning with the day on which section 250E comes into force.
(3) Before publishing the draft regulations required by subsection (1), the Secretary of State must—
(a) carry out a public consultation on the proposals for those regulations, for a period of not less than 12 weeks,
(b) consult the National Data Guardian and such other persons with expertise in the secondary use of health data for research purposes as the Secretary of State considers appropriate, and
(c) publish a response to the consultation carried out under paragraph (a).
(4) In this section—
“confidential patient information” has the same meaning as in section 251;
“National Data Guardian” means the person appointed under section 1 of the Health and Social Care (National Data Guardian) Act 2018;
“patient” includes an individual who needs or receives social care or whose need for such care is being assessed; and
“scientific research” has the same meaning as in Article 4(2) of the UK GDPR.”

This new section seeks to set a timetable for reforming the rules on confidential patient information, so that patient data in the single patient record can be used for scientific research in the public interest, with safeguards for patient privacy and objections, following public consultation.

None 143

Clause 52, page 38, line 16, at end insert—
“250G Single patient record: sovereign data asset, national security and parliamentary accountability
(1) Patient information held in, or made available through, the single patient record is a sovereign data asset, held for the benefit of patients, the health service in England and the public.
(2) The Secretary of State must take appropriate steps for securing that—
(a) patient information held in, or made available through, the single patient record is hosted and stored only on servers located in the United Kingdom, and
(b) no person accesses the single patient record from outside the United Kingdom for the purposes of its technical support, maintenance or administration.
(3) The Secretary of State must not establish, or permit the establishment or continuation of, arrangements for the hosting, storage or processing of patient information held in, or made available through, the single patient record unless satisfied that—
(a) such information is encrypted, when stored and when transmitted, using encryption keys held and controlled only by a health service body, so that it cannot be read by any supplier or subcontractor, or any other person, without the authority of that body,
(b) appropriate safeguards are in place to prevent access to such information that is unauthorised, or compelled under a legal, regulatory or judicial requirement of a jurisdiction outside the United Kingdom, by any person, including a foreign state, foreign public authority, or person acting on their behalf, and to prevent the disclosure or transfer of such information pursuant to any such requirement,
(c) the ownership, governance and control arrangements of any supplier or subcontractor with access to such information do not present an unacceptable national security risk, and
(d) appropriate arrangements are in place to ensure the operational resilience, continuity and recoverability of the single patient record.
(4) In relation to arrangements in place immediately before this section comes into force, subsections (2) and (3) apply only from the end of the period of 24 months beginning with the day on which this section comes into force.
(5) The Secretary of State must, as soon as reasonably practicable after any material change of supplier or subcontractor, or of the ownership or control of a supplier or subcontractor, with access to such information—
(a) review whether subsection (3) continues to be met, and
(b) lay before Parliament a statement of the outcome of that review.
(6) Subsection (2) does not apply to—
(a) the temporary storage of patient information on a device used to access it for the purposes of direct care, including direct care provided in the British Islands outside the United Kingdom, or
(b) access from outside the United Kingdom which is necessary to respond to an emergency incident affecting the security or operation of the single patient record, if the access continues only for as long as is necessary for that purpose and is notified to the National Cyber Security Centre, with the reasons for it, within 24 hours of the access beginning.
(7) In determining whether subsection (3)(c) is met, the Secretary of State must have regard to advice from the National Cyber Security Centre and such other persons as the Secretary of State considers appropriate.
(8) This section is without prejudice to the national security exemption under paragraph 25 of Schedule 2 to the Procurement Act 2023 and the national security exclusion ground under paragraph 14 of Schedule 7 to that Act, which continue to apply to any relevant procurement in connection with the single patient record.
(9) Before a draft of the first regulations under section 250E is laid before Parliament or, if earlier, before the single patient record comes into operation or, if it is already in operation, within three months of this section coming into force, the Secretary of State must lay before Parliament a statement setting out—
(a) how the requirements of this section have been satisfied,
(b) the arrangements for governance of the single patient record,
(c) the categories of organisation that will be permitted access to information made available through the single patient record, and
(d) the safeguards applicable to such access.
(10) The Secretary of State must publish and lay before Parliament an updated statement under subsection (9) at least once in every period of 12 months during which the single patient record is in operation; and each updated statement must summarise any change of supplier or subcontractor during that period which was not the subject of a statement under subsection (5).
(11) In this section—
“health service body” has the meaning given in section 9(4);
“patient information” has the meaning given in section 250E(7);
“the single patient record” means the system for making patient information available referred to in section 250E(1), whether or not established by regulations under that section.”

This new section would make single patient record data a sovereign data asset. The Secretary of State would have to take appropriate steps to secure UK-only storage and no overseas support access, and ensure NHS-held encryption keys, safeguards against foreign access and resilience, reporting to Parliament before establishment and annually.

None 150

After Clause 52, insert the following new Clause—
“Single patient record: development and implementation
(1) The Secretary of State must consult Scottish Ministers, Welsh Ministers and Northern Ireland Ministers on the development and implementation of the single patient record under section 150E of the National Health Service Act 2006 (as inserted by section 52 of this Act).
(2) The Secretary of State must publish an annual report in each calendar year on the progress of the development and implementation of the single patient record.”

None 164

After Clause 56, insert the following new Clause—
“Unauthorised access to patient information
(1) A person commits an offence if the person knowingly accesses patient information and the access is not authorised.
(2) A person who commits an offence under subsection (1) is liable on summary conviction to imprisonment for a term not exceeding 3 months or a fine (or both).
(3) In this section—
“patient information” has the same meaning as section 251(10) of the National Health Service Act 2006 (definition of “patient information”);
“authorised” means in the proper exercise of the person’s functions.”

Opposition Amendment 165

After Clause 56, insert the following new Clause—
“Recording of ethnicity in health and care information
(1) The Secretary of State must ensure that any information standard, and any specification of the single patient record, made or maintained under this Act requires the ethnicity of every patient to be recorded as a standard data field—
(a) as stated by the patient,
(b) using the ethnic group classification used in the most recent census of England and Wales, recorded at the most detailed level of that classification and reportable at each higher level of aggregation, and
(c) subject to correction at the patient’s request.
(2) The Secretary of State must, within 12 months of the day on which this Act is passed, publish updated standards and guidance for the recording of ethnicity in health and care information, superseding any standards or guidance based on a classification other than that described in subsection (1)(b).
(3) The Secretary of State must publish annually an assessment of the completeness, consistency and accuracy of ethnicity recording in NHS records, including variation by region and type of provider, together with the steps being taken to improve it.
(4) The duty in subsection (1) includes ensuring that data relating to conditions with marked differential prevalence or outcomes by ethnicity, including sickle cell disease and thalassaemia, can be planned for, analysed and published by reference to the field recorded under that subsection.”

This new clause ensures that the single patient record established by this Act records every patient’s ethnicity as the patient states it, using current census categories in place of guidance based on the 2001 census, so that conditions such as sickle cell disease can be planned, costed and audited and ethnic inequalities in care identified.

Opposition Amendment 166

After Clause 56, insert the following new Clause—
“Recording of sex in health and care information
(1) The Secretary of State must ensure that any information standard, and any specification of the single patient record, made or maintained under this Act requires—
(a) the sex of every patient to be recorded accurately as a mandatory data field,
(b) that field to record sex at birth, meaning male or female only, and
(c) where a patient so wishes, and where lawful under the data protection legislation and the Gender Recognition Act 2004, gender identity or acquired gender to be recorded as a separate and additional data field.
(2) The data field in subsection (1)(a) may be altered only—
(a) to correct a clerical error, or
(b) to correct the record of a patient with a medically verified difference of sexual development.
(3) Within 12 months of the passing of this Act the Secretary of State must publish a review of the accuracy of sex data held in NHS records, and a plan for its correction, having regard to the recommendations of the independent review of data, statistics and research on sex and gender led by Professor Alice Sullivan (March 2025).
(4) In this section “sex” has the same meaning as in the Equality Act 2010, as interpreted by the Supreme Court in For Women Scotland Ltd v The Scottish Ministers [2025] UKSC 16.”

This new clause ensures that the single patient record established by this Act records every patient’s biological sex accurately as a mandatory field, with gender identity recordable separately, giving statutory effect to the recommendations of the Sullivan Review, which the Secretary of State has accepted, and to the change made to the NHS Core Information Standard in April 2026.

Opposition Amendment 167

After Clause 56, insert the following new Clause—
“Recording and publication of diagnostic data
(1) The Secretary of State must ensure that any information standard, and any specification of the single patient record, made or maintained under this Act requires, in respect of any diagnosis of attention deficit hyperactivity disorder, autism or a common mental health condition, the recording of—
(a) the assessment pathway and type of provider, including whether the assessment was carried out by an independent provider under the NHS right to choose, to be recorded, and
(b) the diagnostic criteria and assessment standards applied to be recorded.
(2) The Secretary of State must publish annually data on diagnoses of the conditions described in subsection (1), disaggregated by age, sex, region, provider type and assessment route, together with waiting times for assessment.
(3) In this section “sex” has the same meaning as in the Equality Act 2010, as interpreted by the Supreme Court in For Women Scotland Ltd v The Scottish Ministers [2025] UKSC 16.”

This new clause ensures that the single patient record and information standards established by this Act record how and by whom diagnoses of ADHD, autism and common mental health conditions are made, and requires annual publication of disaggregated data, so that Parliament, clinicians and researchers can establish whether variation in diagnosis rates reflects need or differences in assessment practice.

None 168

After Clause 56, insert the following new Clause—
“Prohibition on commercial access to identifiable NHS patient data
(1) A commercial entity, or any employee, officer or subcontractor of such an entity, must not be granted access to identifiable patient data held by or on behalf of the NHS.
(2) Subsection (1) applies to all forms of access, including—
(a) direct access to patient records,
(b) administrative, privileged or system-wide access to databases or data environments containing identifiable patient data,
(c) access through software, analytics platforms, application programming interfaces or other technical systems, and
(d) access to identifiable patient data for the purposes of technical support, system maintenance, development or testing.
(3) A commercial entity may provide technical services involving NHS data only where the service can be performed using anonymised data or, where necessary, pseudonymised data within an environment controlled by the NHS.
(4) The Secretary of State must ensure that existing contractual arrangements are brought into compliance with this section within six months of the day on which this Act is passed.
(5) The Secretary of State must publish an annual report identifying any exceptions to subsection (1), the reasons for them, the duration of the access and the safeguards applied.”

This amendment prohibits commercial entities and their personnel from accessing identifiable NHS patient data, including through administrative access to systems, and requires technical services to be delivered using anonymised or pseudonymised data wherever possible.

None 169

After Clause 56, insert the following new Clause—
“Public control of NHS data infrastructure
(1) The Secretary of State must ensure that the digital infrastructure used nationally to integrate, store, access and analyse NHS patient data is owned, operated and controlled by the NHS or another public authority.
(2) No relevant NHS body may enter into or continue an arrangement under which a private company has operational control of national NHS patient-data infrastructure.
(3) A private company may provide technical goods or services to the NHS only where—
(a) the NHS retains ownership and effective control of the infrastructure and all NHS data,
(b) the company has no independent right to access, use, disclose or retain NHS data,
(c) the arrangement does not prevent the NHS from operating, modifying or transferring the infrastructure independently of that company, and
(d) the arrangement includes enforceable provisions for the transfer of systems, data and technical documentation to the NHS or a replacement provider.
(4) The Secretary of State must take all reasonable steps to bring existing arrangements into compliance with this section.
(5) Within six months of the day on which this Act is passed, the Secretary of State must publish a plan, with a timetable, for the establishment of publicly controlled NHS data infrastructure.”

This amendment requires critical NHS data infrastructure to be publicly owned, operated and controlled, while permitting private suppliers to provide technical services without acquiring control over NHS systems or data.

None 170

After Clause 56, insert the following new Clause—
“Women’s health: data and communications
(1) In exercising functions under this Act relating to the collection, analysis or publication of information, the Secretary of State must ensure that data relating to health and care is collected and published disaggregated by sex and age, including in relation to—
(a) maternity and neonatal services,
(b) screening programmes for cervical, breast and ovarian cancer,
(c) conditions that present differently in, or predominantly affect, women, and
(d) clinical research and audit.
(2) Data within subsection (1)(a) and (b) must also be published disaggregated by ethnicity, recorded in accordance with section (Recording of ethnicity in health and care information).
(3) The Secretary of State must ensure that public communications by NHS bodies concerning maternity services and female-specific conditions and screening use clear, accurate, sex-based terminology (including “woman” and “mother”), which may be supplemented by additional terms where an NHS body considers it appropriate.
(4) In this section “sex” has the same meaning as in the Equality Act 2010, as interpreted by the Supreme Court in For Women Scotland Ltd v The Scottish Ministers [2025] UKSC 16.”

This new clause requires health data to be collected and published disaggregated by sex and age, with maternity and screening data also published by ethnicity, and requires NHS communications on maternity care and female-specific conditions and screening to use clear sex-based language, while permitting additional terms.

None 171

After Clause 56, insert the following new Clause—
“NHS Digital Sovereignty Strategy
(1) The Secretary of State must, within 12 months of the day on which this Act is passed, publish and lay before Parliament a strategy (“the NHS Digital Sovereignty Strategy”) setting out the Government’s approach to—
(a) treating NHS patient data as a sovereign data asset, including where such data is stored and from where it may be accessed,
(b) maintaining the security and resilience of relevant NHS information systems by assessing, managing and mitigating risks—
(i) associated with foreign interference, and
(ii) arising from reliance on foreign-supplied technologies,
(c) preventing over-reliance on health care suppliers that are not UK suppliers by building domestic capability, and
(d) enabling access to NHS patient data for scientific research and the development of artificial intelligence models in a manner that maintains public trust.
(2) The strategy must include—
(a) an assessment of the risks associated with—
(i) hardware,
(ii) software,
(iii) supply chains, and
(iv) procurement processes
in the NHS;
(b) a specific focus on security and resilience in NHS digital procurement processes, detailing how the Government intends to reduce strategic dependencies on foreign-owned service providers to mitigate the risk of systemic disruption, and how capability within the United Kingdom, and the extent to which data, control and support remain within the jurisdiction of the United Kingdom, will be taken into account in assessing value for money;
(c) options to prioritise the use of technologies developed in the United Kingdom by UK suppliers in relevant NHS information systems, consistent with the international obligations of the United Kingdom, to reduce reliance on foreign technologies;
(d) the arrangements for publishing and maintaining information standards under section 250 of the Health and Social Care Act 2012 (powers to publish information standards) for the single patient record, including standards for interoperability, and for securing compliance with those standards by persons providing information technology for the single patient record;
(e) the arrangements the Government intends to put in place for a hierarchy of access to pseudonymised patient data from the single patient record for scientific research and the development of artificial intelligence models, including—
(i) preferential access, in descending order of preference, for—
(A) researchers in universities and other public research bodies in the United Kingdom, charities whose purposes include medical or health research, and the health service, including the National Institute for Health and Care Research, when conducting its own research,
(B) UK suppliers, and
(C) other persons;
(ii) the basis on which the health service will share in the value created by such access, which may differ between, and need not involve any charge to, the categories of person in sub-paragraph (i), and how any returns will be reinvested in the health service;
(iii) conditions of access, including a requirement of public benefit and a requirement that data is accessed only within a trusted research environment located in the United Kingdom, with outputs checked before release; and
(iv) how those arrangements build on the model of access operated by the Medicines and Healthcare products Regulatory Agency for the Clinical Practice Research Datalink;
(f) proposals for developing sovereign artificial intelligence model capability for the health service using longitudinal data from the single patient record linking primary care, secondary care and outcome data;
(g) the steps the Government intends to take, and the timetable for taking them, to address barriers to access to NHS patient data for scientific research, including—
(i) reform of the Health Service (Control of Patient Information) Regulations 2002 (S.I. 2002/1438),
(ii) arrangements for linking NHS patient data, including coded primary care data, with other research datasets, including those held by UK Biobank and Our Future Health, and
(iii) arrangements agreed or proposed with the Scottish Ministers, the Welsh Ministers and the Department of Health in Northern Ireland for access to patient data for scientific research across the United Kingdom;
(h) arrangements for transparency about access to NHS patient data and for patients to opt out, including through the NHS App, of the use of their pseudonymised data for scientific research, and how those arrangements relate to the national data opt-out;
(i) the steps the Government intends to take to support and develop sufficient domestic capability in the NHS where it does not currently exist; and
(j) where risks are identified, how the Government intends to address those risks by supporting the use or development of domestic technologies or systems.
(3) In preparing the strategy, the Secretary of State must consult—
(a) the National Cyber Security Centre,
(b) the Information Commissioner,
(c) the National Data Guardian,
(d) persons representing the interests of patients,
(e) the Scottish Ministers, the Welsh Ministers and the Department of Health in Northern Ireland, and
(f) such other persons as the Secretary of State considers appropriate.
(4) The Secretary of State must—
(a) lay before Parliament a report on progress in implementing the strategy at least once in every period of 12 months, and
(b) review the strategy at least once in every period of three years and publish and lay before Parliament any revised strategy.
(5) In this section—
“National Data Guardian” means the person appointed under section 1 of the Health and Social Care (National Data Guardian) Act 2018;
“NHS patient data” means patient information (within the meaning given in section 250E(7) of the National Health Service Act 2006) relating to persons who have received health care or social care in England;
“pseudonymised” , in relation to data, means processed by way of pseudonymisation within the meaning given in Article 4(1)(5) of the UK GDPR;
“relevant information system” means an information or communications system which forms part of the single patient record or is used to hold or process patient information for the purposes of it;
“the single patient record” means the system for making patient information available referred to in section 250E(1) of the National Health Service Act 2006, whether or not established by regulations under that section;
“UK supplier” means a company incorporated in the United Kingdom which either has no parent undertaking or each of whose parent undertakings (within the meaning of section 1162 of the Companies Act 2006) is incorporated, and has its head office, in the United Kingdom.”

This new clause would require an NHS Digital Sovereignty Strategy within 12 months of Royal Assent, on treating NHS patient data as a sovereign data asset, reducing reliance on foreign technology, building UK capability, and research access to pseudonymised data, including preferential access, NHS benefit-sharing and confidential patient information reform.

None 172

After Clause 56, insert the following new Clause—
“NHS data: standards
(1) NHS patient and public health data is to be treated according to the standards in subsection (2).
(2) The standards for treating NHS data are—
(a) that the data is stored in the United Kingdom;
(b) that any use of the data for research and innovation purposes must be in the public interest;
(c) that the economic and technical value of any intellectual property or technology or information system built using the data must be retained in the UK and shared with the NHS;
(d) that any use of the data must comply with UK data protection laws;
(e) that application programming interfaces must be used as bridges between the data asset and client software of authorised license holders.
(3) The Secretary of State must make the following provisions in relation to NHS data—
(a) provisions to enable priority access to NHS data to researchers based in the United Kingdom;
(b) provisions to ensure that any researcher who builds intellectual property or a technology or information system using NHS data is based in the UK;
(c) provisions to restrict access to intellectual property or a technology or information system built using NHS data, if ownership of the intellectual property is to be transferred from a researcher based in the UK to a researcher based overseas.”

This amendment seeks to establish protections to ensure that NHS patient data remains in the UK, and that the benefits and value of technology built using NHS data is retained in the UK for the NHS and patient care.

Opposition Amendment 180

After Clause 57, insert the following new Clause—
“National Care Service: implementation plan
(1) The Secretary of State must, within six months of the day on which this Act is passed, lay before Parliament a report setting out the Government’s proposals for the establishment of a National Care Service.
(2) The report must include—
(a) the intended functions and scope of the National Care Service,
(b) a statement of how the National Care Service would work alongside—
(i) the National Health Service,
(ii) local authorities,
(iii) charities and voluntary organisations,
(iv) social enterprises, and
(v) existing public and independent social care providers,
(c) a statement of how the establishment of the National Care Service would affect the statutory responsibilities of NHS bodies and local authorities,
(d) the arrangements for the commissioning and provision of services by the organisations listed in subsection (2)(b),
(e) the Government’s estimate of the costs of establishing and operating the National Care Service,
(f) the proposed sources and levels of funding for the National Care Service,
(g) the period for which funding settlements are expected to be made,
(h) the expected timetable for the establishment and implementation of the National Care Service, and
(i) the arrangements for transitional funding and for maintaining continuity of existing social care services.
(3) In preparing the report, the Secretary of State must consult—
(a) NHS bodies,
(b) local authorities,
(c) persons receiving social care and their carers,
(d) representatives of the social care workforce,
(e) charities and voluntary organisations involved in the provision of social care, and
(f) other persons providing social care services whom the Secretary of State considers appropriate.
(4) The report must include a summary of the consultation undertaken under subsection (3) and explain how the views expressed have informed the Government’s proposals.”

This new clause would require the Secretary of State to publish an implementation plan for a National Care Service, including its relationship with the NHS, local authorities, charities and existing social care providers, together with details of its funding, commissioning arrangements and implementation timetable.

None 189

After subsection (4) insert—
“(4A) Any report published by the Commissioner must present data on maternity and neonatal outcomes disaggregated by—
(a) the age, ethnicity and area deprivation of the mother, and
(b) the sex of the baby,
so far as such data is held, with ethnicity recorded in accordance with section (Recording of ethnicity in health and care information).”

This amendment ensures the Commissioner reports outcomes by the factors known to drive maternal and neonatal risk, including the near-threefold higher maternal mortality of Black women and the doubled rate in the most deprived areas reported by MBRRACE-UK.

None 190

After subsection (5) insert—
“(5A) In communications to patients and the public, the Commissioner must use clear and accurate sex-based terminology, including “woman” and “mother”, which may be supplemented by additional terms where the Commissioner considers it appropriate.”

This amendment requires the Commissioner to communicate in clear language about women and mothers, while permitting additional terms.

None 191

After subsection (10) insert—
“(11) In this section—
“woman” has the meaning given by section 212(1) of the Equality Act 2010, as interpreted by the Supreme Court in For Women Scotland Ltd v The Scottish Ministers [2025] UKSC 16;
“mother” , in relation to a child, means the woman who is carrying or has carried the child.”

This amendment defines “woman” consistently with the Equality Act 2010 as interpreted by the Supreme Court, and “mother” consistently with section 33 of the Human Fertilisation and Embryology Act 2008, for the purposes of the Commissioner’s functions.

None 205

After Clause 78, insert the following new Clause—
“Environmental impact of NHS medicines and medical products
(1) The Secretary of State must take all reasonable steps to ensure that NHS bodies, when procuring medicines, medical devices and other healthcare products, assess and take account of their environmental impact.
(2) The duty in subsection (1) includes consideration of environmental impacts arising from the manufacture, transport, use and disposal of those products, including their supply chains.
(3) The Secretary of State must issue guidance setting out standardised environmental information to be provided by manufacturers and suppliers for the purposes of subsection (1).
(4) The guidance under subsection (3) must, in particular, address—
(a) greenhouse gas emissions,
(b) the use of natural resources, including water and raw materials,
(c) pollution and waste arising from manufacture, use and disposal, and
(d) the environmental impacts of supply chains.
(5) The Secretary of State must publish a report on the implementation of this section within two years of its coming into force and at intervals of no more than three years thereafter.”

This new clause would require the Secretary of State to ensure that NHS procurement bodies assess and take account of the environmental impacts of medicines, medical devices and other healthcare products when making procurement decisions.

Opposition Amendment 257

After Clause 84, insert the following new Clause—
“Review of clinical negligence legislation
The Secretary of State must within 12 months of the day on which this Act is passed, publish and lay before Parliament a review of the operation of section 2(4) of the Law Reform (Personal Injuries) Act 1948 in relation to clinical negligence cases.”

This amendment seeks to probe a review of section 2(4) of the Law Reform (Personal Injuries) Act to ask judges to consider, when determining the level of compensation to be awarded to patients, the provisions provided via the NHS and whether claimants are utilising services for remedial treatment, as current legislation does not take into account the existence of the NHS.

None 258

After Clause 84, insert the following new Clause—
“Antisemitism, racism and extremism: duties of NHS bodies and annual report
(1) Each integrated care board, NHS trust and NHS foundation trust must, in the exercise of its functions, have regard to the need to—
(a) prevent antisemitism and other forms of racism affecting patients and staff,
(b) prevent conduct by persons working for or on behalf of the body which constitutes an offence under any of sections 11 to 13 of the Terrorism Act 2000 (offences relating to proscribed organisations), and
(c) respond effectively where antisemitic or racist conduct occurs, including by supporting patients and staff affected by it.
(2) The Secretary of State must, before the end of the period of 12 months beginning with the day on which this Act is passed, and in each subsequent year, lay before Parliament a report on—
(a) how integrated care boards, NHS trusts and NHS foundation trusts have discharged the duty in subsection (1),
(b) the incidences of antisemitism and other forms of racism reported by patients and staff in the health service in England, including in the NHS staff survey, with that information disaggregated by ethnicity and by religion or belief,
(c) how those bodies have discharged the duty in section 26 of the Counter-Terrorism and Security Act 2015 (general duty on specified authorities), and
(d) progress in implementing the recommendations of the independent review of antisemitism and other forms of racism in the NHS and healthcare regulatory system, published in June 2026.
(3) In preparing a report under subsection (2), the Secretary of State must consult—
(a) the Care Quality Commission,
(b) the Professional Standards Authority for Health and Social Care, and
(c) such other persons as the Secretary of State considers appropriate.
(4) In this section “NHS trust” and “NHS foundation trust” have the same meanings as in the National Health Service Act 2006.”

This new clause would require integrated care boards and NHS trusts to have regard to the need to prevent and respond to antisemitism, other forms of racism and support for proscribed organisations. The duty is intended complement the public sector equality duty and existing race equality standards.

None 259

After Clause 84, insert the following new Clause—
“Performers lists: suitability conditions
(1) Within six months of the day on which this Act is passed, the Secretary of State must lay before Parliament a statement setting out whether the Secretary of State intends to amend the National Health Service (Performers Lists) (England) Regulations 2013 to enable conditions to be imposed on a practitioner’s inclusion in a performers list on grounds of suitability, including in cases of racist conduct or conduct constituting an offence under any of sections 11 to 13 of the Terrorism Act 2000.
(2) If the Secretary of State does not intend to make such amendments, the statement must give reasons.”

This amendment seeks to set out the government’s plans to implement recommendation 26 of the Lord Mann review, allowing conditions to be placed on primary care practitioners on suitability grounds, including racist or extremist conduct, not only on efficiency grounds.

Opposition Amendment 260

After Clause 84, insert the following new Clause—
“Single sex facilities
(1) The Secretary of State is required to ensure that there are single sex—
(a) changing rooms for NHS staff,
(b) toilets and washing facilities for NHS staff,
(c) wards for NHS patients, and
(d) toilets and washing facilities for NHS patients.
(2) The Secretary of State may make exemptions to the duty in subsection (1)(c) and (1)(d) where necessary for—
(a) children,
(b) intensive care units,
(c) critical care, and
(d) specialist high observation areas such as resuscitation in Accident and Emergency and the initial recovery area in theatres.”

This new clause creates a requirement for the Secretary of State to ensure certain single sex facilities are made available for NHS staff and patients. It provides exemptions in certain circumstances. It restates New Clause 143, divided upon in the House of Commons on 8 September 2026.

Opposition Amendment 261

After Clause 84, insert the following new Clause—
“Intimate examinations and intimate care: same-sex practitioners and chaperones
(1) A patient may request—
(a) that an intimate examination of the patient, or intimate care provided to the patient, be carried out by a practitioner of the same sex as the patient, and
(b) that any chaperone present be of the same sex as the patient,
and either or both requests may be made.
(2) A relevant NHS provider must meet each request so far as reasonably practicable, having regard to clinical urgency, patient safety and the availability of appropriately qualified staff.
(3) A patient need not give reasons for a request, and a request must not by itself be treated as a refusal of care.
(4) Where a request cannot be met, the provider must, unless immediate treatment makes this impracticable, explain why before the examination or care, discuss a clinically safe alternative time or provider where available, and respect applicable consent requirements.
(5) The provider must record each request, any decision not to meet it and the reasons, and must publish anonymised annual totals of requests not met, with appropriate small-number safeguards.
(6) The provider must hold only such information about the sex of practitioners as is necessary to respond to requests under this section, restrict access to it to authorised persons, and process and disclose it only where lawful and necessary.
(7) Nothing in this section requires the delay of treatment where delay would create a risk of death or serious harm, or authorises care without consent.
(8) Within 12 months of the day on which this Act is passed the Secretary of State must report to Parliament on whether professional registers and employer records adequately support the safe handling of requests under this section, including the confidentiality and data-protection implications.
(9) In this section—
“intimate care” includes personal care involving washing, bathing, toileting or dressing, or such exposure or touching;
“intimate examination” means examination involving exposure or touching of the breasts, genitalia or rectum;
“practitioner” includes any person providing that examination or care;
“sex” has the same meaning as in the Equality Act 2010, as interpreted by the Supreme Court in For Women Scotland Ltd v The Scottish Ministers [2025] UKSC 16.”

This new clause gives every patient the right to request that intimate examinations and intimate care be carried out by a practitioner of the same sex, with a same-sex chaperone, to be met so far as reasonably practicable, and requires unmet requests to be explained, recorded and reported.

None 262

After Clause 84, insert the following new Clause—
“Minimum expenditure on mental health
The Secretary of State must ensure that, in each financial year, expenditure on mental health services commissioned or provided as part of the health service in England is not less than 10 per cent of total expenditure on the health service in England for that year.”

None 263

After Clause 84, insert the following new Clause—
“Minimum expenditure on primary care
The Secretary of State must ensure that, in each financial year, expenditure on primary care services commissioned or provided as part of the health service in England is not less than 12 per cent of total expenditure on the health service in England for that year.”

None 264

After Clause 84, insert the following new Clause—
“Single sex provision of hospital accommodation
(1) The Secretary of State must ensure that the provision of single-sex hospital accommodation, including wards and other sleeping accommodation, is organised on the basis of a patient’s biological sex.
(2) In this section, “biological sex” means the sex recorded at birth.
(3) NHS bodies must have regard to this section in the exercise of their functions.”

None 265

After Clause 84, insert the following new Clause—
“Implementation of the Women's Health Strategy
(1) The Secretary of State must, within 90 days of the day on which this Act is passed, publish a women's health implementation plan (the “implementation plan”) setting out how the commitments in the document entitled “The Renewed Women's Health Strategy for England” published on 15 April 2026 (or any successor document) will be delivered.
(2) The implementation plan must include, in particular—
(a) a timetable for delivering simpler access to long-acting reversible contraception (LARC),
(b) a trajectory for reducing the gynaecology waiting list and for reducing average diagnosis times for endometriosis,
(c) a plan for establishing the regional specialist centres for group-based women's health pathways, including contraception, heavy periods, auto-gynaecology and menopause, and
(d) measurable targets and milestones for each commitment in the strategy, including a baseline and timetable for delivery.
(3) The Secretary of State must lay the implementation plan before Parliament on the day it is published.
(4) In preparing the implementation plan, the Secretary of State must consult—
(a) the Royal College of Obstetricians and Gynaecologists,
(b) the College of Sexual and Reproductive Healthcare, and
(c) patient organisations representing women affected by the conditions addressed by the strategy.”

This new clause would require the Secretary of State to publish a women's health implementation plan setting out how the commitments in the document entitled "The Renewed Women's Health Strategy for England” will be delivered.

None 266

After Clause 84, insert the following new Clause—
“Discussion of potential harms before prescribing antidepressants
(1) A registered healthcare professional must, before prescribing an antidepressant medicinal product to a patient—
(a) explain, in a manner appropriate to the patient’s age, needs and circumstances, the nature and intended purpose of the proposed treatment,
(b) discuss the reasonably foreseeable benefits, material risks and potential adverse effects of the medicinal product, including, where relevant, its effects on sexual function, sleep, emotional experience and the risk of increased suicidal thoughts or behaviour,
(c) explain the possibility of withdrawal symptoms or other difficulties associated with reducing or discontinuing the medicinal product, including the importance of seeking appropriate clinical advice before changing or stopping treatment,
(d) discuss reasonable alternative treatment options, including psychological therapies, other clinically appropriate interventions, and the option of declining or deferring medication where clinically appropriate,
(e) provide the patient with an opportunity to ask questions, express preferences and consider the information provide, and
(f) confirm, so far as reasonably practicable, that the patient has understood the material information relevant to the decision.
(2) The healthcare professional must take reasonable steps to ensure that the information provided is accessible and understandable to the patient and must allow reasonable time for consideration of the information, taking account of the patient’s circumstances and clinical needs.
(3) The healthcare professional must record in the patient’s clinical record—
(a) that the discussion of potential harms has taken place,
(b) the material benefits, risks and alternatives discussed,
(c) the patient's decision and any material preferences expressed, and
(d) any reasonable adjustments, additional support or further discussion required to facilitate informed decision-making.
(4) The requirements of this section apply whether the prescription is issued in primary care, secondary care, a community setting or another healthcare setting in which the medicinal product is prescribed.”

None 267

After Clause 84, insert the following new Clause—
“Public Health Committee
(1) The Secretary of State must establish a Public Health Committee within six months of the day on which this Act is passed to ensure a cross-governmental focus and consideration of the promotion of public health in government policy and address national health inequalities.
(2) The Public Health Committee under subsection (1) must—
(a) include at least one minister from each government Department in its membership,
(b) include all cabinet ministers in its membership,
(c) be chaired by the Prime Minister, and
(d) meet once in each annual quarter.
(3) Under subsection (2)(b), cabinet members must attend at least three quarters of the Public Health Committee's meetings each year.
(4) Each government department must publish an annual report on their department's consideration of public health in its policy and the extent of joint policy formulation with other government departments.
(5) The Secretary of State must establish a Health Creation Unit to support the Public Health Committee.
(6) The Health Creation Unit must submit an annual report on its activities, decision-making and cross-government progress to the Liaison Committee.”

This new clause would establish a Public Health Committee and Health Creation Unit to promote public health and cross-government policy making.

None 268

After Clause 84, insert the following new Clause—
“Commercial interests and integrity in health policy
(1) The Secretary of State must take all reasonable steps to ensure that the development and implementation of health policy is independent of undue commercial influence and serves the public interest.
(2) For the purposes of this section, undue commercial influence includes—
(a) attempts by a commercial entity to influence health policy in a manner that conflicts with the public interest,
(b) financial, contractual or other arrangements that create an actual or perceived conflict of interest for a person involved in health policy decision-making, and
(c) lobbying, sponsorship or partnership activity that could reasonably be expected to compromise the independence, integrity or impartiality of health policy.
(3) The Secretary of State must publish and lay before Parliament an annual report setting out—
(a) interactions between the Department of Health and Social Care and relevant NHS bodies on the one hand and commercial entities on the other hand relating to the development of health policy,
(b) the steps taken to identify, manage and mitigate conflicts of interest arising from those interactions, and
(c) any breaches of duties under this section and the action taken in response.
(4) Integrated care boards and other relevant NHS bodies must—
(a) maintain and publish registers of interests for members, officers and advisers involved in policy development, commissioning or procurement,
(b) ensure that persons with a material conflict of interest do not participate in relevant decisions unless the conflict has been effectively managed, and
(c) ensure that commissioning, procurement and partnership decisions are made in the interests of patients and the public, on the basis of relevant evidence and transparent criteria.
(5) The Secretary of State must issue statutory guidance on identifying commercial determinants of health, assessing and managing undue commercial influence, and ensuring transparency in commercial interactions relating to health policy.
(6) Relevant NHS bodies must have regard to the guidance issued under subsection (5).”

This amendment seeks to protect health policy from undue commercial influence by strengthening transparency, conflict-of-interest safeguards and public accountability in policy development, commissioning and procurement.

None 269

After Clause 84, insert the following new Clause—
“Health improvement plans
(1) The Secretary of State must prepare a health improvement plan within 12 months of the date on which this Act is passed.
(2) A “health improvement plan” is a plan for significantly improving the health of the nation in the period to which the plan relates.
(3) That period must be no shorter than 10 years and no longer than 20 years.
(4) A health improvement plan must set out the steps His Majesty’s Government intends to take to improve the provision of health services and overall quality of health of the nation in the period to which the plan relates.
(5) The Secretary of State must prepare a workforce plan alongside the health improvement plan.”

This is to put the Health Improvement Plan on a statutory footing, including the workforce plan with annual reporting and regular review.

None 270

After Clause 84, insert the following new Clause—
“Annual reports on health improvement plans
(1) The Secretary of State must prepare annual reports on the implementation of the current health improvement plan under section (Health improvement plans).
(2) An annual report must—
(a) describe what has been done, in the period to which the report relates, to implement the health improvement plan, and
(b) consider whether the health of the nation and the provision of the service has, or particular aspects of it have, improved during that period.
(3) In considering the matters in subsection (2)(b)—
(a) all data and other information used to create the report must be published in full;
(b) the progress that has been made towards achieving any targets, or any relevant targets, included in the NHS constitution must be included, and
(c) the progress on the workforce plan produced under section (Health improvement plans) should be included.
(4) The first annual report on the first health improvement plan may relate to any 12 month period that includes the day on which this section comes into force.
(5) The first annual report on a subsequent health improvement plan must relate to the first 12 months of the period to which the plan relates.
(6) Subsequent annual reports on an health improvement plan must relate to the 12 month period immediately following the 12 month period to which the previous annual report relates.
(7) An annual report must be laid before Parliament before the end of the four month period beginning immediately after the last day of the period to which the report relates.”

This is to put the Health Improvement Plan on a statutory footing, including the workforce plan with annual reporting and regular review.

None 271

After Clause 84, insert the following new Clause—
“Reviewing and revising health improvement plans
(1) The Secretary of State must review the current health improvement plan under section (Healthcare improvement plans) at least every five years.
(2) In reviewing a health improvement plan, the Secretary of State must consider—
(a) what has been done to implement the plan in the period since it was published, or (if it has been reviewed before) last reviewed,
(b) whether His Majesty’s Government should take further or different steps to improve the quality of health (compared to those set out in the plan) in the remainder of the period to which the plan relates.
(3) If as a result of a review the Secretary of State does not revise the health improvement plan, the Secretary of State must lay before Parliament a statement explaining that and the reasons for it.
(4) If as a result of a review the Secretary of State of State considers it appropriate to revise the plan as a result of the review, it must revise the plan within 6 months of that review.
(5) If as a result of a review the Secretary of State revises the health improvement plan, the Secretary of State must lay before Parliament—
(a) the revised health improvement plan, and
(b) a statement explaining the revisions and the reasons for them.
(6) The period to which a revised plan relates must end at the same time as the period to which the plan it revises relates.
(7) The first review of the first health improvement plan must be completed by 31 May 2033.
(8) The first review of a subsequent health improvement plan must be completed before the end of the 5 year period beginning with the day on which it replaces the previous plan.
(9) Subsequent reviews of a health improvement plan must be completed before the end of the 5 year period beginning with the day on which the previous review was completed.
(10) The Secretary of State must publish the documents laid under subsection (3) or (5).
(11) A review is completed when the Secretary of State has laid and published the documents mentioned in subsection (3) or (5).
(12) References in this Act to a health improvement plan include a revised health improvement plan.”

This is to put the Health Improvement Plan on a statutory footing, including the workforce plan with annual reporting and regular review.

None 272

After Clause 84, insert the following Clause—
“Regulation of online fertility services
(1) The Human Fertilisation and Embryology Act 1990 is amended as follows.
(2) After section 5 (the Human Fertilisation and Embryology Authority) insert—
“5A Regulation of online fertility services
(1) The Human Fertilisation and Embryology Authority shall be responsible for the licensing of organisations providing online fertility services in England and Wales.
(2) In this section “online fertility services” include related concierge services which provide non-clinical advice related to the provision of clinical services.
(3) The Secretary of State may by regulations make further provision regarding the arrangements for the licensing of organisations under subsection (1).”
(3) In section 45(4A) (provisions to which the affirmative procedure applies) after the entry for section 4A(5) or (11), insert—
“section 5A;””

This new clause would implement a recommendation of the Human Fertilisation and Embryology Authority to extend its regulatory remit to include organisations providing online fertility services.

None 273

After Clause 84, insert the following new Clause—
“Review of the regulation and advertising of private diagnostic tests
(1) The Secretary of State must undertake a review of the regulation and advertising of diagnostic tests offered directly to consumers by private providers.
(2) The review must consider—
(a) the adequacy of existing arrangements for ensuring the accuracy and clinical validity of private diagnostic tests,
(b) whether advertising claims about the accuracy, reliability and clinical significance of test results are adequately substantiated,
(c) whether consumers are adequately informed about the limitations of tests and the risks of false positive and false negative results,
(d) the respective roles of the Care Quality Commission, the United Kingdom Accreditation Service, the Medicines and Healthcare products Regulatory Agency and the Advertising Standards Authority in protecting consumers in relation to at-home diagnostic tests, and
(e) whether changes made to the regulation of private testing services during the coronavirus pandemic have implications for the current regulatory framework.
(3) In conducting the review, the Secretary of State must consult relevant regulatory bodies, healthcare professionals and organisations representing patients and consumers.
(4) The Secretary of State must publish the findings of the review and any proposed action within 12 months of the day on which this section comes into force.”

This new clause requires a review of the regulation and advertising of private diagnostic tests, including whether claims about their accuracy and clinical usefulness are supported by evidence.

None 274

After Clause 84, insert the following new Clause—
“Review on deaths related to antimicrobial resistant infection
Within six months of the day on which this Act is passed, the Secretary of State must conduct and publish a review into the number of yearly deaths in the UK which are related to antimicrobial resistant infection.”

This new clause would require the Secretary of State to conduct and publish a review into the number of yearly deaths in the UK which are related to antimicrobial resistant infection.

None 275

After Clause 84, insert the following new Clause—
“Gender services: disclosure of data for research
(1) This section applies to any person providing, by or on behalf of the health service in England, assessment or treatment for gender dysphoria or gender incongruence to persons of any age (“a gender service provider”).
(2) A gender service provider must disclose to the persons conducting an approved study such information about persons referred to or treated by it as the persons conducting an approved study reasonably require for the purposes of the study, within such period as they reasonably specify.
(3) An “approved study” is—
(a) the data linkage study recommended by the Independent Review of Gender Identity Services for Children and Young People (published April 2024) (“the Cass study”), and
(b) any other study of the outcomes of assessment or treatment for gender dysphoria or gender incongruence which has received a favourable opinion from a research ethics committee and is commissioned by, or approved for the purposes of this section by, the Secretary of State.
(4) It is a condition of any contract to provide services to which this section applies that the provider complies with subsection (2).
(5) A disclosure required by subsection (2) does not breach any obligation of confidence owed by the provider, and is to be treated as necessary for compliance with a legal obligation for the purposes of data protection legislation.
(6) Information disclosed under this section must be pseudonymised so far as is consistent with the purposes of the study, may be disclosed only to the persons conducting the study, and may not be used for any other purpose.
(7) The Secretary of State must exercise the power conferred by section 22(5) of the Gender Recognition Act 2004 so as to secure that no disclosure required by subsection (2) for the purposes of an approved study constitutes an offence under that section.
(8) Where a person’s NHS number or other identifier has been changed in connection with a change of gender, the Secretary of State must ensure that records held under the former and current identifiers can be linked for the purposes of an approved study.
(9) In relation to the Cass study, the Secretary of State must—
(a) within three months of the day on which this Act is passed, publish a timetable for its completion,
(b) ensure that it includes all persons who, before reaching the age of 25, were referred to or treated by the Gender Identity Development Service or any successor service for children and young people, or by any adult gender dysphoria service in England, and
(c) lay the Cass study’s findings before Parliament within three months of the day of its completion.
(10) Any function relating to the Cass study exercisable by NHS England immediately before its abolition is exercisable by the Secretary of State.
(11) The Secretary of State must, within six months of the day on which this Act is passed, and every six months thereafter until the Cass study is completed, and annually after that, lay before Parliament a report setting out—
(a) the progress of each approved study against its timetable,
(b) any gender service provider that has failed to comply with subsection (2), and the steps taken in response, and
(c) any legal, technical or data-access barrier to an approved study, and the steps taken to remove it.”

This new clause seeks to turn the Government’s expectation that gender clinics will share data into a legal duty. The clause requires every NHS-funded children’s and adult gender service to disclose pseudonymised data, extends the legal protection to every such study, requires the Cass study to be completed on a published timetable and requires six-monthly reports to Parliament.

None 276

After Clause 84, insert the following new Clause—
“Specialist detransition service
(1) The Secretary of State must, before the end of the period of two years beginning with the day on which this Act is passed, arrange for the provision of a specialist service for persons who wish to detransition (“the detransition service”).
(2) The detransition service must—
(a) be provided separately from any service which provides gender-related treatment,
(b) be available to any person who wishes to detransition, whether that person’s gender-related treatment (if any) was provided—
(i) by or on behalf of the health service in England,
(ii) by any other provider in the United Kingdom, or
(iii) by a provider outside the United Kingdom, including a provider operating online, and
(c) provide such psychological, medical, endocrine, surgical and other care as is appropriate to meet the needs of persons who wish to detransition, including care in relation to the physical effects of previous gender-related treatment.
(3) The Secretary of State must ensure that the detransition service records the following, in respect of each person who uses it and consents to the information being recorded for the purposes of this section—
(a) the reasons the person gives for wishing to detransition,
(b) the nature of any gender-related treatment the person received, the age at which they received it, and which of the descriptions in subsection (2)(b)(i) to (iii) applies to the provider of that treatment, and
(c) whether the person reports any concerns about assessment, diagnosis, the consideration of co-occurring conditions, the process of obtaining informed consent, or safeguarding as part of their experience.
(4) The Secretary of State must prepare a report and lay it before each House of Parliament before the end of the period of 12 months beginning with the day on which the detransition service begins to operate, and in each subsequent 12-month period, setting out—
(a) the number of persons who have used the detransition service,
(b) an aggregated analysis of the information recorded under subsection (3), and
(c) any recurring themes identified from information recorded under subsection (3)(c), and the steps the Secretary of State has taken or intends to take in response, including in relation to commissioning, guidance or regulation.
(5) A report under subsection (4) must not include information from which an individual patient, practitioner or provider could be identified.
(6) In this section—
“gender-related treatment” means any of the following, provided for the purpose of a gender transition: puberty-suppressing hormones; masculinising or feminising hormones; surgery;
“puberty-suppressing hormones” means gonadotrophin-releasing hormone analogues;
a person “wishes to detransition” if the person has undergone a social or medical gender transition and wishes to stop that transition, or to reverse, or receive care in respect of, its effects.”

This new clause requires a specialist detransition service within two years, separate from gender services and open to anyone regardless of where they were treated, as recommended by the Cass Review, with aggregated annual reporting to Parliament on the reasons people seek it and the lessons for commissioning and regulation.

Opposition Amendment 277

After Clause 84, insert the following new Clause—
“Procurement by NHS bodies: patient care, resilience and the United Kingdom economy
(1) Within six months of the day on which this Act is passed, the Secretary of State must lay before Parliament a report on procurement by and on behalf of NHS bodies.
(2) The report must set out how procurement policy applicable to NHS bodies supports, consistently with the United Kingdom’s international obligations—
(a) the provision of safe and effective care to patients,
(b) value for money, including whole-life value,
(c) the resilience and security of supply chains,
(d) opportunities for businesses operating in the United Kingdom, including small and medium-sized enterprises, and
(e) the creation and retention of employment, skills, manufacturing capacity and research capability in the United Kingdom.
(3) The report must explain how the matters in subsection (2) are addressed in relation to—
(a) the procurement of goods, works and services under the Procurement Act 2023,
(b) the arrangement of healthcare services under the Health Care Services (Provider Selection Regime) Regulations 2023, and
(c) procurements undertaken centrally or collaboratively for or on behalf of one or more NHS bodies.
(4) The report must also assess whether environmental, social-value or other non-clinical procurement requirements—
(a) are proportionate to the subject matter and value of the contract,
(b) create barriers to participation by small and medium-sized enterprises,
(c) materially reduce competition or the resilience of supply, or
(d) risk delaying or reducing access to products or services required for patient care.
(5) In carrying out procurement, an NHS body must have regard to the need to secure safe and effective patient care, value for money and continuity of supply.
(6) In this section, “NHS body” means NHS England, an integrated care board, an NHS trust, an NHS foundation trust or a Special Health Authority.”

This probing amendment would require the Secretary of State to report on how NHS procurement supports patient care, value for money, resilient supply chains and economic activity in the United Kingdom, consistently with international procurement obligations. It would cover both procurement under the Procurement Act 2023 and the arrangement of healthcare services under the Provider Selection Regime.

None 278

After Clause 84, insert the following new Clause—
“Health Data Research Service strategy
(1) Within six months of the day this Act is passed, the Secretary of State must publish a Health Data Research Service strategy.
(2) The Health Data Research Service strategy must include proposals for—
(a) making all patient and public health data that is available for research and innovation either interoperable, or available in the same location;
(b) making new health data available for access quickly, including streamlined processes for data handling and cleaning, and real time public health data;
(c) establishing consistent standards for researcher approval to access health datasets, including across England and Wales, Scotland, and Northern Ireland;
(d) ensuring that data used by research and innovation improves patient care and provides fair value to the NHS;
(e) establishing proportionate standards and governance processes based upon—
(i) whether research has been conducted by organisations headquartered in the UK or abroad;
(ii) the location of those accessing patient and public health data;
(iii) the research and commercial profile of those accessing patient and public health data;
(iv) the risk profile of the data.
(f) ensuring transparency of how data will be used, including, but not limited to—
(i) transparency of process for patient and public approval;
(ii) mandatory reporting on outcomes of research;
(iii) logging of every data request;
(iv) safeguards to protect patients and the public;
(v) a strategy for promoting understanding of how patient data will be used for research and innovation;
(g) annual reporting on progress in patient care and technological developments from the use of Health Data Research Service data;
(h) accelerating deployment of research and innovation conducted using data from the Health Data Research Service.
(3) In preparing a strategy, the Secretary of State must give consideration to—
(a) patient privacy and existing data protection laws;
(b) the short and long-term costs to the NHS of providing high-quality patient care;
(c) the costs of conducting research and innovation;
(d) the strategic importance of the NHS to the UK’s national security;
(e) the fact that patient and public health data may be held by different organisations;
(f) how data from the single patient record could be integrated into the Health Data Research Service.
(4) The strategy must be laid before both Houses of Parliament upon publication.”

This amendment would require the Secretary of State to publish a strategy for the Health Data Research Service which explains how the service will address issues with researcher access to health data, whilst maintaining privacy and public trust.

None 279

After Clause 84, insert the following new Clause—
“Mental Health Commissioner
(1) The Secretary of State must, within six months of the day on which this Act is passed, appoint a Mental Health Commissioner, based within the Department of Health and Social Care.
(2) The functions of the Mental Health Commissioner must include—
(a) overseeing the implementation and operability of functions discharged by relevant bodies and persons regarding the provision of treatment, care, and detention of people with a mental disorder.
(b) overseeing the implementation and operability of functions discharged by relevant bodies and persons which relate to the Mental Capacity Act 2005, the Mental Health Act 2007 and the Mental Health Act 2025.
(3) The Mental Health Commissioner must publish an annual report which must assess—
(a) the quality of mental health care treatment provided by relevant services;
(b) the accessibility of mental health care treatment services;
(c) mental health service provision in the criminal justice system;
(d) inequalities in mental health care provision regarding protected characteristics under the Equality Act 2010;
(e) the use and effectiveness of detention measures under the Mental Health Act 1983, including but not limited to Community Treatment Orders, for the purposes of therapeutic benefit outlined in section 1(2B) of that Act;
(f) challenges surrounding stigma of mental health conditions;
(g) the accessibility of advice and support to mental health service users, their families and carers on their legal rights;
(h) other issues deemed appropriate by the Mental Health Commissioner.
(4) In fulfilling their duties under subsection (2)(a), the Mental Health Commissioner may review, and monitor the operation of, arrangements falling within subsection (2) and (3) for the purpose of ascertaining whether, and to what extent, the arrangements are effective in promoting the principles in section 118(2B) of the Mental Health Act 1983.
(5) The person appointed as Commissioner must—
(a) be a person with knowledge, expertise and experience relevant to the discharge of functions of the role,
(b) have first-hand experience of working in mental health services, so far as reasonably possible, and
(c) not be a Member of Parliament.”

None 289

Clause 88, page 65, line 19, after “Sections” insert “(NHS Digital Sovereignty Strategy), (Duty as to UK suppliers and sovereign capability),”

This amendment would bring the new clauses on an NHS Digital Sovereignty Strategy and a duty as to UK suppliers and sovereign capability into force on Royal Assent, so the deadline for publishing the strategy runs from then and the supplier duty applies immediately to contracts involving NHS patient data.

None 92

After Clause 22, insert the following new Clause—
“Mental health workforce sufficiency assessment by integrated care boards
(1) Each integrated care board must conduct a mental health workforce sufficiency assessment every two years to evaluate whether it has sufficient workforce resources to deliver services under this Act effectively.
(2) The assessment may include—
(a) an analysis of current workforce levels across all relevant mental health service areas;
(b) identification of mental health workforce shortfalls;
(c) an evaluation of the impact of mental health staff shortages on patient care and service delivery;
(d) proposals to address mental health workforce challenges.
(3) Integrated care boards may consult any relevant personnel or organisations they deem appropriate when conducting the assessment.
(4) Each integrated care board must publish a report outlining its findings upon completing the assessment.
(5) Each integrated care board must publish its first report under subsection (4) within 12 months of the day on which this Act is passed.”

The amendment requires integrated care boards to produce a biennial report assessing their mental health workforce sufficiency, identifying shortages and proposing measures to address mental health workforce challenges in delivering services.

Opposition Amendment 101

After Clause 25, insert the following new Clause—
“Voluntary sector role in neighbourhood health plans
(1) In preparing a neighbourhood health plan, a responsible local authority and integrated care board must take and demonstrate reasonable steps to ensure the plan is co-produced with meaningful involvement by the local voluntary, community and social enterprise sector in that area, including the development, design, implementation, monitoring and evaluation of the plan.
(2) In meeting the requirement under subsection (1) a local authority and integrated cared board must have regard to—
(a) organisations representing people with lived experience of health conditions,
(b) organisations working with an underserved or marginalised population, and
(c) the role of voluntary, community and social enterprise organisations in delivering community-based services.
(3) The responsible local authority and integrated care board must demonstrate how they have ensured ongoing and meaningful representation of voluntary, community and social enterprise organisations across the governance, decision-making and commissioning arrangements relating to neighbourhood health plans at all stages of the planning process.”

This new clause would require local authorities and integrated care boards to take and demonstrate reasonable steps to ensure neighbourhood health plans are co-produced with meaningful involvement by the local voluntary, community and social enterprise sector in the local area.

None 141

Clause 52, page 37, line 28, at end insert—
“(8) Regulations under this section must make provision for appropriately regulated healthcare providers to be eligible to access relevant patient information through the single patient record system for the purposes of providing direct patient care.
(9) Eligibility for access under subsection (8) must be determined by compliance with such clinical, regulatory, governance, cybersecurity and information assurance requirements as may be prescribed and must not be determined solely by—
(a) whether the provider delivers services under arrangements with the National Health Service, or
(b) whether healthcare services are delivered in person, remotely or through digital means.
(10) Access under subsection (8) must be subject to—
(a) access being limited to information reasonably required for the specific healthcare service being provided to the patient,
(b) compliance with applicable legal and professional requirements relating to confidentiality, data protection and the use of patient information for direct patient care,
(c) secure authentication, role-based access controls and comprehensive audit arrangements recording access to patient information and the purpose of such access,
(d) appropriate professional registration and regulatory oversight by any relevant statutory or professional regulator,
(e) arrangements enabling patients to view an accessible record of access to their information, including through the NHS App where technically practicable,
(f) such safeguards as may be prescribed in relation to particularly sensitive categories of health information, and
(g) safeguards ensuring that any patient controls relating to information sharing do not prevent access to information necessary for safe and effective direct patient care.
(11) Information obtained through access to the single patient record under this section may be used only for the provision of direct patient care and must not be used for commercial, underwriting, marketing or other secondary purposes except where authorised by law.
(12) Regulations under this section may make provision enabling eligible healthcare providers to contribute information relevant to the provision of direct patient care, subject to such governance and quality assurance requirements as may be prescribed.
(13) Nothing in this section requires access to be granted to any provider or healthcare professional who does not meet the requirements prescribed under regulations made under this section”

This amendment ensures that providers of care that sit outside the NHS, whether physical or digital, can have access to the single patient record so that they can best respond to the medical needs of a patient with complete information to make the best recommendation for their health.

None 186

After Clause 69, insert the following new Clause—
“Health Services Safety Investigations Body: recommendations, monitoring and powers
(1) The Health and Care Act 2022 is amended as follows.
(2) In section 110(1) (investigation of incidents with safety implications)—
(a) in paragraph (a), after “health care services” insert “or adult social care services”, and
(b) in paragraph (b), after “patients” insert “or of persons receiving adult social care services”.
(3) After section 116 insert—
“116A Monitoring of recommendations by the Care Quality Commission
(1) The Care Quality Commission must monitor and review the implementation of recommendations contained in final reports published by the HSSIB under section 113, so far as those recommendations relate to—
(a) providers of health care services, or
(b) providers of adult social care services.
(2) The Care Quality Commission must integrate its assessment of the implementation of recommendations under subsection (1) into its exercise of functions under Chapter 3 of Part 1 of the Health and Social Care Act 2008 (quality of health and social care).
(3) The Care Quality Commission must publish an annual report on the implementation of recommendations made by the HSSIB by providers of health care services and adult social care services.
(4) For the purposes of exercising its functions under this section, the Care Quality Commission—
(a) may rely only on information contained in final reports published under section 113 or other publicly available information, and
(b) may not have access to, or require the disclosure of, any protected material.
116B Implementation of recommendations by the Secretary of State
(1) Where a final report published under section 113 contains a recommendation for action by the Secretary of State, the Secretary of State must, so far as is practicable, implement that recommendation.
(2) Within three months of the publication of the final report, the Secretary of State must lay before Parliament a plan setting out—
(a) the steps to be taken to implement the recommendation,
(b) the timetable for taking those steps, and
(c) where the Secretary of State considers that it is not practicable to implement the recommendation in full, the reasons for that view.
(3) The Secretary of State must lay before Parliament an annual report setting out, for each recommendation under this section that has not been fully implemented—
(a) the progress made against the plan under subsection (2), and
(b) the reasons for any delay.”
(4) In section 135 (Interpretation of Part 4), at the appropriate place insert—
“adult social care services” means services which consist of or include the provision of social care, within the meaning of section 9(3) of the Health and Social Care Act 2008, to adults.”

This amendment would extend the remit of the Health Services Safety Investigations Body to adult social care, and require the Care Quality Commission to monitor providers’ implementation of its recommendations without access to protected material

None 246

After Clause 84, insert the following new Clause—
“Review of clinic negligence model
(1) Within six months beginning with the day on which this Act is passed, the Secretary of State must set up a commission to review the current framework and process used by the NHS to respond to clinical negligence claims.
(2) The review under subsection (1) must consider proposals for improving the process and framework used by the NHS to respond to clinical negligence claims, including—
(a) reducing the time from incident to resolution,
(b) reducing legal costs for individuals and organisations, and
(c) providing support for patients and their families where an incident has occurred.
(3) The commission must consist of—
(a) an independent chair, and
(b) representative of patients, clinicians and legal entities.
(4) The commission must—
(a) complete its review within the period of 18 months beginning with the day on which this Act is passed, and
(b) publish a report which must be laid before Parliament.”

This amendment seeks to require a review of the current clinical negligence system, looking particularly into proposals for reducing legal costs and providing an improved resolution for patients.

None 247

LORD PATEL

After Clause 84, insert the following new Clause—
“Cancer genomic testing and personalised medicines
(1) In exercising functions in relation to the health service in England, the Secretary of State must take all reasonable steps to ensure that—
(a) timely and comprehensive molecular and genomic testing (including for rarer actionable drivers) is provided as a standard part of cancer diagnostic pathways,
(b) integrated care boards and NHS providers have appropriate tissue collection, processing and storage facilities to facilitate personalised treatments,
(c) integrated care boards and NHS providers put in place consistent operational arrangements for the safe and effective delivery of personalised cancer medicines, and
(d) regional and demographic variation in access to genomic testing, specialist cancer treatments and supporting data infrastructure is reduced.
(2) In discharging the duty under subsection (1) the Secretary of State must have regard to the objectives of the National Cancer Plan for England.”

This new clause would strengthen requirements on the Secretary of State to put in place timely, comprehensive molecular and genomic testing, to ensure integrated care boards put in place consistent operational arrangements for the delivery of personalised cancer treatments and to reduce regional and demographic variation, consistent with the National Cancer Plan’s goals.

None 248

After Clause 84, insert the following new Clause—
“Resilience to climate and environmental degradation risks
Each NHS trust and NHS foundation trust must publish plans setting out—
(a) an assessment of the risks to its premises, workforce and services from current and predicted impacts of climate change and environmental degradation, and
(b) details of plans to implement measures which can address those risks.”

None 249

After Clause 84, insert the following new Clause—
“Health improvement and health inequalities outcome targets for children
(1) Within six months of the day on which this Act is passed, the Secretary of State must—
(a) make regulations made by statutory instrument to set long term outcome targets for improving the health of children in England and reducing inequalities in health between children in England, and
(b) publish a cross-government strategy to set out how the target set by regulations under paragraph (a) will be achieved.
(2) In preparing the strategy under subsection (1)(b) the Secretary of State must consult any relevant bodies which they consider appropriate.
(3) A Minister of the Crown must have regard to the strategy when exercising functions of the Minister.
(4) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

This new clause requires the Secretary of State to set statutory long-term targets for improving children's health and reducing health inequalities, publish a cross-government strategy for meeting those targets, and secure parliamentary approval of the targets through the affirmative procedure.

None 250

LORD PATEL

After Clause 84, insert the following new Clause—
“Radiotherapy services: national planning and improvement
(1) The Secretary of State must exercise functions in relation to the health service in England with a view to securing effective arrangements for planning and delivering improvements to radiotherapy services.
(2) For the purposes of subsection (1), the Secretary of State must publish a national delivery programme, informed by an assessment of clinical need and service capacity, setting out measures to—
(a) improve access to radiotherapy services and reduce avoidable treatment delays,
(b) address shortfalls in workforce, equipment and treatment capacity, including geographical inequalities in access, and
(c) improve access to evidence-based modern radiotherapy techniques.
(3) The programme must identify the actions required, the bodies responsible for their delivery and the timescales for implementation.
(4) The Secretary of State must make arrangements for implementing the programme through the exercise of relevant statutory functions and keep the effectiveness of those arrangements under review.
(5) The programme may form part of the National Cancer Plan for England, or any successor plan, provided that the requirements of this section are met.”

This new clause would require the Secretary of State to secure effective arrangements for planning and delivering improvements to radiotherapy services, supported by a national delivery programme addressing access, waiting times, capacity and modern treatments.

None 251

After Clause 84, insert the following new Clause—
“National strategy for inflammatory bowel disease
(1) The Secretary of State must, within 12 months of the day on which this Act is passed, prepare and publish a national strategy for improving treatment, care and outcomes of persons living with inflammatory bowel disease.
(2) The strategy must—
(a) establish nationally consistent standards of care and performance measures, informed by nationally recognised clinical guidelines, quality standards and service specifications,
(b) set measurable objectives for improving patient outcomes and quality of life, supported by consistent data that enables comparison between areas and over time,
(c) promote workforce planning and training sufficient to meet the needs of persons living with inflammatory bowel disease, and
(d) address inequalities in access to care and outcomes.
(3) In preparing the strategy, the Secretary of State must consult—
(a) persons living with inflammatory bowel disease and their carers,
(b) organisations representing persons living with inflammatory bowel disease,
(c) healthcare professionals with expertise in inflammatory bowel disease, and
(d) such other persons as the Secretary of State considers appropriate.
(4) The Secretary of State must review and, if considered appropriate, revise the strategy at intervals not exceeding five years.
(5) In this section, “inflammatory bowel disease” includes Crohn’s disease, ulcerative colitis and such related conditions as the Secretary of State may specify in regulations made by statutory instrument.
(6) Regulations under this section may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.”

The amendment seeks to establish a clear national framework for improving inflammatory bowel disease care, including an agreed set of standards and measures against which local performance can be assessed consistently.

None 290

Clause 88, page 65, line 22, at end insert—
“(za) section (Cap on care costs) (cap on care costs);”

This amendment is consequential on my amendment inserting a new clause after Clause 57 to commence the cap on care costs under the Care Act 2014. It provides for that clause to be brought into force two months after Royal Assent.

After Clause 4, insert the following new Clause- "Urban health equity (1) The Secretary of State must, within 12 months of the day on which this Act is passed, publish a strategy for reducing health inequalities in urban areas in England. (2) The strategy must address the effect on health of deprivation, air quality, housing and access to health services. (3) The Secretary of State must lay before Parliament an annual report on progress in implementing the strategy."

After Clause 12, insert the following new Clause- "Specialised commissioning: children and young people (1) Before any decision to delegate, transfer or otherwise devolve responsibility for commissioning specialised services, the Secretary of State must have regard to- (a) the need for age-appropriate specialised services for children and young people, (b) the need for equitable access to those services across England, (c) the impact of the decision on the quality, safety, sustainability and clinical effectiveness of those services, (d) the effect of the small and geographically dispersed population of children and young people requiring those services, (e) the impact on patients from Wales, Scotland and Northern Ireland who use those services in England, and (f) the benefits of retaining national commissioning or oversight where this supports sufficient patient volumes, clinical expertise, service standards or equitable access. (2) Before making a decision under subsection (1) that relates to specialised services for children and young people, the Secretary of State must publish an impact assessment setting out the likely effect on - (a) access to services, (b) clinical outcomes and patient experience, (c) health inequalities, (d) clinical expertise and service sustainability, (e) service integration and continuity of care, (f) patients, families and carers, and (g) the quality, consistency and equity of services. (3) In preparing an impact assessment under subsection (2), the Secretary of State must consult such persons as the Secretary of State considers appropriate, including children and young people who use specialised services, their families and carers, clinicians, and relevant provider and support organisations. (4) The Secretary of State must lay before Parliament an annual report on the provision, accessibility, quality and outcomes of specialised services for children and young people. (5) In this section- "children and young people" means persons under the age of 25; "specialised services" means services commissioned under regulations made under section 3B of the National Health Service Act 2006 (regulation-making power to require Secretary of State to commission services)."

After Clause 14, insert the following new Clause- "Sight tests: people with learning disabilities In regulation 3(1) of the Primary Ophthalmic Services Regulations 2008 (S.I. 2008/1186) (sight tests: eligibility) - (a) at the end of paragraph (h), omit "or", (b) at the end of paragraph (i), for the full stop substitute "; or", and (c) after paragraph (i) insert- "(j) who is eligible for registration as having a learning disability with their GP or is already registered as having a learning disability with their GP.""

Schedule 1, page 72, line 30, at end insert - "(5) After subsection (2) insert- "(2A) Eligibility for, and the scope of, the sight-testing service mentioned in subsection (2), and the fees payable for it, must be set nationally by the Secretary of State, and an integrated care board may not vary them in its area."

Schedule 1, page 73, line 6, at end insert- "116C Primary ophthalmic services for people with learning disabilities The Secretary of State must- (a) assess, or make arrangements for the assessment of, the need for primary ophthalmic services among people with learning disabilities, (b) direct integrated care boards to commission primary ophthalmic services to meet those needs, and (c) monitor and evaluate the effectiveness of those services."

Schedule 1, page 72, line 30, at end insert - "(5) After subsection (2) insert- "(2A) Eligibility for, and the scope of, the sight-testing service mentioned in subsection (2), and the fees payable for it, must be set nationally by the Secretary of State, and an integrated care board may not vary them in its area.'"

Schedule 1, page 73, line 6, at end insert- "116C Primary ophthalmic services for people with learning disabilities The Secretary of State must- (a) assess, or make arrangements for the assessment of, the need for primary ophthalmic services among people with learning disabilities, (b) direct integrated care boards to commission primary ophthalmic services to meet those needs, and (c) monitor and evaluate the effectiveness of those services."

Clause 16, page 12, line 22, at end insert - "(3) Regulations under subsection (1) must make provision for enabling people to choose the provider of appropriate non-consultant-led community services, including- (a) optometry-led monitoring and management of low-risk glaucoma, and (b) community urgent eye care services. (4) The Secretary of State must keep under review the services to which regulations under subsection (1) apply, with a view to extending patient choice for care in the community."

After Clause 16, insert the following new Clause- "Reservation and prioritisation of contracts for the voluntary, community and social enterprise sector (1) In exercising their commissioning functions, integrated care boards must take reasonable steps to secure the participation of voluntary, community and social enterprise organisations in the provision of services. (2) The Secretary of State must by regulations made by statutory instrument enable integrated care boards to reserve and prioritise contracts to be delivered by voluntary, community and social enterprise organisations as part of their commissioning process. (3) Circumstances in which contracts may be appropriate to be reserved and prioritised under subsection (2) include - (a) services that are, or could be, community-based, (b) services that are intended to reach populations that are underserved, marginalised, or experiencing health inequalities, or (c) where voluntary, community and social enterprise organisations are best placed to deliver person-centred or culturally competent care. (4) In exercising functions under this section, integrated care boards must have regard to- (a) the need to reduce health inequalities, (b) the importance of securing equitable access to services across different areas, and (c) the sustainability of voluntary, community and social enterprise provision. (5) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament."

After Clause 17, insert the following new Clause - "Patient choice: onward referrals by virtual and integrated health services (1) The Secretary of State must by regulations made by statutory instrument make provision to ensure that a patient who is referred onward by a designated health service body to a provider for elective care or treatment is offered the same choices in respect of that referral as would apply if the referral had been made by a general practitioner, dentist or optometrist. (2) Regulations under subsection (1) must in particular ensure that a designated health service body - (a) does not maintain a closed list of preferred providers for onward referrals which excludes providers that would otherwise be available to patients under the NHS choice framework, (b) does not direct a patient to a particular provider for elective care without first offering the patient the opportunity to exercise their right to choice, and (c) has access to the NHS e-Referral Service, or any successor system, for the purpose of facilitating patient choice in respect of onward referrals. (3) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament. (4) In this section- "designated health service body" means - (a) an NHS trust or NHS foundation trust, (b) a body designated by the Secretary of State as providing virtual care or triage services to NHS patients in England, or (c) a body designated by the Secretary of State as an integrated healthcare organisation or organisation of equivalent description; "onward referral" means a referral made by a designated health service body to another provider for the purposes of the patient receiving further investigation, treatment or care."

Clause 22, page 16, line 19, at end insert- "(2A) The constitution must also provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include at least one member nominated jointly by providers of primary care services in the integrated care board's area, including providers of primary ophthalmic services, and must set out the process for that nomination."

After Clause 22, insert the following new Clause - "Quality and outcomes for people living with inflammatory bowel disease (1) Each integrated care board must monitor and assess variation in the quality of care, access to services and outcomes for people living with inflammatory bowel disease within its area. (2) In carrying out an assessment under subsection (1), an integrated care board must assess its performance against the national standards and measures established under section (National strategy for inflammatory bowel disease). (3) For each financial year, an integrated care board must publish a report on its performance against the national standards and measures established under section (National strategy for inflammatory bowel disease), including any unwarranted variation identified within its area and the action taken or proposed to reduce it. (4) In this section, "inflammatory bowel disease" includes Crohn's disease, ulcerative colitis and such related conditions as the Secretary of State may specify in regulations made under section (National strategy for inflammatory bowel disease). (5) The first report under this section must be published within 12 months of the day on which this section comes into force, and subsequent reports must be published annually."

Clause 25, page 18, line 22, at end insert - "(4A) Any guidance issued by the Secretary of State under subsection (4) must include provision on - (a) identifying unmet need and unwarranted variation in access to services for people with long-term, complex or fluctuating health conditions, (b) establishing appropriate clinical pathways, including access to specialist advice and arrangements for referral or escalation where necessary, (c) assessing the workforce and service capacity required to meet identified needs, and (d) specifying the responsibilities of partner organisations, measurable objectives and arrangements for monitoring progress, using existing reporting mechanisms where appropriate."

Clause 52, page 36, line 16, after "received", insert "publicly funded"

Clause 52, page 36, line 17, after "received", insert "publicly funded"

Clause 48, page 33, line 10, at end insert - "(2A) The Secretary of State must give integrated care boards directions to increase spending on mental health services at least in line with the change in level of their total programme funding."

Clause 48, page 33, line 14, after "(1)" insert "or (2A)".

Clause 48, page 33, line 37, at end insert - "(f) require the integrated care board to use a portion of designated amount for the provision of social care services and support for the physical and mental health and wellbeing of unpaid carers."

After Clause 49, insert the following new Clause- "Primary care investment standard (1) The Secretary of State must by regulations made by statutory instrument establish a primary care investment standard for integrated care boards. (2) The primary care investment standard must require each integrated care board to increase its spending on primary care services, in each financial year, by at least the same proportion as any increase in the level of its total programme funding for that year. (3) Regulations under this section may make provision about- (a) the description of services that constitute "primary care services" for the purposes of this section; (b) how compliance with the primary care investment standard is to be measured, monitored and enforced; (c) circumstances in which the standard may be varied or disapplied. (4) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament."

Clause 52, page 36, line 16, after "received", insert "publicly funded"

Clause 52, page 36, line 17, after "received", insert "publicly funded"

Clause 52, page 36, line 18, after "of" insert "publicly funded"

Clause 52, page 36, line 19, at end insert - "(1A) The regulations must make provision for patient information to be readily available to providers of palliative and end-of-life care including voluntary sector providers."

Clause 52, page 36, line 37, at end insert - "(2A) The regulations must make provision for- (a) persons providing optometry services to have access to relevant patient information through the system, (b) the system to be interoperable with the digital systems used by such persons, and (c) persons providing optometry services to be represented in the governance and implementation of the system."

Clause 52, page 36, line 37, at end insert- "(2A) The regulations must provide that any patient may opt out of all or any information relating to them being included in the system."

Clause 52, page 37, line 14, after "condition" insert ", and includes optometry services, including primary ophthalmic services"

Clause 52, page 37, line 23, at end insert- ""publicly funded" care includes care which is partly funded out of public funds;"

After Clause 52, insert the following new Clause- "Single patient record: review of data minimisation (1) Before making regulations under section 250E of the National Health Service Act 2006 (single patient record), the Secretary of State must undertake a review of- (a) the patient information to be provided to or processed through the system established under that section, (b) the identifiable patient information to be held by suppliers, contractors, partners and service providers whose information or services will be used to establish, populate or operate the system, (c) whether that identifiable patient information can be anonymised, pseudonymised or processed using a unique identifier before it is disclosed to or processed by those persons, (d) the periods for which identifiable patient information will be retained by those persons, (e) whether the establishment of the system will result in unnecessary duplication of identifiable patient information, and (f) the cybersecurity risks of the unnecessary retention, disclosure or duplication of identifiable patient information. (2) The review must make recommendations for reducing the amount of identifiable patient information held by persons participating in the system and increasing the use of anonymisation, pseudonymisation and unique identifiers. (3) The Secretary of State must lay before Parliament a report setting out the findings and recommendations of the review."

After Clause 56, insert the following new Clause - "Protection of confidential psychological therapy records (1) The Secretary of State must by regulations made by statutory instrument provide for safeguards governing the inclusion of information relating to psychotherapy, counselling or other psychological therapies in the single patient record. (2) The regulations must provide that detailed narrative records of psychotherapy, counselling or other psychological therapies may not be routinely disclosed through the single patient record to health or social care professionals unless the patient has given explicit and informed consent to the disclosure. (3) Subsection (2) does not apply where disclosure is necessary to address an immediate risk to the life, safety or wellbeing of the patient or another person. (4) Any disclosure under subsection (3) must be limited to the information reasonably necessary for that purpose, and the reasons for the disclosure must be recorded. (5) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament."

After Clause 57, insert the following new Clause- "National respite care scheme (1) Within six months of the day on which this Act is passed, the Secretary of State must establish a national respite care scheme. (2) The scheme under subsection (1) must make provision for - (a) where a local authority carries out an assessment of the needs of an unpaid carer under any enactment for the time being in force in England, an assessment by the local authority of whether the unpaid carer is able to take sufficient breaks from their caring responsibilities; (b) unpaid carers to receive support to take breaks from their caring responsibilities to - (i) maintain their physical and mental health and emotional wellbeing, (ii) participate in work, education, training or recreation, and (iii) participate in family and community life; (c) a carer to receive appropriate support if a local authority carrying out an assessment under subsection (2)(a) determines that a carer is unable to take sufficient breaks from caring. (3) Under subsection (2), "support" may include- (a) replacement care for the cared-for person; (b) respite services; (c) any other steps a local authority considers appropriate as support. (4) The Secretary of State must provide sufficient support to local authorities to ensure the scheme under subsection (1) is delivered in every local authority. (5) For the purposes of this section, "unpaid carer" means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work."

After Clause 71, insert the following new Clause- "Functions of the Commissioner (1) The Maternity and Neonatal Commissioner for England must promote improvements in maternity and neonatal care in England.

After Clause 84, insert the following new Clause - "NHS mental health workforce plan (1) Within 12 months of the publication of the first NHS workforce plan since the 2023 NHS workforce plan, the Secretary of State must publish a follow-up mental health workforce plan. (2) The plan should include but not be limited to detail on- (a) how the mental health workforce will be effectively retained and recruited to meet the scale of the mental health demand, including for people with learning disabilities and autistic people; (b) investment required to achieve the commitments in the plan. (3) The Secretary of State must produce an annual report to Parliament on the achievements made in delivering the plan."

After Clause 84, insert the following new Clause- "Health and care workforce strategy (1) The Secretary of State must, within 12 months of the day on which this Act is passed, publish a health and care workforce strategy for England. (2) The strategy must set out- (a) an assessment of the number of staff, including registered nurses and primary care practitioners, needed to meet current and projected demand for health and care services, and (b) a funded plan to close any gap between that number and the staff available. (3) In this section "primary care practitioners" includes general practitioners, dentists, optometrists and pharmacists. (4) The Secretary of State must lay before Parliament an annual report on progress in implementing the strategy."

After Clause 84, insert the following new Clause- "Autism, ADHD and learning disabilities: responsibility following abolition of NHS England (1) No regulations may be made under section 88 (commencement) bringing section 1 into force unless the Secretary of State has published, and laid before Parliament, a statement under this section. (2) A statement under this section must set out - (a) how each function exercised by NHS England in relation to the assessment, diagnosis, treatment and support of autistic people and people with ADHD will be exercised following the abolition of NHS England, and by which person or body, (b) how the functions exercised by NHS England in connection with its national programme for people with a learning disability and autistic people will be exercised following that abolition, and by which person or body, (c) the senior officer of the Department of Health and Social Care with lead responsibility for the matters in paragraphs (a) and (b), and (d) how the Secretary of State will monitor, and report to Parliament on, waiting times for autism and ADHD assessment. (3) In this section- "ADHD" means attention deficit hyperactivity disorder; "autistic people" includes people with any autism spectrum condition."

After Clause 84, insert the following new Clause- "Autism and ADHD: publication of information and prevalence surveys (1) The Secretary of State must publish information about the assessment of autism and ADHD in England, including- (a) the number of people referred for an autism assessment, and the number of people referred for an ADHD assessment, who are waiting for that assessment, (b) the length of time for which those people have been waiting, and (c) information disaggregated by integrated care board area, age group and sex. (2) Information under subsection (1) must be published - (a) at intervals no longer than those at which equivalent information was published by NHS England immediately before the day on which section 1 comes into force, and (b) in a form which allows comparison with the information published by NHS England before that day. (3) The Secretary of State must arrange for surveys to be carried out to estimate the prevalence of autism and ADHD among children and adults in England. (4) The first survey under subsection (3) must be commissioned within two years of the day on which this Act is passed and further surveys must be commissioned at intervals of not more than five years. (5) The Secretary of State must publish the results of each survey under subsection (3) and lay a copy before Parliament. (6) In this section "ADHD" means attention deficit hyperactivity disorder, and "autism" includes any autism spectrum condition."

After Clause 84, insert the following new Clause- "Treatment at sporting and cultural events (1) The Secretary of State must, within six months of the day on which this Act is passed, by regulations made by statutory instrument establish an exception from registration under Chapter 2 of Part 1 of the Health and Social Care Act 2008 (registration in respect of provision of health or social care) for the provision of treatment of disease, disorder or injury by a listed healthcare professional where - (a) the treatment is provided to - (i) an athlete or performer, or (ii) a person providing essential support to an athlete or performer, (b) the treatment is provided in connection with preparation for, travel to or from, or participation in a sporting competition, sporting event or cultural performance, (c) the healthcare professional is registered with the professional regulator relevant to their profession, (d) the treatment is provided in accordance with relevant quality and clinical governance standards recognised by the Secretary of State, and (e) the healthcare professional has notified the Care Quality Commission that they intend to operate under the exception. (2) For the purposes of this section, "athlete" includes - (a) a professional or elite athlete; (b) an amateur athlete; (c) a child or young person participating in sport; (d) a person participating in a grassroots, community, school or recreational sporting competition or event. (3) Regulations under subsection (1) must make provision in relation to- (a) elite and professional competitions and performances, (b) amateur and non-elite competitions and performances, (c) grassroots and community sporting events, (d) school and youth sporting events, and (e) competitions and events involving disabled athletes or performers. (4) The standards recognised under subsection (1)(d) must include standards relating to- (a) safeguarding, including the safeguarding of children and vulnerable adults, (b) clinical governance, (c) professional competence, (d) indemnity, (e) medicines management, (f) record keeping, and (g) emergency escalation. (5) The Care Quality Commission must maintain a register of listed healthcare professionals who have notified it under subsection (1)(e). (6) Entry in the register under subsection (5) - (a) does not constitute registration under Chapter 2 of Part 1 of the Health and Social Care Act 2008, and (b) may be suspended or removed where the Care Quality Commission is satisfied that the professional no longer meets the conditions in subsection (1). (7) Before making regulations under this section, the Secretary of State must consult - (a) the Care Quality Commission, (b) relevant professional regulators, (c) national governing bodies for sport and cultural activities, (d) bodies representing sport and exercise medicine and pre-hospital care, and (e) bodies representing grassroots, community, school and youth sport. (8) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament."

Clause 88, page 65, line 27, at end insert ", subject to the provisions of section (Autism, ADHD and learning disabilities: responsibility following abolition of NHS England) (autism, ADHD and learning disabilities: responsibility following abolition of NHS England)."

Clause 88, page 65, line 27, at end insert ", subject to the provisions of section (Autism, ADHD and learning disabilities: responsibility following abolition of NHS England) (autism, ADHD and learning disabilities: responsibility following abolition of NHS England)."

Clause 6, page 4, line 20, at end insert- "(5) The Secretary of State must establish a transformational fund, within a year of the date on which the Health Act 2026 is passed, to enable improvements in access to specialist palliative care and its support to generalist services."

LORD PATEL

Clause 7, page 4, line 31 at end insert- "(1A) The Secretary of State must publish an independently verified long-term assessment of the workforce needs of the health service and a ten year education and training plan to deliver on those needs. (1B) The first assessment and plan under subsection (1A) must be published within one month of the day on which this Act is passed. (1C) The Secretary of State must keep the assessment and plan under review and revise both at least once every five years."

Clause 16, page 12, line 10, at end insert- "(3) Regulations must impose duties on integrated care boards with respect to waiting times for treatments or other services provided to children which they arrange in the exercise of their commissioning functions. (4) Regulations under subsection (3) must include provision as to the arrangements integrated care boards must make where a specified treatment or other specified service for a child is not provided within a specified period. (5) The first regulations under subsection (3) must be made before the end of the period of 12 months beginning with the day on which section 16 of the Health Act 2026 comes into force. (6) In this section “child” means a person under the age of 18."

After Clause 52, insert the following new Clause— “Single patient record: right to opt out of use for purposes other than direct care (1) Regulations under section 250E of the National Health Service Act 2006 (as inserted by section 52 of this Act) must enable a patient to opt out of information relating to them which is made available through the system established under those regulations being used for any purpose other than their direct care. (2) The regulations must enable a patient to opt out, or to withdraw an opt-out, at any time and free of charge – (a) through their GP practice, (b) electronically, or (c) by other means accessible to persons without internet access. (3) The regulations may not permit an opt-out to be overridden except where required by an order of a court or where necessary to protect the patient’s life.”

After Clause 52, insert the following new Clause— “Single patient record: access logs and audit (1) The Secretary of State must ensure that a record is kept of each occasion on which patient information is accessed or otherwise processed by means of the system established under regulations under section 250E of the National Health Service Act 2006 (as inserted by section 52 of this Act) (“the single patient record”), setting out— (a) the person or organisation by whom it was accessed or processed, (b) the date and time it was accessed or processed, (c) the information accessed or processed, and (d) the purpose for which it was accessed or processed. (2) The Secretary of State must ensure that a patient is able to view, free of charge and by electronic means, the record kept under subsection (1) in relation to information about them. (3) The Secretary of State must publish, at least once every three months, a register of each disclosure of patient information obtained from or derived from the single patient record for purposes other than direct care, including research, setting out— (a) the recipient, (b) the purpose, (c) the legal basis for the disclosure, (d) whether the information disclosed was identifiable, pseudonymised or anonymised, and (e) the date of the disclosure and the period for which the information may be retained. (4) The Secretary of State must arrange for an independent audit, at least once in each financial year, of access to and processing of patient information by means of the single patient record, and must lay a report of each audit before Parliament.”

After Clause 52, insert the following new Clause— “Single patient record: sexual and reproductive health information (1) Regulations under section 250E of the National Health Service Act 2006 (as inserted by section 52 of this Act) must not require or authorise information relating to the provision of sexual and reproductive health services to a patient to be made available through the system established under those regulations, unless the patient has given explicit consent. (2) A patient may withdraw consent given under subsection (1) at any time. (3) In this section “sexual and reproductive health services” includes – (a) testing for and treatment of HIV and other sexually transmitted infections, (b) contraception, and (c) the termination of pregnancy.”

After Clause 52, insert the following new Clause— “Right to receive sexual health services anonymously (1) A person seeking testing for, or treatment of, HIV or any other sexually transmitted infection from a sexual health service must not be required, as a condition of receiving that service, to give their name or any other information which identifies them. (2) Information identifying a person who receives a service under subsection (1) must not be disclosed without that person’s consent, except where necessary to prevent a serious risk of harm to the person or to others.”

After Clause 56, insert the following new Clause— “Retention of NHS number on following adoption (1) The Secretary of State must ensure that, where a person is the subject of an adoption order, the person’s NHS number is not changed by reason only of the making of that order. (2) The Secretary of State must ensure that a person’s health record is maintained as a single and continuous record under that NHS number after the making of an adoption order, to the same extent as it was maintained immediately before the order was made. (3) The duties in subsections (1) and (2) apply in relation to— (a) an adoption order made in public law proceedings, and (b) an adoption order made in private law proceedings, including an order made in favour of a step-parent or the partner of a parent. (4) In this section— “adoption order” has the meaning given by section 46 of the Adoption and Children Act 2002; “health record” has the meaning given by section 205 of the Data Protection Act 2018; “NHS number” has the same meaning as “consistent identifier” in section 251A of the Health and Social Care Act 2012.”

After Clause 57, insert the following new Clause— “Cap on care costs (1) Sections 15 (cap on care costs) and 16 (cap on care costs: annual adjustment) of the Care Act 2014 come into force at the end of the period of two months beginning with the day on which this Act is passed. (2) The Secretary of State must make regulations under section 15(4) of the Care Act 2014 to take effect no later than 12 months after the entry into force of sections 15 and 16 of the Care Act 2014.”

After Clause 57, insert the following new Clause— “Integrated personal health and care budgets (1) The National Health Service Act 2006 is amended as follows. (2) After section 12DB (inserted by Schedule 12 to this Act) insert – “12DC Right to an integrated personal health and care budget (1) This section applies where— (a) The Secretary of State or an integrated care board (‘the relevant NHS body’) is responsible for arranging the provision to an adult of one or more community-based health services, (b) the relevant NHS body has identified an amount which is sufficient to secure the provision of those services in accordance with an agreed care plan, and (c) a local authority is required, or has decided, to meet needs of that adult under Part 1 of the Care Act 2014 and the adult has a personal budget under section 26 of that Act. (2) The adult, or an authorised representative acting on the adult’s behalf, may request that the amounts available from the relevant NHS body and the local authority be provided as an integrated personal health and care budget. (3) Where a request is made under subsection (2), the relevant NHS body and the local authority must— (a) grant the request unless one of the grounds in subsection (8) applies; (b) prepare, with the adult or authorised representative, a single personalised health and care plan; (c) identify in that plan— (i) the adult’s assessed health needs and care and support needs; (ii) the outcomes which the arrangements are intended to achieve; (iii) the amount to be provided by the relevant NHS body; (iv) the amount to be provided by the local authority; (v) any amount which the adult is required to pay following a financial assessment under the Care Act 2014; and (vi) the total amount of the integrated personal health and care budget; (d) designate one of them as the lead body responsible for administering the budget; and (e) establish a single system for payment, management, monitoring and review of the budget. (4) An integrated personal health and care budget may be managed by – (a) a direct payment to the adult or an authorised representative, (b) a direct payment to a person nominated by the adult or authorised representative, (c) a managed account administered by a person or body independent of the relevant NHS body and the local authority, (d) a notional budget administered by the lead body in accordance with the personalised health and care plan, or (e) a combination of the arrangements in paragraphs (a) to (d). (5) The relevant NHS body and the local authority must give effect to the adult’s preferred method of management under subsection (4), except to the extent that a ground in subsection (8) applies. (6) Amounts comprised in an integrated personal health and care budget may be applied to any service, support, item or arrangement specified in the personalised health and care plan where the bodies are satisfied that it will contribute to meeting one or more of the needs or outcomes specified in that plan. (7) Expenditure under subsection (6) need not be classified exclusively as expenditure on health care or on care and support, but the personalised health and care plan must make provision sufficient to meet all the needs which the relevant NHS body and the local authority are respectively required to meet. (8) A request, or a preferred method of managing the budget, may be refused only where— (a) the proposed arrangement would be unlawful, (b) it would give rise to a material risk to the health, safety or welfare of the adult or another person which cannot reasonably be mitigated, (c) the adult, authorised representative or nominee would be unable to manage the arrangement safely or effectively notwithstanding any support which could reasonably be provided, (d) the requested arrangement relates to a service which regulations expressly exclude from integrated personal budgets, or (e) the proposed expenditure would not contribute to meeting a need or outcome specified in the personalised health and care plan. (9) Where a request is refused in whole or in part, the relevant NHS body and the local authority must— (a) give the adult and any authorised representative written reasons, (b) identify any alternative arrangement which they propose, (c) inform them of the right to require a review, and (d) continue to secure the services required to meet the adult’s assessed needs while the review is determined. (10) A review under subsection (9) must— (a) be undertaken by a person who was not involved in the original decision, (b) involve the adult and any authorised representative, (c) be completed within the prescribed period, and (d) result in a written decision with reasons. (11) Nothing in this section – (a) transfers from the relevant NHS body or the local authority responsibility for any function or duty for which that body is otherwise responsible, (b) permits a charge to be imposed for any service which must be provided free of charge as part of the health service, (c) permits an amount payable by the relevant NHS body to be taken into account as resources of the adult for the purposes of a financial assessment under the Care Act 2014, (d) permits either body to reduce the amount it would otherwise be required to provide solely because the other body is contributing to the integrated budget, or (e) affects the right of the adult to have services arranged directly instead of receiving or managing a personal budget. (12) To the extent that an integrated personal health and care budget consists of— (a) NHS funding, a payment made under this section is to be treated as a direct payment under section 12A; (b) money payable by a local authority to meet needs under Part 1 of the Care Act 2014, the payment is to be treated as a direct payment under section 31 or 32 of that Act, as appropriate. (13) In this section “authorised representative” means – (a) where the adult has capacity to make the relevant decision, a person whom the adult has authorised to act on the adult’s behalf, (b) a donee of a lasting power of attorney, or a deputy appointed by the Court of Protection, who has authority to make the relevant decision, (c) a person nominated by the adult before the adult lost capacity to make the relevant decision, or (d) where there is no person within paragraphs (b) or (c), a suitable person approved jointly by the relevant NHS body and the local authority to act in the adult’s best interests. (14) An authorised representative may nominate a person or organisation to administer a managed account where the authorised representative does not have authority, or does not wish, personally to receive and manage the money. (15) In this section “community-based health services” means health services arranged for an adult in the adult’s home or in a community setting, including— (a) NHS Continuing Healthcare, (b) community nursing, therapy, rehabilitation and mental-health services, (c) equipment and other support required to enable the adult to live in the community, and (d) such other services as may be prescribed. (16) The Secretary of State must make regulations providing for— (a) the period within which a request must be determined and implemented, (b) the calculation and sufficiency of the NHS contribution, (c) support for adults and authorised representatives in preparing and managing a budget, (d) monitoring, review, audit and recovery of payments, (e) resolution of disputes between responsible bodies without interruption to the adult’s care, and (f) the limited descriptions of service which may be excluded under subsection (8)(d).” (3) In section 75 of the National Health Service Act 2006, after subsection (3) insert- “(3A) Regulations under this section must make provision enabling NHS bodies and local authorities to discharge their duties under section 12DC. (3B) The absence of arrangements under this section does not relieve an NHS body or local authority of a duty imposed by section 12DC. יי

After Clause 57, insert the following new Clause— “Consequential amendments to the Care Act 2014 (1) The Care Act 2014 is amended as follows. (2) In section 25, after subsection (2) insert- “(2A) Where section 12DC of the National Health Service Act 2006 applies, the requirements of this section may be satisfied by a single personalised health and care plan prepared under that section.” (3) For section 26(3) substitute – “(3) Where section 12DC of the National Health Service Act 2006 applies, the personal budget must— (a) specify the amount of NHS money available in the adult’s case, (b) form part of the integrated personal health and care budget prepared under that section, and (c) identify separately the amounts provided by the local authority, the relevant NHS body and the adult. (3A) In any other case, a personal budget may specify other amounts of public money available in the adult’s case, including amounts relating to housing, healthcare or welfare.” (4) In sections 31 and 32, after subsection (3) insert- “(3A) Where a direct payment forms part of an integrated personal health and care budget under section 12DC of the National Health Service Act 2006, the local authority must coordinate the payment, account, conditions and review arrangements with the relevant NHS body and must not require a separate account or administrative process unless this is necessary for the protection of the adult. """

After Clause 69, insert the following new Clause— “Health Services Safety Investigations Body: recommendations, monitoring and powers (1) The Health and Care Act 2022 is amended as follows. (2) In section 110(1) (investigation of incidents with safety implications) – (a) in paragraph (a), after “health care services” insert “or adult social care services”, and (b) in paragraph (b), after “patients” insert “or of persons receiving adult social care services”. (3) After section 116 insert- “116A Monitoring of recommendations by the Care Quality Commission (1) The Care Quality Commission must monitor and review the implementation of recommendations contained in final reports published by the HSSIB under section 113, so far as those recommendations relate to— (a) providers of health care services, or (b) providers of adult social care services. (2) The Care Quality Commission must integrate its assessment of the implementation of recommendations under subsection (1) into its exercise of functions under Chapter 3 of Part 1 of the Health and Social Care Act 2008 (quality of health and social care). (3) The Care Quality Commission must publish an annual report on the implementation of recommendations made by the HSSIB by providers of health care services and adult social care services. (4) For the purposes of exercising its functions under this section, the Care Quality Commission— (a) may rely only on information contained in final reports published under section 113 or other publicly available information, and (b) may not have access to, or require the disclosure of, any protected material. 116B Implementation of recommendations by the Secretary of State (1) Where a final report published under section 113 contains a recommendation for action by the Secretary of State, the Secretary of State must, so far as is practicable, implement that recommendation. (2) Within three months of the publication of the final report, the Secretary of State must lay before Parliament a plan setting out— (a) the steps to be taken to implement the recommendation, (b) the timetable for taking those steps, and (c) where the Secretary of State considers that it is not practicable to implement the recommendation in full, the reasons for that view. (3) The Secretary of State must lay before Parliament an annual report setting out, for each recommendation under this section that has not been fully implemented – (a) the progress made against the plan under subsection (2), and (b) the reasons for any delay.” (4) In section 135 (Interpretation of Part 4), at the appropriate place insert – “adult social care services” means services which consist of or include the provision of social care, within the meaning of section 9(3) of the Health and Social Care Act 2008, to adults.”

After Clause 71, insert the following new Clause— “Powers for coroners and medical examiners to review suspected failings in obstetric, neonatal and paediatric care (1) The Secretary of State must, by regulations made by statutory instrument, establish a standard mechanism whereby coroners and medical examiners must review cases of deaths, bought to them by patients, medical staff or other relevant whistleblowers, where there are suspected failings in the provision of obstetric, neonatal and paediatric care. (2) A coroner or a medical examiner has a duty to review cases using the mechanism established under subsection (1) if, in the course of their duties, there are reasonable grounds to suspect that a death or incident involved systemic failings or clinical negligence in a health care setting. (3) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

After Clause 71, insert the following new Clause- "Health Service Commissioner In section 1 of the Health Service Commissioners Act 1993 (the Commissioner), after subsection (1) insert— "(1A) The office of Health Service Commissioner for England cannot be held by the person who holds the office of Parliamentary Commissioner (as defined by the Parliamentary Commissioner Act 1967). """

After Clause 71, insert the following new Clause- "Powers for coroners and medical examiners to review suspected failings in obstetric, neonatal and paediatric care (1) The Secretary of State must, by regulations made by statutory instrument, establish a standard mechanism whereby coroners and medical examiners must review cases of deaths, bought to them by patients, medical staff or other relevant whistleblowers, where there are suspected failings in the provision of obstetric, neonatal and paediatric care. (2) A coroner or a medical examiner has a duty to review cases using the mechanism established under subsection (1) if, in the course of their duties, there are reasonable grounds to suspect that a death or incident involved systemic failings or clinical negligence in a health care setting. (3) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament."

LORD PATEL

The above-named Lords give notice of their intention to oppose the Question that Schedule 11 be the eleventh Schedule to the Bill.

After Clause 78, insert the following new Clause- "Infant feeding bottles: materials (1) A relevant NHS body must, when procuring or supplying infant feeding bottles for use by infants in its care, procure or supply bottles which are not made wholly or partly of plastic. (2) The duty in subsection (1) does not apply where the responsible clinician considers that the use of a bottle not made of plastic would be contrary to the clinical interests of a particular infant. (3) A relevant NHS body satisfies the duty in subsection (1) by procuring or supplying bottles the container of which is made of a safe alternative material. (4) The Secretary of State may by regulations specify a material as a safe alternative material, or remove a material previously so specified, but may only specify a material where satisfied, on the basis of the best available scientific and clinical evidence and applying a precautionary approach, that in normal conditions of use the material does not release into the contents of the bottle— (a) microplastic particles, (b) bisphenols or their derivatives, (c) phthalates or other plasticisers, or (d) any other substance having endocrine-disrupting properties, in quantities which may pose a risk to the health of an infant. (5) In subsection (4), "normal conditions of use" includes sterilisation, the preparation of feed with water at temperatures used in clinical and domestic settings, repeated washing, and the expected service life of the bottle. (6) The Secretary of State must make the first regulations under subsection (4) within 12 months of the day on which this section comes into force. (7) Before making regulations under subsection (4), the Secretary of State must consult— (a) the United Kingdom Health Security Agency, (b) the Food Standards Agency, (c) the Health and Safety Executive, (d) such organisations representing paediatric, neonatal and maternity clinicians as the Secretary of State considers appropriate, and (e) such other persons as the Secretary of State considers appropriate. (8) The Secretary of State must issue guidance to relevant NHS bodies about the discharge of the duty in subsection (1), including guidance on cleaning, sterilisation and safe handling, and a relevant NHS body must have regard to that guidance. (9) Within 12 months of the day on which this section comes into force, and annually thereafter, the Secretary of State must lay before Parliament a report on compliance with the duty in subsection (1), including an estimate of the number of infant feeding bottles procured or supplied by relevant NHS bodies in the reporting period and the materials of which they were made. (10) In this section— "infant" means a child under the age of 24 months; "infant feeding bottle" means the container from which an infant is fed, and does not include the teat, valve or collar; "relevant NHS body" means— (a) an integrated care board, (b) an NHS trust, or (c) an NHS foundation trust; "responsible clinician" means the registered medical practitioner or registered nurse with responsibility for the care of the infant"

After Clause 84, insert the following new Clause- "Review of clinic negligence model (1) Within six months beginning with the day on which this Act is passed, the Secretary of State must set up a commission to review the current framework and process used by the NHS to respond to clinical negligence claims. (2) The review under subsection (1) must consider proposals for improving the process and framework used by the NHS to respond to clinical negligence claims, including- (a) reducing the time from incident to resolution, (b) reducing legal costs for individuals and organisations, and (c) providing support for patients and their families where an incident has occurred. (3) The commission must consist of- (a) an independent chair, and (b) representative of patients, clinicians and legal entities. (4) The (a) commission must- complete its review within the period of 18 months beginning with the day on which this Act is passed, and (b) publish a report which must be laid before Parliament."

After Clause 84, insert the following new Clause- "Cancer genomic testing and personalised medicines (1) In exercising functions in relation to the health service in England, the Secretary of State must take all reasonable steps to ensure that - (a) (b) (c) (d) timely and comprehensive molecular and genomic testing (including for rarer actionable drivers) is provided as a standard part of cancer diagnostic pathways, integrated care boards and NHS providers have appropriate tissue collection, processing and storage facilities to facilitate personalised treatments, integrated care boards and NHS providers put in place consistent operational arrangements for the safe and effective delivery of personalised cancer medicines, and regional and demographic variation in access to genomic testing, specialist cancer treatments and supporting data infrastructure is reduced. (2) In discharging the duty under subsection (1) the Secretary of State must have regard to the objectives of the National Cancer Plan for England."

After Clause 84, insert the following new Clause- "Resilience to climate and environmental degradation risks Each NHS trust and NHS foundation trust must publish plans setting out- (a) an assessment of the risks to its premises, workforce and services from current and predicted impacts of climate change and environmental degradation, and (b) details of plans to implement measures which can address those risks."

After Clause 84, insert the following new Clause- "Health improvement and health inequalities outcome targets for children (1) Within six months of the day on which this Act is passed, the Secretary of State must- (a) (b) make regulations made by statutory instrument to set long term outcome targets for improving the health of children in England and reducing inequalities in health between children in England, and publish a cross-government strategy to set out how the target set by regulations under paragraph (a) will be achieved. (2) In preparing the strategy under subsection (1)(b) the Secretary of State must consult any relevant bodies which they consider appropriate. (3) A Minister of the Crown must have regard to the strategy when exercising functions of the Minister. (4) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament."

After Clause 84, insert the following new Clause- "Radiotherapy services: national planning and improvement (1) The Secretary of State must exercise functions in relation to the health service in England with a view to securing effective arrangements for planning and delivering improvements to radiotherapy services. (2) For the purposes of subsection (1), the Secretary of State must publish a national delivery programme, informed by an assessment of clinical need and service capacity, setting out measures to- (a) improve access to radiotherapy services and reduce avoidable treatment delays, (b) address shortfalls in workforce, equipment and treatment capacity, including geographical inequalities in access, and (c) improve access to evidence-based modern radiotherapy techniques. (3) The programme must identify the actions required, the bodies responsible for their delivery and the timescales for implementation. (4) The Secretary of State must make arrangements for implementing the programme through the exercise of relevant statutory functions and keep the effectiveness of those arrangements under review. (5) The programme may form part of the National Cancer Plan for England, or any successor plan, provided that the requirements of this section are met."

After Clause 84, insert the following new Clause- "National strategy for inflammatory bowel disease (1) The Secretary of State must, within 12 months of the day on which this Act is passed, prepare and publish a national strategy for improving treatment, care and outcomes of persons living with inflammatory bowel disease. (2) The strategy must- (a) (b) establish nationally consistent standards of care and performance measures, informed by nationally recognised clinical guidelines, quality standards and service specifications, set measurable objectives for improving patient outcomes and quality of life, supported by consistent data that enables comparison between areas and over time, (c) promote workforce planning and training sufficient to meet the needs of persons living with inflammatory bowel disease, and (d) address inequalities in access to care and outcomes. (3) In preparing the strategy, the Secretary of State must consult- (a) persons living with inflammatory bowel disease and their carers, (b) organisations representing persons living with inflammatory bowel disease, (c) healthcare professionals with expertise in inflammatory bowel disease, and (d) such other persons as the Secretary of State considers appropriate. (4) The Secretary of State must review and, if considered appropriate, revise the strategy at intervals not exceeding five years. (5) In this section, "inflammatory bowel disease" includes Crohn's disease, ulcerative colitis and such related conditions as the Secretary of State may specify in regulations made by statutory instrument. (6) Regulations under this section may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament."

Clause 88, page 65, line 22, at end insert - "(za) section (Cap on care costs) (cap on care costs);"

None 83

Clause 22, page 16, line 25, at end insert—
“(4A) The constitution must provide for the ordinary members of the integrated care board to include—
(a) at least one qualified, professionally registered, consultant in public health who provides wholly independent, transparent, leadership and advice to the board on preventing and reducing disease and improving the health of the population it serves,
(b) at least two clinicians with current experience of providing primary care services, at least on of whom is a general practitioner, and
(c) at least one medical practitioner with current experience of providing secondary care services.
(4B) A person appointed under sub-paragraph (5) must not be appointed to represent the interests of a provider organisation whose services are commissioned by the integrated care board.”

This amendment would require every Integrated Care Board to include an independent qualified and registered consultant in public health, at least two clinicians from primary care, and a clinical representative from secondary care.

None 91

After Clause 22, insert the following new Clause—
“Duty of integrated care boards to commission stalking-related healthcare services
(1) Each integrated care board must make arrangements to commission, participate in or provide funding for public health services for victims of stalking within its area.
(2) The arrangements referred to in subsection (1) must have the objectives of—
(a) reducing physical and psychological harm to victims and others affected by stalking,
(b) identifying, assessing and addressing the clinical, psychological and psychiatric factors associated with stalking perpetration, and
(c) reducing demand upon health and social care services arising from stalking-related harm.
(3) The arrangements referred to in subsection (1) must include—
(a) specialist healthcare and psychological support for victims of stalking,
(b) specialist clinical assessment, treatment and therapeutic intervention for perpetrators of stalking where indicated,
(c) structured multi-agency physical and mental health risk assessments, and
(d) information sharing between relevant healthcare agencies.
(4) The duties under this section apply regardless of whether the stalking behaviour falls within the definition of domestic abuse under section 1 of the Domestic Abuse Act 2021 (definition of “domestic abuse”).
(5) In fulfilling its duties under this section, an integrated care board must cooperate with—
(a) police forces and local policing bodies,
(b) local authorities,
(c) probation services,
(d) mental health providers,
(e) NHS trusts and primary care providers, and
(f) relevant voluntary and community sector organisations.
(6) The Secretary of State must publish guidance concerning the discharge of duties under this section, including guidance on—
(a) evidence-based multi-agency ways of working,
(b) health service responses to stalking victims,
(c) clinical assessment and treatment pathways for stalking perpetrators, and
(d) the collection and publication of outcome data, including health impacts and cost-benefit measures.
(7) In preparing guidance under subsection (6), the Secretary of State must consult organisations with expertise in stalking, mental health and public health.
(8) In this section, “stalking” has the meaning given in section 2A of the Protection from Harassment Act 1997 (offence of stalking).”

This amendment places a duty on integrated care boards to make arrangements for multi-agency mental and physical healthcare support for stalking victims and in order to prevent stalking through psychological and psychiatric treatment of perpetrators, so as to reduce risk, improve outcomes and achieve cost benefits.

None 133

Clause 52, page 36, line 38, leave out from “regulations” to “any” in line 39 and insert “must provide that the processing of information in accordance with the regulations complies with”

This amendment would ensure that regulations made in relation to the disclosure or other processing of patient data must comply with the common law duty of confidentiality owed to the patient by those accessing their data.

None 30

Clause 8, page 5, line 7, leave out “relate to the health service” and insert “are public health functions”

This amendment, consequential on the amendment in the name of Lord Scriven to replace clause 11, limits delegation directions to ICBs to public health functions.

None 31

Clause 8, page 5, line 8, at end insert—
“(1A) A direction under subsection (1) may provide for a function of the Secretary of State, other than a public health function, to be exercised by an integrated care board only with the agreement of that board.”

This amendment, consequential on the amendment in the name of Lord Scriven to replace clause 11, requires an ICB’s agreement before it is directed to exercise any function other than a public health function.

None 40

Leave out Clause 11 and insert the following new Clause—
“Outcomes for the health service and integrated care boards
(1) The National Health Service Act 2006 is amended as follows.
(2) After section 1CC (inserted by section 6 of this Act) insert—
“1CD National outcomes for the health service
(1) The Secretary of State must publish a statement of the outcomes which the health service in England is to achieve in the period specified in the statement.
(2) The outcomes must be expressed as results to be achieved for patients and populations, and may relate to—
(a) health and wellbeing;
(b) the safety, quality and effectiveness of care;
(c) access to services, including waiting times;
(d) the reduction of inequalities;
(e) the sustainable use of resources.
(3) The Secretary of State may revise the statement.
(4) Before publishing or revising the statement, the Secretary of State must consult—
(a) integrated care boards, and
(b) such other persons as the Secretary of State considers appropriate.
(5) The Secretary of State must lay before Parliament—
(a) the statement and any revised statement, together with the reasons for any revision, and
(b) in respect of each financial year, a report on the progress made towards achieving the outcomes.”
(3) For sections 14Z61 and 14Z62 and the italic heading before those sections substitute—
“Outcomes, accountability and intervention
14Z61 Outcomes for integrated care boards
(1) The Secretary of State must, in respect of each financial year, specify by notice given to each integrated care board the outcomes which that board is to achieve (“ICB outcomes”).
(2) ICB outcomes—
(a) must be consistent with the most recent statement published under section 1CD,
(b) may differ between integrated care boards, and
(c) must specify results to be achieved, and not the means by which any function is to be exercised.
(3) In specifying ICB outcomes for an integrated care board, the Secretary of State must have regard to—
(a) any assessment of relevant needs under section 116 of the Local Government and Public Involvement in Health Act 2007 (health and social care: joint strategic needs assessments), and
(b) any neighbourhood health plan under section 116A of that Act (health and social care: joint local health and wellbeing strategies), which relates to the whole or any part of the board’s area.
(4) Before specifying ICB outcomes for an integrated care board, the Secretary of State must—
(a) consult the board, and
(b) consider any representations made by a relevant local authority or by the mayor of a relevant mayoral strategic authority.
(5) The Secretary of State must publish each notice given under subsection (1).
(6) An integrated care board must exercise its functions with a view to achieving its ICB outcomes.
(7) In this section and sections 14Z61A to 14Z62B—
“relevant local authority” , in relation to an integrated care board, means a local authority (within the meaning given by section 2B(5)) whose area coincides with, or includes the whole or any part of, the board’s area;
“relevant mayoral strategic authority” , in relation to an integrated care board, means a mayoral strategic authority (within the meaning given by paragraph 8(7) of Schedule 1B) whose area coincides with, or includes the whole or any part of, the board’s area.
14Z61A Accountability for ICB outcomes
(1) The Secretary of State must publish a framework (“the accountability framework”) setting out—
(a) how progress towards achieving ICB outcomes is to be measured,
(b) the information which integrated care boards must provide for that purpose, and
(c) how often progress is to be assessed.
(2) The Secretary of State may require an integrated care board—
(a) to provide such information as the Secretary of State considers necessary for the purposes of the accountability framework, and
(b) to publish a report on its progress towards achieving its ICB outcomes.
(3) Where a performance assessment under section 14Z59 shows that an integrated care board is not achieving its ICB outcomes, the Secretary of State may—
(a) require the board to publish a plan for achieving them, and
(b) provide assistance or support to the board under section 12DA.
(4) Nothing in this section confers power to give directions to an integrated care board.
14Z62 Intervention: appointment of commissioners
(1) The Secretary of State may by order appoint one or more persons (“commissioners”) to exercise specified functions of an integrated care board in place of the board if satisfied that—
(a) the board is seriously and persistently failing to achieve its ICB outcomes and, as a result, there is a serious risk to the safety or quality of care or to the proper management of public funds, or
(b) an emergency has occurred or is imminent which makes the appointment necessary.
(2) Before making an order on the ground in subsection (1)(a), the Secretary of State must—
(a) have conducted a performance assessment under section 14Z59 which shows the failure,
(b) give the board written notice of the proposed order and the reasons for it,
(c) allow the board a period of not less than 28 days, beginning with the day on which the notice is given, to make representations, and consider any representations made,
(d) consult each relevant local authority and the mayor of each relevant mayoral strategic authority, and
(e) consider what assistance or support has been provided to the board and what action the board has taken to address the failure.
(3) Where the Secretary of State makes an order on the ground in subsection (1)(b), the Secretary of State must give the board written notice of the order and the reasons for it as soon as practicable.
(4) In subsection (1)(b), “emergency” has the meaning given by section 1 of the Civil Contingencies Act 2004 (meaning of “emergency”).
(5) An order under subsection (1) must—
(a) name the commissioners,
(b) specify the functions to be exercised by them, and
(c) set out the reasons for the order, and has effect for such period, not exceeding 12 months, as is specified in the order.
(6) The Secretary of State may by order extend the period for which an order under subsection (1) has effect, on one occasion only, by a further period not exceeding 12 months.
(7) An order under subsection (6) may not be made unless a draft of the statutory instrument containing it has been laid before, and approved by a resolution of, each House of Parliament.
(8) Within 7 days of making an order under subsection (1), the Secretary of State must publish the order and the reasons for it and lay a copy of each before Parliament.
(9) The Secretary of State must—
(a) review each order under subsection (1) at intervals of not more than 3 months,
(b) publish the outcome of each review, and
(c) revoke the order if satisfied that neither of the conditions in subsection (1) continues to be met.
(10) Commissioners appointed under this section—
(a) must exercise the specified functions with a view to achieving the board’s ICB outcomes,
(b) are subject to the duties of the board in relation to those functions,
(c) must consult the chair of the board and each relevant local authority, and
(d) must report to the Secretary of State at intervals of not more than 6 months.
(11) The Secretary of State must publish each report made under subsection (10)(d).
(12) The integrated care board must co-operate with the commissioners.
14Z62A Intervention: exceptions
An order under section 14Z62 may not authorise commissioners to exercise a function in relation to—
(a) the appointment or employment of a particular individual,
(b) a decision about the services to be provided to a particular individual for or in connection with the prevention, diagnosis or treatment of illness, or
(c) the provision of any drug, medicine or other treatment, or the use of any diagnostic technique, in a manner inconsistent with a recommendation or guidance given by NICE.
14Z62B Restriction on directions to integrated care boards
The Secretary of State may not give directions to an integrated care board about the exercise of its functions except under—
(a) section 133 (inadequate provision of pharmaceutical services);
(b) section 223GA (directions about use and management of resources);
(c) section 253 (emergency powers).””

This probing amendment would replace the Secretary of State’s new power to direct integrated care boards (ICBs) with national and ICB outcomes. The only intervention power would be to appoint commissioners where an ICB is seriously and persistently failing, or in an emergency, as with a failing local authority.

None 55

Clause 12, page 9, line 14, at end insert “, and,
(b) must have regard to the most recent statement published under section 1CD (national outcomes for the health service)”

This amendment, consequential on the amendment in the name of Lord Scriven to replace clause 11, requires ICBs commissioning under section 3 of the National Health Service Act 2006 to have regard to the national outcomes statement.

None 56

Clause 12, page 9, line 22, at end insert “, and
(b) must have regard to the most recent statement published under section 1CD (national outcomes for the health service)”

This amendment makes the same change as the amendment to clause 12, page 9, line 14 in the name of Lord Scriven in section 3A of the National Health Service Act 2006.

None 69

Clause 16, page 13, leave out lines 1 to 3 and insert—
“(b) make an order under section 14Z62 on grounds relating to the discharge of the board’s functions in relation to those matters,”

This amendment, consequential on the amendment in the name of Lord Scriven to replace clause 11, updates a cross-reference to the direction powers which that amendment removes.

None 76

Clause 21, page 16, line 2, at end insert “, including its progress towards achieving its ICB outcomes (see section 14Z61)”

This amendment, consequential on the amendment in the name of Lord Scriven to replace clause 11, requires ICB performance assessments to cover progress against ICB outcomes.

None 77

Clause 21, page 16, line 5, at end insert—
“(4) The Secretary of State must publish each performance assessment conducted under this section.”

This amendment requires each ICB performance assessment to be published in full.

None 239

After Clause 84, insert the following new Clause—
“Reducing inequalities in mortality for people with a learning disability and autistic people
(1) The Secretary of State must make and maintain arrangements under this section for identifying and reducing inequalities in life expectancy or avoidable mortality experienced by people with a learning disability or autistic people compared with the general population, including arrangements for—
(a) detailed reviews of the deaths of people with a learning disability and autistic people,
(b) the identification and annual publication, by each integrated care board, of themes, inequalities, service failures and learning arising from those reviews,
(c) the annual national aggregation, analysis and independent academic audit of findings from those reviews and integrated care board reports to identify national themes, systemic failures, opportunities for improvement and data gaps, and
(d) annual public reporting and oversight by the Secretary of State of the operation and effectiveness of arrangements under this section.
(2) The arrangements under subsection (1) must require integrated care boards to—
(a) identify deaths falling within the scope of the arrangements,
(b) ensure detailed reviews are carried out in accordance with the standard set out in subsection (3), covering at least a nationally specified minimum proportion of deaths set out in subsection (4),
(c) ensure deaths meeting the criteria for enhanced scrutiny set out in subsection (5) undergo detailed review,
(d) produce, publish, and implement an annual action plan specifying concrete steps and measurable targets to address learning and service failures,
(e) provide findings from reviews for national analysis, and
(f) publish an annual report in accordance with subsection (6).
(3) A detailed review must—
(a) be carried out by a reviewer who is independent of any body that provided health or social care to the person in the year before their death,
(b) be completed within six months of the integrated care board being notified of the death,
(c) include examination of the person’s health and care records,
(d) seek the views of a family member, carer or advocate of the person,
(e) assess—
(i) the quality of the health and social care the person received,
(ii) whether reasonable adjustments were made to that care,
(iii) whether the death was potentially avoidable, and
(iv) any learning for the integrated care board, providers or other bodies, and
(f) be recorded in a format common to all integrated care boards, so that reviews are consistent and comparable nationally.
(4) In each financial year, each integrated care board must ensure that the number of deaths subject to detailed review is not less than one half of the deaths it identifies under subsection (2)(a), and deaths reviewed under subsection (2)(c) count towards that proportion.
(5) The criteria for enhanced scrutiny are that—
(a) the person was from an ethnic minority background,
(b) the person was autistic and did not have a learning disability,
(c) a family member, carer or advocate of the person has requested a detailed review,
(d) at the time of their death, the person was detained under the Mental Health Act 1983, deprived of their liberty under the Mental Capacity Act 2005, or an inpatient in a mental health or learning disability setting, or
(e) a concern has been raised by any person about the care or treatment the person received.
(6) Each integrated care board must produce and publish an annual report setting out in relation to deaths of people with a learning disability or autistic people—
(a) the number and proportion of identified deaths subject to detailed review,
(b) recurring themes, service failures, and health inequalities,
(c) measurable progress made against previous action plans, and
(d) significant data gaps and actions required to rectify them.
(7) The Secretary of State must ensure that—
(a) findings from individual reviews and integrated care board reports are aggregated and analysed nationally at least annually, and
(b) the national aggregated findings, data and analysis are audited by an independent academic body to verify their accuracy and ensure independent evaluation prior to publication.
(8) The Secretary of State must publish, at least annually, a national report setting out in relation to deaths of people with a learning disability or autistic people—
(a) national mortality data, recurring themes, systemic failures, and inequalities,
(b) the findings and verification assessment of the independent academic audit conducted under subsection (7)(b),
(c) national priorities, mandatory targets, and system-wide actions required for improvement,
(d) actions taken or proposed by the Secretary of State, NHS bodies, providers, and regulators, and
(e) steps taken to address identified data gaps.
(9) Where a report under subsection (6) or (8), or a performance assessment under section 14Z59 of the National Health Service Act 2006 (performance assessment of integrated care boards), indicates recurring service failures, persistent mortality inequalities, or a failure by an integrated care board or NHS body to implement required improvements, the Secretary of State may issue binding directions to that board or body specifying—
(a) the mandatory improvement actions required, and
(b) the time frame within which those actions must be completed.
(10) An integrated care board, NHS trust or NHS foundation trust must comply with any direction given under subsection (9).
(11) The Secretary of State must, in respect of each financial year—
(a) conduct a review of the operation, effectiveness and impact of arrangements under this section,
(b) assess the extent to which relevant bodies have implemented learning and complied with directions,
(c) lay the national report and statutory review before Parliament, and
(d) make an oral statement to Parliament on the findings of the review and overall progress in reducing avoidable mortality.
(12) In conducting a performance assessment of an integrated care board under section 14Z59 of the National Health Service Act 2006 (performance assessment of integrated care boards), the Secretary of State must evaluate the board's compliance with this section and its implementation of directions issued under subsection (9).
(13) The Secretary of State must issue statutory guidance on the operation of these arrangements, and integrated care boards and relevant NHS bodies must act in accordance with that guidance.
(14) Guidance under subsection (13)—
(a) must make provision about—
(i) the notification of deaths to integrated care boards,
(ii) the training and independence of reviewers,
(iii) support for families, carers and advocates during reviews, and
(iv) the common format required by subsection (3)(f)
(b) may make further provision about the matters in subsections (3) to (5), but may not disapply or reduce any requirement of those subsections,
(c) must be published following consultation with people with a learning disability, autistic people, their families and carers, and organisations representing them, and
(d) must be laid before Parliament.”

Opposition Amendment 240

LORD PATEL

After Clause 84, insert the following new Clause—
“De-registration of doctors and health care professionals found to have committed sexual misconduct
(1) The Secretary of State must make regulations made by statutory instrument requiring a statutory regulator of a health or care profession to remove from its register any person found to have committed sexual misconduct.
(2) Regulations under subsection (1) must provide that removal from the register is the mandatory sanction and may not be replaced by a lesser sanction.
(3) In this section, “sexual misconduct” includes sexual abuse, sexual assault, sexual harassment, sexually motivated conduct, and any sexual conduct involving an abuse of a position of professional trust.
(4) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

This amendment seeks to require statutory regulators of health and care professions to permanently remove from their professional register any person found to have committed sexual misconduct and would prevent regulators from imposing a lesser sanction in such cases.

None 241

After Clause 84, insert the following new Clause—
“Periodic review of public health system
(1) The Secretary of State must ensure that an independent review of the state of the public health system is conducted at intervals of no more than three years.
(2) The Secretary of State must lay a report of each review before Parliament.”

This amendment seeks to probe the Government on whether it would support a statutory requirement for regular independent reviews of the public health system in order to assess its overall condition, identify emerging provisions and ensure parliamentary scrutiny.

None 242

LORD PATEL

After Clause 84, insert the following new Clause—
“Integration of voluntary sector and health and social care services in the provision of palliative care
(1) An integrated care board must take all reasonable steps to integrate the specialist palliative care provided by the voluntary sector with such services provided by the NHS.
(2) Such integration must include, but is not limited to—
(a) provision of specialist palliative care support,
(b) provision of in-patient palliative care beds when required,
(c) sharing of equipment,
(d) availability of NHS pharmacy services and supply of medication,
(e) collaboration in education and training of the health and social care workforce, and
(f) provision of honorary contracts across different providers, to ensure staff mobility as required for patient care.
(3) An integrated care board must publish an annual statement specifying how it has complied with this section.
(4) The Secretary of State may issue guidance about the application of this section to which integrated care boards must have regard.”

This amendment seeks to ensure streamlined provision of services for patients receiving specialist palliative care irrespective of where they are being cared for.

Government Amendment 1

Clause 2, page 1, line 16, at end insert—
“(1A) The Secretary of State may not make a transfer scheme transferring anything to—
(a) a Scottish public body, without the consent of the Scottish Ministers;
(b) a Welsh public body, without the consent of the Welsh Ministers;
(c) a Northern Ireland public body, without the consent of a Northern Ireland department.”

This amendment would require the Secretary of State to seek the consent of the appropriate devolved nation before making a transfer scheme which transferred property, rights and liabilities from NHS England to a Scottish public body, Welsh public body or Northern Ireland public body.

Government Amendment 2

Clause 2, page 2, line 14, leave out subsection (4)

This is consequential on my amendment to Clause 2, page 2, line 21.

Government Amendment 3

Clause 2, page 2, line 21, at end insert—
“(7) In this section—
“Northern Ireland public body” means a public body whose functions are exercisable only or mainly in or as regards Northern Ireland and relate only or mainly to transferred matters (within the meaning of the Northern Ireland Act 1998);
“Scottish public body” means a body that is a Scottish public authority with mixed functions or no reserved functions (within the meaning of the Scotland Act 1998);
“the TUPE regulations” means the Transfer of Undertakings (Protection of Employment) Regulations 2006 (S.I. 2006/246);
“Welsh public body” means a body that is a devolved Welsh authority as defined by section 157A of the Government of Wales Act 2006.”

This is consequential on my amendment to clause 2, page 1, line 16.

None 14

Clause 4, page 3, line 29, at end insert—
“(c) reduce inequalities between people living in coastal and inland areas with respect to their ability to access health services and the outcomes achieved for them by the provision of health services, with particular regard to prevention, the planning and commissioning of services, and the recruitment, retention and distribution of the health workforce.”

This amendment would require the Secretary of State, when exercising functions in relation to the health service, to have specific regard to reducing inequalities in access to health services and health outcomes between coastal and inland communities, including in relation to prevention, service planning and commissioning, and workforce recruitment, retention and distribution.

None 48

After Clause 11, insert the following new Clause—
“Support for helping people stay and get back into work
In the National Health Service Act 2006, after section 1C insert—
“1CA Duty to support people to stay and get back into work
In exercising functions in relation to the health service, the Secretary of State must have regard to the need to offer workplace health provision support to—
(a) small and medium sized employers, and
(b) institutions and providers within the National Health Service, considering the need to support the workforce of—
(i) small and medium sized employers, and
(ii) the National Health Service
in order to tackle ill health and reduce work days lost to sickness.””

None 54

Clause 12, page 9, line 8 at end insert—
“(za) in subsection (1), after (j) insert—
“(k) such other services and facilities as are required for persons with a primary health need arising from a progressive or deteriorating disease which is reasonably expected to continue for the remainder of the person's life, including where the person's condition is intermittent or fluctuating, and without regard to the rate of such progression or deterioration or whether a person is entering a terminal phase of their life.””

This amendment would ensure that a wider range of serious chronic diseases, such as severe dementia, would qualify for NHS Continuing Care and not have eligibility restricted on grounds that the condition is fluctuating or is deemed to be in a terminal phase.

None 72

After Clause 17, insert the following new Clause—
“Commissioning functions: minimum waiting time prohibition
(1) An NHS commissioning body or an NHS provider must not apply any policy, contractual term, activity planning assumption or other commissioning arrangement which requires a patient to wait for a minimum period before receiving an assessment, diagnostic test or treatment, where that minimum period is imposed for administrative, financial or capacity-management reasons rather than on clinical grounds.
(2) In this section “NHS commissioning body” includes national bodies, integrated care boards and the Secretary of State.”

This amendment seeks to prohibit NHS commissioning bodies and providers from imposing or implementing minimum waiting periods for assessments, tests or treatment for administrative, financial or management reasons, while preserving clinically justified decisions about the timing of care.

None 78

LORD PATEL

Clause 21, page 16, line 5, at end insert—
“(4) Performance assessments must include details of the extent to which palliative care services or facilities provided by each integrated care board meet the reasonable requirements of the people for whom the board is responsible.
(5) For the purposes of subsection (4) the following guidances are considered reasonable requirements—
(a) NICE guideline NG31 on care of dying adults in the last days of life;
(b) NICE guideline NG142 on end of life care for adults and service delivery;
(c) NICE quality standard QS13 on end of life care for adults;
(d) NHS England statutory guidance for integrated care boards on palliative and end of life care.”

This amendment would require annual performance assessments to incorporate an assessment of whether each integrated care board is providing a reasonable standard of palliative and end of life care.

None 81

Clause 22, page 16, line 16, leave out “mayor of each mayoral”

This amendment, and others in the name of Lord Lansley, would ensure that the NHS can enter into arrangements with local authorities who have social care and other health-related functions and with all the new strategic authorities, including single foundation strategic authorities, and not only those with mayors.

None 84

Clause 22, page 16, leave out lines 30 to 43 and insert—
““Strategic Authority” has the meaning given by section 1 of the English Devolution and Community Empowerment Act 2026.”

This amendment, and others in the name of Lord Lansley, would ensure that the NHS can enter into arrangements with local authorities who have social care and other health-related functions and with all the new strategic authorities, including single foundation strategic authorities, and not only those with mayors.

Government Amendment 103

Clause 28, page 20, line 27, at end insert—
“(b) after subsection (5) insert—
“(5A) The power under subsection (1) may not be used for the purpose of establishing a body that performs functions only or mainly in respect of Wales.””

This spells out that the power in section 28 of the NHS Act 2006 cannot be used to create a Wales-only Special Health Authority. It is needed because of the removal of the territorial restriction in section 271, which limited the exercise of the power to England.

Government Amendment 104

Clause 28, page 20, line 30, at end insert—
“(c) after subsection (2) insert—
“(3) In this section a reference to a Special Health Authority is to a Special Health Authority which—
(a) performs functions only or mainly in respect of England, or
(b) neither performs functions only or mainly in respect of England, nor performs functions only or mainly in respect of Wales.””

This clarifies that the power to make regulations about the delegation of Special Health Authority functions is not exercisable in relation to Wales-only Special Health Authorities. It is needed because of the removal of the territorial restriction in section 271, which limited the exercise of the power to England.

None 107

Clause 41, page 30, leave out lines 1 to 3 and insert “a strategic authority as defined in section 1 of the English Devolution and Community Empowerment Act 2026.”

This amendment, and others in the name of Lord Lansley would ensure that the NHS can enter into arrangements with local authorities who have social care and other health-related functions and with all the new strategic authorities, including single foundation strategic authorities, and not only those with mayors.

Government Amendment 128

Clause 52, page 36, line 37, at end insert—
“(2A) A requirement by virtue of subsection (2)(b) may be imposed on a person providing health care or social care only if they provide health care or social care in England.”

Regulations can require people to disclose information for the purposes of making it available through the single patient record etc. This ensures that the regulation-making power can only be used to require information from those who provide health care or social care in England.

Government Amendment 151

Schedule 8, page 116, line 26, at end insert—
“(2A) But the Secretary of State may establish and operate an information system under subsection (2) for the purposes of, or in connection with, the provision of health care or adult social care in Scotland, Wales or Northern Ireland only if the appropriate national authority consents.
(2B) Consent under subsection (2A) may be given subject to conditions relating to the following so far as relating to the information system to which the consent applies—
(a) the making of requests for information under section 259(1)(c);
(b) the publication of information under section 260;
(c) the disclosure of information under section 261.”

The effect of this amendment is that the Secretary of State can establish information systems relating to Scotland, Wales or Northern Ireland only with the consent of the devolved administrations. Consent may be given subject to conditions as to certain matters.

Government Amendment 152

Schedule 8, page 116, line 27, at end insert—
““appropriate national authority” —
(a) in relation to Scotland, means the Scottish Ministers;
(b) in relation to Wales, means the Welsh Ministers;
(c) in relation to Northern Ireland, means the Department of Health;”

This is consequential on my amendment to Schedule 8, page 116, line 26.

Government Amendment 153

Schedule 8, page 118, line 19, at end insert—
(3A)After subsection (2) insert—
(2A)The power under subsection (1)(c) is subject to any conditions imposed by virtue of section 254(2B) (power for devolved administrations to give consent to establishment and operation of an information system subject to conditions).””

This provides that the Secretary of State’s power to request information for purposes relating to the establishment or operation of an information system relating to Scotland, Wales or Northern Ireland is subject to any conditions imposed by the appropriate national authority when it gave its consent to the system.

Government Amendment 154

Schedule 8, page 119, line 16, at end insert—
“(2A) The power under subsection (1) is subject to any conditions imposed by virtue of section 254(2B) (power for devolved administrations to give consent to establishment and operation of an information system subject to conditions).”

This provides that the Secretary of State’s power to publish information obtained in the operation of an information system relating to Scotland, Wales or Northern Ireland is subject to any conditions imposed by the appropriate national authority when it gave its consent to the system.

Government Amendment 155

Schedule 8, page 120, line 20, at end insert—
“(3A) The power under subsection (1) is subject to any conditions imposed by virtue of section 254(2B) (power for devolved administrations to give consent to establishment and operation of an information system subject to conditions)."”

This provides that the Secretary of State’s power to disclose information obtained in the operation of an information system relating to Scotland, Wales or Northern Ireland is subject to any conditions imposed by the appropriate national authority when it gave its consent to the system.

Government Amendment 157

Schedule 8, page 122, line 10, at end insert—
““appropriate national authority” has the meaning given by section 254(3);”;

This is consequential on my amendment to Schedule 8, page 116, line 27.

Government Amendment 181

Clause 58, page 43, line 9, at end insert—
“(1A) Before making arrangements under subsection (1)(a) with a Scottish health body the Secretary of State must obtain the consent of the Scottish Ministers.”

This requires the Secretary of State to obtain the consent of the Scottish Ministers before making arrangements with a Scottish health body about information services etc under the provision inserted by clause 58.

Government Amendment 182

Clause 59, page 43, leave out line 29 and insert—
“(1A) Omit section 295 (arrangements between NHS England and Northern Ireland Ministers to commission services).
(2) After section 294B (inserted by section 58 of this Act) insert—”

This is consequential on my amendment to clause 87, page 65, line 6. The repeal of existing section 295 of the Health and Social Care Act 2012 will extend to England and Wales (since that section extends to England and Wales only) but the new section 295 will have UK extent.

Government Amendment 183

Clause 59, page 43, line 40, at end insert—
“(1A) Before making arrangements under subsection (1)(a) with a Scottish health body the Secretary of State must obtain the consent of the Scottish Ministers.”

This requires the Secretary of State to obtain the consent of the Scottish Ministers before making arrangements to commission services etc with a Scottish health body under the provision inserted by clause 59.

Government Amendment 187

After Clause 71, insert the following new Clause—
“Maternity and Neonatal Commissioner for England
(1) The Secretary of State must appoint a person as the Maternity and Neonatal Commissioner for England (
“the Commissioner” ).
(2) Schedule (Maternity and Neonatal Commissioner for England) makes provision about the Commissioner.”

This amendment would require the Secretary of State to appoint a Maternity and Neonatal Commissioner for England, and would also introduce a new schedule (after Schedule 11) setting out how the Commissioner will operate.

Government Amendment 188

After Clause 71, insert the following new Clause—
“Functions of the Commissioner
(1) The Maternity and Neonatal Commissioner for England must promote improvements in maternity and neonatal care in England.
(2) In the discharge of that function the Commissioner may, among other things—
(a) scrutinise the effectiveness of programmes designed to improve maternity and neonatal care;
(b) carry out reviews into the provision of maternity and neonatal care;
(c) facilitate or otherwise promote discussion about how maternity and neonatal care can be improved (including discussion involving people providing or receiving care);
(d) advise the Secretary of State on the provision of maternity and neonatal care;
(e) carry out reviews into the connection between the general health care needs of women and any potential future pregnancy of theirs;
(f) carry out reviews into how the health care needs of women are affected by pregnancy;
(g) carry out reviews into how to better meet the health care needs of newborn children;
(h) prepare and publish reports relating to any matter reviewed or considered by the Commissioner in the exercise of any of their functions;
(i) make recommendations (whether in a report or otherwise).
(3) A person to whom a recommendation is made under subsection (2)(i) must respond to that recommendation within such period and in such manner as the Commissioner may require (and the Commissioner may publish details of any failure to comply).
(4) The Commissioner must send to the Secretary of State a copy of any report published by the Commissioner in the exercise of functions conferred under this section.
(5) The Commissioner must, when exercising their functions, have regard to the need to reduce inequalities between the people of England with respect to the provision of maternity and neonatal care.
(6) When exercising their functions, the Commissioner must take reasonable steps to find out the views of women and others with an interest in maternity and neonatal care.
(7) In this section—
(a) a reference to maternity care includes—
(i) the provision of services to family members of a woman in connection with her pregnancy or childbirth;
(ii) health care needed by a woman as a consequence of a past pregnancy;
(b) a reference to neonatal care includes the provision of services to family members of a newborn child in connection with the health care needs of the child.
(8) The Secretary of State may by regulations made by statutory instrument exclude particular descriptions of care from the meaning of maternity or neonatal care in this section.
(9) A statutory instrument containing regulations under subsection (8) is subject to annulment in pursuance of a resolution of either House of Parliament.
(10) Section 9(1) of the Gender Recognition Act 2004 is to be disregarded for the purposes of construing this section.”