House of Commons
Speaker’s Statement
(1 day, 4 hours ago)
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Mr Speaker
Colleagues, today we mark the 10th anniversary of the murder of our former colleague and friend to so many in this place, Jo Cox. Jo was proud to be the Member of Parliament for Batley and Spen. She was dedicated to serving her constituents and was a relentless campaigner for equality, human rights and social justice. Jo’s death while carrying out her constituency duties shocked Members across the House. In my role as chair of the parliamentary security committee at the time of her death, and since then as Speaker, I have made it my personal mission to improve the security and safety of Members, their families and staff, because no Member should fear carrying out their democratic duties.
In remembering Jo today, I invite all the House to reflect on the words she shared during her maiden speech, when she said:
“we are far more united and have far more in common than that which divides us.”—[Official Report, 3 June 2015; Vol. 596, c. 674-75.]
Our thoughts are with Jo’s family and friends on this day.
Oral Answers to Questions
(1 day, 4 hours ago)
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Kerry McCarthy (Bristol East) (Lab)
The Parliamentary Under-Secretary of State for Foreign, Commonwealth and Development Affairs (Seema Malhotra)
Mr Speaker, I echo your words about Jo Cox, our friend and colleague, who we remember in our hearts. Had she not been so brutally murdered, she would have been in this House and, I am almost certain, would have been present for Foreign Office questions today.
Rivers originating from the Tibetan plateau are thought to sustain 1.8 billion people directly, providing drinking water, irrigation and power generation. Through the Himalayan resilience action programme, the UK has supported research into climate and environment risks around the Tibetan plateau and supported efforts to strengthen climate resilience in the region. The resilience action programme has promoted science-based policy and dialogue across the Hindu Kush Himalaya.
Kerry McCarthy
Mr Speaker, I echo what you said about Jo Cox. I think her message is more important today than it ever was.
I thank the Minister for her response. China’s actions, from environmentally destructive mining to building dams to divert water sources, will have consequences far beyond the Tibetan plateau, as she says, as will the failure to address the impact of climate change on the third pole. What steps can the UK take to raise these issues at a global level? Does the Minister agree that the voices of Tibetans should be heard in any such talks?
Seema Malhotra
The UK continues to engage with China on climate and environmental issues. During the recent UK-China environment dialogue, the Secretary of State for Environment, Food and Rural Affairs secured agreement for greater collaboration with China on ecosystem resilience, biodiversity, conservation and multilateral environmental processes. Our Himalayan resilience action plan is building regional resilience through nature-based solutions, tackling water insecurity, air quality management and promoting dialogue through the International Centre for Integrated Mountain Development. As countries come together in pursuit of these solutions, it is important that affected communities are consulted.
Wera Hobhouse (Bath) (LD)
The Tibetan Parliament in exile, which the all-party parliamentary group on Tibet visited a couple of weeks ago—we have engaged extensively with it—is terribly worried that the central Tibet Autonomous Region is completely closed off by the Chinese Communist party to any outside access. Little comes out and almost nothing goes in. Is the Minister not worried about the complete secrecy in which the Chinese authorities can conduct environmental destruction that has a massive global impact?
Seema Malhotra
The hon. Lady raises an important concern. We are concerned by reporting from the UN special rapporteurs that large-scale environmental projects in Tibet risk the forced displacement of Tibetans from their ancestral villages. It is important that we keep these issues on our radar.
Vikki Slade (Mid Dorset and North Poole) (LD)
The Secretary of State for Foreign, Commonwealth and Development Affairs (Yvette Cooper)
I stand and look at the shield to Jo Cox above us today, and I add my personal tribute to Jo. She was a fellow West Yorkshire MP and a passionate and committed internationalist, as well as somebody who brought communities together here at home. We think of Jo’s family and especially of her sister Kim who is keeping Jo’s legacy alive.
The US is our deepest security and intelligence ally, our biggest trading partner and our top export market, and I saw again the strength of our people-to-people relationship when I joined His Majesty the King on the state visit to mark 250 years since the declaration of independence.
Vikki Slade
I regret that I never had the chance to meet Jo Cox, but the Secretary of State is right: her sister is doing her very proud.
As well as being the year in which the current US President was born, 1946 was the year in which the UK-US special relationship was formally cemented in Winston Churchill’s “Sinews of Peace” speech, and was credited by Russian historians with marking the start of the cold war. That war ended in the 1980s, but the relationship between western allies and Russia is distinctly chilly again, with threats appearing close to our shores even this weekend.
I welcome the progress on an Iranian ceasefire, but over the three months for which the US and Israel have been at war with Iran, the conflict has made many people rich, and it has been reported that Russian revenue from oil and petroleum has increased by 39%. Given that the actions of the United States appear to be helping Russia rather than supporting Ukraine and NATO, does the Foreign Secretary share my concern that that is causing further damage to a special relationship that has endured for 80 years?
Yvette Cooper
The Prime Minister is discussing the importance of support for Ukraine at the G7 today, and the G7 has had meetings with President Zelensky about the importance of maintaining the economic pressure on Russia. The hon. Lady is right to highlight the risk that Russia will become a beneficiary from the conflict in Iran. It is crucial that we ensure that that is not the case and also maintain that pressure, which we are working with the US to do.
Chris Vince (Harlow) (Lab/Co-op)
May I echo your words, Mr Speaker, and those of the Secretary of State about Jo Cox? I am sure that everyone in the House is thinking of her today.
Our special relationship with the United States is about more than just the President; it is about a deep connection with the American people, and I think we should always remember that. I am very proud of my Prime Minister’s actions with regard to the conflict in Iran, but does the Foreign Secretary agree that it is hugely important for us to continue to have that special relationship with the United States, not just with the American people but with American businesses such as Raytheon in my constituency of Harlow?
Yvette Cooper
I thought for a second that we were not going to get to the mention of Harlow, but eventually we did, with my hon. Friend’s final word. I welcome his question. He is right: the UK took a different view from the US at the start of the Iran conflict, and I think we were right to do so, but our countries continue to engage in close security and economic co-operation—and, having met representatives of many of the businesses most closely involved in that relationship during the King’s visit, I know that my hon. Friend’s businesses in Harlow will continue to do so as well.
Priti Patel (Witham) (Con)
I echo your sombre words about Jo Cox, Mr Speaker. Her memory and her family are in our thoughts today.
The United Kingdom’s long-standing strategic, security, defence and intelligence relationship with the United States is crucial for us and for our allies. Can the Foreign Secretary tell us what role Britain has played in the negotiations between the United States and the middle east in relation to Iran, given our historic links to partners in the region? Have the Government seen the US-Iran agreement, and what is Britain’s role in shaping future foreign policy and the security architecture in the middle east?
Yvette Cooper
The shadow Foreign Secretary has made an immensely important point. I spoke to Secretary of State Rubio on Friday about the final stages of the discussions that were taking place before the memorandum of understanding was agreed. It is just the start of many further phases of work, negotiations and discussions, including discussions on nuclear power—we are clear about the fact that Iran must never obtain a nuclear weapon, and we stand ready to support those detailed and technical talks—and on the importance of reopening the strait of Hormuz. We have engaged in discussions not just with the US but with France, with which we have been building the maritime mission, and also with partners in the Gulf, so we can ensure that freedom of navigation is restored as swiftly as possible.
Mr Clive Betts (Sheffield South East) (Lab)
Jeff Smith (Manchester Withington) (Lab)
Luke Murphy (Basingstoke) (Lab)
Alex McIntyre (Gloucester) (Lab)
The Secretary of State for Foreign, Commonwealth and Development Affairs (Yvette Cooper)
The settlements in the west bank are a fundamental barrier to peace, and a flagrant breach of international law. We condemn the rising and incredibly disturbing settler violence that we have seen over the past year. Last week I announced a new wave of sanctions to target the networks that are supporting this violence, which is the fourth package of sanctions against extremist Israeli settlers under this Government.
Mr Betts
Let me add a few words about the murder of Jo Cox. I was a friend and colleague of Jo’s, and I still remember the numbness and shock that I felt on hearing the news. Quite simply, no Member of this House should fear for their life because they speak out on behalf of their constituents.
The west bank is illegally occupied by Israel. The settlements are illegal and have been expanded through extreme violence by settlers, supported by the Israel Defence Forces. I do not know whether my right hon. Friend is aware that, in May, the Dutch Government decided to ban trade in goods from settlements. They did so because they wanted to put pressure on the Israeli Government. The Dutch Foreign Minister made it very clear that the Dutch Government acknowledged that enforcement would be difficult and that they carefully weigh up these matters, but they decided in the end that doing anything was better than doing nothing. May I suggest that might be an appropriate course of action for our Government? We ought to be seen on the right side of this, and finding reasons why we cannot act is not right. We ought to be acting on this matter.
Yvette Cooper
Let me respond to my hon. Friend’s important point. We are clear that action is needed, and we are acting. This Government have done more on this issue in the last two years than any Government have done for many decades, because we are so concerned about settlement expansion and settler violence. We have not only had the recent sanctions against settler violence but sanctioned two Israeli Cabinet Ministers, because we take this issue so seriously. However, I think my hon. Friend and I agree on the principle that the settlements are legal. No one should be profiting from them, and we do not want businesses to be trading with them or operating within illegal settlements. A number of countries have explored legal bans but have also had challenges with them, and we are looking at what they have done.
Jeff Smith
There have been over 760 incidents this year, resulting in casualties, property damage and 57 deaths, so it is clear that diplomacy and the action we have taken so far are not moving the dial. I appreciate that we are only one voice in the international community, but we clearly need to be seen to be doing absolutely everything we can to make a difference on this issue. What will it take for the Government to take further action, and to go further on sanctions and settlement trade?
Yvette Cooper
Last week, we did take further action and set out a new wave of sanctions. On Friday, I went to Paris for a meeting with other Foreign Ministers, and also met civil society organisations and community organisations from across Israel and Palestine. Last week, we launched the international peace fund with Australia and Canada in order to support the community-level building of the foundations of a two-state solution. Later this week, I will go to Egypt to have similar discussions. In the end, we will only make progress through concerted international diplomacy and working in partnership, because no country can do this alone.
Luke Murphy
May I echo what hon. Members have said about Jo Cox?
One Palestinian child has been killed every week in the west bank since January 2025. Hundreds remain in detention, and many more face significant disruption to their education. What steps are the Government taking with international partners to improve the safety of children in the west bank and to ensure that they can enjoy an education free from violence?
Yvette Cooper
My hon. Friend is right to raise the plight of children in the west bank. I would add to that the terrible plight of children in Gaza, where there is still not sufficient humanitarian support—that has gone backwards too. He is also right to say that some of this is about the impact of violence. Some of the targeted and ideologically driven violence against Palestinians on their own land is settler terrorism, and we should call it that. We are continuing to provide support for children in Palestine, including by providing additional funding for the Palestinian Authority so that it can pay the salaries of teachers and keep schools going.
Alex McIntyre
Last week I signed a letter to the Foreign Secretary, along with 140 colleagues, asking the Government to take further action in response to settler violence and the rhetoric used by two far-right Israeli Government Ministers. Over the last two years, I have heard from hundreds of my constituents expressing their deep concern about the Israeli Government’s actions in the west bank. Will the Secretary of State commit today to banning all trade with illegal settlements, and if not, why not?
Yvette Cooper
I thank my hon. Friend for his question. The expansion of Israeli settlements and some of the violence circulating in them is a deliberate attempt by hardliners to undermine any possibility of a two-state solution and to pursue in many areas what is effectively illegal annexation—that is their intention. We agree on the principles that no one should be trading with illegal settlements. That is different from long-standing legitimate trade with businesses across Israel, which we continue to support. A small number of countries have explored legal bans, but they have had challenges with them. The most effective impact we can have on all these issues is to work internationally with other countries to provide new energy behind the two-state solution, as we had last year.
Simon Hoare (North Dorset) (Con)
I welcome the Foreign Secretary’s use of the term “settler terrorism”. She is absolutely right; the phrase “settler violence” does not do justice to what is happening. She will be aware that settler terrorism is often enabled and encouraged, or at best a blind eye is turned, by both the Israeli police and the IDF. She will know the damage perpetrated by that terrorist activity. If Israel wishes to remain the villa in the jungle it has always wished to be, can she at least remind her Israeli Government counterparts of the importance of the rule of law and the separation of the duties of the IDF and the police when it comes to protecting the citizens of both Israel and Palestine?
Yvette Cooper
We continually raise these issues with the Israeli Government, because we cannot have what we have seen: property damage, intimidation, farmers’ olive trees burnt down, families’ water disconnected and mobs rampaging. That is why we have introduced the scale of the breadth of sanctions, including on organisations such as the Farms Association which have been supporting them. It is also why we need to challenge any culture of impunity. There has to be accountability for what are, effectively, criminal acts.
Andrew George (St Ives) (LD)
The Secretary of State says she is looking at options and that she wishes to work in partnership in the international sphere. She must accept that the UK has significant history and responsibility in this region. Does she not listen to the words of her Back Benchers? It is incumbent on her to take action now—not simply to look at things and to seek partnership—to have real effect on this appalling, continuing outrage.
Yvette Cooper
I would point out to the hon. Gentleman that the action we have already taken has a stronger impact than many of the other measures he is talking about. That includes imposing sanctions on individual members of the Israeli Cabinet, which very many other Governments have not done. We encourage other Governments to do what we have done. It also includes the work internationally to seek to find new energy behind the two-state solution. That includes the 20-point peace plan in Gaza, but must include the west bank as well. Tomorrow, when I travel to Egypt, I will be meeting the new Palestinian National Committee that will be operating in Gaza. It is that concerted international effort that we need to have an impact.
Brendan O’Hara (Argyll, Bute and South Lochaber) (SNP)
Last week Amnesty International published a report entitled “Erasing Anything Palestinian”, which shines a powerful light on Israel’s ethnic cleansing in the west bank. It makes clear that what is happening is not driven by rogue settlers or a few extremist Ministers; rather, it is state sanctioned and state financed. Yet to date the UK’s response has been largely performative and, unfortunately, fairly inconsequential. Do the Government accept that this is state-enabled ethnic cleansing? If they do, should they not be doing much, much more to prevent it and to punish the perpetrator?
Yvette Cooper
Once again, I point out the strength of the action we have taken; we have brought together countries from across the world—and gone further than most countries. What is being driven here is deeply disturbing: both the level of violence, and the deliberate attempt—with the E1 settlements in particular—to undermine any possibility of a two-state solution. That is a long-term thing, and it has been supported by many people across the Israeli Government. It is a deep challenge for everyone, which is why we need international action. In the autumn, we had the international consensus and energy to deliver the 20-point plan for Gaza, which nobody expected would be achieved. We need to pull that energy together again. That is why I was in Paris on Friday, it is why I discussed this issue with Australia and Canada, as well as European colleagues, and it is why I will go to Egypt—to the middle east, where the energy on many of these things has come from—in order to try to make progress on it again.
Dr Ellie Chowns (North Herefordshire) (Green)
I would like to start by joining you, Mr Speaker, and colleagues across the House in paying tribute to the memory of Jo Cox. Her words about seeking what we have in common, and working to counter the politics of division, are today more relevant than ever—for all of us.
The Secretary of State set out piecemeal and entirely inadequate measures last week in relation to west bank settlement activity. It was raised with her then that the UK would be hosting the Great Israeli Real Estate Event at the weekend, and she undertook to look into it. That event took place, with properties in illegal settlements being marketed on British territory—the Government have been sent the evidence. How is it that this Government fail even to prevent the marketing of illegal property in this country? How is it that they still fail to take action? The Secretary of State continues to tell us about the meetings that she has had, but what we want is leadership. The UK has a particular responsibility, so will she step up and ban trade with illegal settlements?
Yvette Cooper
We have been very clear not only that no businesses should be engaging in trade or marketing around the illegal settlements, but that they certainly should not be doing so on UK soil. We take this issue so seriously, which is why the Minister for the Middle East and North Africa and the Department for Culture, Media and Sport have raised it directly with the Advertising Standards Authority. We have asked the authority to urgently look into the matter and reassure us that, if there is any evidence of the advertising or promotion of property in illegal settlements at that event or any others, it will uphold the law, regulations and guidance that apply. It is extremely important that those standards are met in the UK, and that is exactly why we have raised the matter so seriously with the Advertising Standards Authority.
Calum Miller (Bicester and Woodstock) (LD)
May I associate my party with your tribute to the life and work of Jo Cox, Mr Speaker, and extend our thoughts to her family and her many friends?
The prospect of a two-state solution rests on at least two essential conditions: the protection of Palestine’s territorial integrity, and political reform within the Palestinian state. This weekend in London, we saw the selling of properties in illegal settlements. The expansion of such settlements must instead be reversed by cutting off their finance at source. Will the Foreign Secretary commit to withdrawing the licence to operate of any UK financial institution facilitating credit or services for illegal settlement activity? Given that President Abbas has now announced that legislative and presidential elections will be held in early 2027, what measures are the Government taking to ensure that those elections will be free and fair?
Yvette Cooper
I welcome the points made by the hon. Member. We continue to look at what further sanctions could be needed in order to address illegal settlements, the activity linked to them, and settler violence. We are also looking at whether and where we may need to strengthen our overall sanctions regime, as well as at individual sanctions issues.
We support the reform measures around the Palestinian Authority, including the free and fair elections, which are crucial. We are also providing direct funding to the Palestinian Authority, including to pay salaries, and, through Michael Barber, we are providing expertise to support the modernisation of the Palestinian Authority, because that is a fundamental part of having a Palestinian state. Whether in the west bank, in Gaza, or in East Jerusalem, it is crucial that Palestine must be run by Palestinians.
Gregory Stafford (Farnham and Bordon) (Con)
Dr Danny Chambers (Winchester) (LD)
The Minister of State, Foreign, Commonwealth and Development Office (Stephen Doughty)
As you will know, Mr Speaker, Jo Cox was a good friend of mine long before we came into this place, as well as a colleague of mine at Oxfam, and I have to say that coming in today on this anniversary is particularly sad. I also know that Jo would have told me to stop getting so emotional and to get on with the job in her inimitable way, as she often did—so I will do just that.
We are committed to increasing the economic pressure on Russia by disrupting the revenue the Kremlin generates from Russia’s energy trade, including oil, which remains its primary means of financing the illegal war in Ukraine. The Prime Minister has today announced further sanctions, designating and specifying 70 individuals, entities and ships under the UK’s sanctions regulations, including 20 shadow fleet vessels.
Gregory Stafford
While diplomatic pressure on China, India and Turkey is essential, we must also do more militarily to disrupt the shadow fleet carrying Putin’s oil. I pay tribute to our armed forces who, this weekend, boarded a Russia-linked tanker in UK waters under new Government powers. Since those powers were announced in March, 184 sanctioned shadow fleet vessels have made 238 journeys through UK waters, including 94 journeys into territorial waters, without a single interdiction until now. What is the Department doing with the Ministry of Defence and international partners to ensure that this is a sustained approach, rather than a one-off?
Stephen Doughty
The hon. Gentleman will understand that I am not going to comment on future operational matters. What I can say is that we have also assisted in the interdictions of other vessels, including by working with the French and the United States in relation to the Bella 1. We keep Russia’s activities under very close review and designate hundreds of vessels under the shadow fleet measures, and we will look at all opportunities to ensure that they cannot evade sanctions.
Dr Chambers
Two years ago, I visited Ukraine, taking medical supplies in refurbished ambulances; we had to stop only twice to fill up with diesel, which made us realise just how close to us the frontline really is. It is deeply troubling that the Government are now reneging on their full support of Ukraine by pursuing an indefinite waiver on imports of Russian oil via third countries. I ask the Foreign Secretary to reverse course on this, and to close any loopholes putting any money into Putin’s war machine.
Stephen Doughty
With respect, the hon. Gentleman may not have caught up with developments on that front. First, it was never an indefinite waiver; we said that we were keeping it under two-weekly review—my colleagues in the Department for Business and Trade made that very clear. Yesterday in the House, and indeed in announcements over the weekend, we set clear end dates for those temporary licences, which are to phase in these measures. Of course, these are new measures—we were never watering down previous sanctions; these are toughening the sanctions on Russia, but with sensible provisions in place to phase them in.
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
The Minister will be aware that the sanctioned oil and gas that is sold by Russia to Turkey and China is often used by companies in those countries to manufacture products, including ceramics. Those products are then dumped into the UK, distorting our domestic manufacturing base. That is a secondary impact of the profits coming from that sanctioned material. What evidence is the Department sharing with the Department for Business and Trade so that it can put in place the trade remedies necessary to protect our domestic manufacturing from the impacts of this illegal trading?
Stephen Doughty
My hon. Friend raises an important issue. I would be happy to discuss it further with him, as, I am sure, would colleagues from the Department for Business and Trade.
Mr Andrew Snowden (Fylde) (Con)
We pay tribute to our armed forces for their courage and bravery in boarding and seizing the Russian shadow fleet vessel at the weekend. We also welcome the further sanctions announced today, including those targeting the shadow fleet. We urge the Government to put pressure on those who buy and refine Russian oil, as the freedom of Ukraine depends on cutting off the funds that finance Putin’s illegal war. Given the urgency on the battlefields of Ukraine and the inflated revenue Putin has recently had from Russian oil, does the Minister think that the situation can wait until 2027 for the introduction of the ban on Russian-originated diesel and jet fuel imports?
Stephen Doughty
The shadow Minister asks an important question. I made it clear in yesterday’s Delegated Legislation Committee that that is the end date, but we are keeping it under review every two weeks and the licence could end before then, with the appropriate notice in place for industry. I am clear that our sanctions are having a categorical impact on the Russian economy. Russia has slashed its economic growth forecasts, and collectively our sanctions have denied Russia access to $450 billion, which could have fuelled the war for many more years. Our sanctions are having an impact, but we will continue to toughen them.
Mr Snowden
We both agree that this is important. While Putin uses globally inflated oil prices to fund his war machine, our own defence investment plan is in tatters. The former Defence Secretary’s shocking resignation letter said that the Prime Minister was “unable”, and the Chancellor “unwilling”, to provide the funding for the defence investment plan. That is absolutely damning. Astonishingly, the very next day the Government announced £4.5 billion to paint 10,000 new zebra crossings. Given that the FCDO made a big cut to its own budget to fund defence last year, does the Minister share my anger that other Departments are refusing to contribute to keep our country safe?
Mr Speaker
Order. We have to be careful not to go very wide of the original question—and I think that was well wide, so I will call Rachel Hopkins to ask the next question.
Rachel Hopkins (Luton South and South Bedfordshire) (Lab)
The Minister of State, Foreign, Commonwealth and Development Office (Stephen Doughty)
As the Foreign Secretary said in her Locarno speech in December, and as the Chief of the Secret Intelligence Service reinforced a week later, an industrial-scale attack is being waged every day through social media, designed to undermine our democracies and divide our societies. We know that networks attributed to Russia, including Doppelgänger, are flooding social media in countries across the world—not just the UK—with counterfeit documents and deepfake material in an attempt to weaken global support for Ukraine. We are taking tough action on this front with our international partners.
Rachel Hopkins
Every single day a tidal wave of disinformation is being targeted at social media users in our country and around the world—and if we are in any doubt who is behind that wave of lies and fake images, we need only look at how much of it is designed to undermine the Ukrainian war effort or attack President Zelensky. Does the Minister agree that in order to protect the people of Ukraine, we need to take the fight to the sources of this information warfare?
Stephen Doughty
I completely agree with my hon. Friend. That is exactly why we have taken the action that we have: since October 2024, we have exposed and sanctioned 96 actors and entities involved in this type of activity, and in May we imposed sanctions on another 56 individuals and entities that are particularly involved in activity to undermine Ukraine. That included employees of Social Design Agency and ANO Dialog. We are constantly looking at what measures we can take, and taking action. The Kremlin is spending billions of dollars on information warfare. We will expose this activity and take it down.
Sir Jeremy Hunt (Godalming and Ash) (Con)
In 2017 there was appalling ethnic cleansing in Myanmar, and Facebook was used to recruit civilian death squads. Atrocities continue to this day. The UK holds the pen on Myanmar at the UN. At the General Assembly this year, will the Foreign Secretary hold a high-level meeting to look at this issue and shine a spotlight on the human rights abuses that continue to this day in Myanmar?
Stephen Doughty
I am sure that my ministerial colleagues with responsibility for Myanmar would like to follow up with the right hon. Gentleman on that issue. The challenge of misinformation and disinformation relates not only to Russia but to a whole series of contexts—and not just states. We also see it in non-state actors, including Daesh and other organisations. We are working very closely with partners to identify and tackle those networks.
Emily Thornberry (Islington South and Finsbury) (Lab)
The political murder of Jo Cox was deeply affecting for many of us—and, frankly, none of us should ever recover from it. She was not only brave and principled; she was also funny. If I ever need to cheer myself up, I simply remember her throwing her little body into the interparliamentary tug-of-war and how very funny it was—and she knew it.
My Committee and the Philip Rycroft review have found that the UK is already experiencing Russian disinformation warfare and that our defences to it are worryingly weak. We have both recommended a statutory, public-facing national counter-disinformation centre to ensure a co-ordinated response. The French have done it. The Swedes have done it. The Ukrainians have done it. I wonder whether the Minister can hold out hope that, someday soon, Britain might do it too.
Stephen Doughty
Well, Jo certainly was funny. I remember standing in King Charles Street with her once just before going to see officials in the Foreign Office—she had lots of climbing ropes in her bag as she had just got back from a hiking expedition. There were many fun moments with her over the years.
My right hon. Friend raises a crucial point. I really welcome the work that she and her Committee have done on this issue. We have taken their recommendations seriously and I will continue the conversation with her. I cannot make the promise that she is asking for at the moment, but we are certainly looking closely at the suggestion.
Richard Foord (Honiton and Sidmouth) (LD)
At the end of March, the Foreign Affairs Committee published a report into disinformation diplomacy. We investigated how malign actors are seeking to undermine democracy in the UK from overseas using information manipulation and interference, with such techniques as spoofing, bots and co-ordinated inauthentic behaviour. The Committee recommended that the Government demand greater transparency from social media companies in relation to the algorithms exploited by malign actors overseas. What discussions are being had with other Government Departments to make that so?
Stephen Doughty
I assure the hon. Member that we are very much having discussions with counterparts across Government. I am sure that in the next few days I will be meeting the new Security Minister and the new Minister for the Armed Forces. I also recently met a Minister at the Department for Science, Innovation and Technology to discuss these very issues. I assure him that we are working closely together across Government on this issue.
Dr Beccy Cooper (Worthing West) (Lab)
Adam Thompson (Erewash) (Lab)
The Parliamentary Under-Secretary of State for Foreign, Commonwealth and Development Affairs (Chris Elmore)
The UK has allocated £26.9 million of UK aid funding to support the response to the current Ebola outbreak within the DRC. That funding will strengthen disease surveillance and rapid response, and improve infection prevention and control. We are also working with the World Health Organisation and the Africa Centres for Disease Control and Prevention to help scale up the response and adapt existing programmes. This is a deeply concerning situation. Over the coming weeks, we will continue to work intensively alongside international partners to monitor developments and take the necessary action to protect both regional and global health security.
Dr Cooper
The Ebola outbreak now spans 29 health zones across three eastern provinces and is a reminder to us all that infectious diseases do not respect borders. With global health funding under significant pressure, does the Minister share my concern that we risk undermining the early warning systems that ultimately protect people here at home? Can he set out what steps the UK is taking to maintain its leadership role in global security?
Chris Elmore
I am glad to say that the UK is not stepping back; our response to the outbreak confirms that. We currently sit on the board of the WHO, the Global Fund, Gavi and the Pandemic Fund. Our investment helps to maintain critical global health security infrastructure, as well as tackling other health security threats such as antimicrobial resistance. Our leadership is amplified by world-class research and development, and is a trailblazer in the life sciences sector.
Adam Thompson
The covid-19 pandemic showed us how quickly infectious diseases can spread globally and the importance of acting early to contain outbreaks at source. Given that lesson, can the Minister outline how the UK is working with international partners to strengthen pandemic preparedness through this response, including by improving surveillance, early warning systems and rapid response capacity in countries like the Democratic Republic of the Congo, so that outbreaks such as Ebola are contained before they pose a wider global health risk?
Chris Elmore
As my hon. Friend said, our immediate priority is supporting the DRC and the Africa-led response to the Ebola outbreak. The UK and international support will also strengthen health systems so that countries can better respond to future outbreaks. That includes backing Government-owned surveillance systems through the World Bank and major global health organisations. It also means providing UK expertise through mechanisms such as the UK Health Security Agency’s UK public health rapid support team.
Sir Andrew Mitchell (Sutton Coldfield) (Con)
Thank you, Mr Speaker, for your wonderful words about Jo Cox and for the brilliant debate we had last Thursday as the main business of the House.
Following acknowledgment by the Development Minister, the noble Baroness Chapman, that Labour’s horrific development and aid cuts undermine the response to the Ebola crisis, and that funding is only 5% of the help provided for the last Ebola emergency a decade ago, will the Government make it clear that these pandemics cross borders and are a serious danger to all of us unless they are contained? Is that not the essence of the case for international development?
Chris Elmore
I can confirm that the UK is leading the global response on Ebola and was one of the first countries to respond with funding. I can also confirm that the Foreign Secretary is leading the charge on international funding to tackle the Ebola outbreak. The right hon. Gentleman is right to raise the concerns over international health security, and that is why the UK Government are continuing to lead from the front in tackling the Ebola outbreak.
Brian Mathew (Melksham and Devizes) (LD)
This morning, we held an informal International Development Committee meeting with Professor Wim de Villiers and Richard Gordon of the University of Stellenbosch on the Ebola outbreak in the DRC. The University of Stellenbosch’s disease identification unit has been involved in working on strategies to combat this outbreak, and the team commended the FCDO and its involvement so far from Pretoria, citing the £100,000 funding committed locally. They made the point that in a situation like this, being fleet of foot is vital, and that much can be done locally in Africa to develop diagnostics and monitoring of the disease and, in the medium term, vaccines. Can the Minister confirm that all is being done to further support these local responses and initiatives—
Chris Elmore
The hon. Member is absolutely right to say that this should be an Africa-led response, and it is extremely important that we listen to what the African countries are telling us about how we respond to the Ebola outbreak. On investment in areas such as vaccinations, the Department of Health and the FCDO have invested £160 million in the Coalition for Epidemic Preparedness Innovations to ensure that we are at the forefront of helping to develop vaccines. If the hon. Member would like to write to me further, he is very welcome to do so.
Ian Lavery (Blyth and Ashington) (Lab)
The Secretary of State for Foreign, Commonwealth and Development Affairs (Yvette Cooper)
The closure of the strait of Hormuz has hit the global economy and prices at the pump here at home. No country should be able to hijack the global economy in this way. That is why we welcome the announcement of the memorandum of understanding between the US and Iran, and why the UK has been leading diplomatic work across the world to maintain the consensus behind the crucial principle of freedom of navigation and international maritime law, without tolls, restrictions or the threat of attack in the strait of Hormuz.
Ian Lavery
They say the devil is in the detail. While we await the full details of the US-Iran agreement, does the Secretary of State agree that, had we followed the calls from Opposition Members to rush into war, it would only have prolonged the conflict and caused more financial misery to our constituents? Despite the noise and bluster, is it not the case that the only boats Opposition Members have stopped, through their cheerleading of the US aggression, are those left anchored between Iran and the Gulf states carrying oil bound for Britain?
Yvette Cooper
We took a very different view from that of the US and Israel at the start of this conflict, and we were right to do so, and also a very different view from that of the Conservatives. However, we also believe in working internationally to bring this securely to an end, to support the further negotiations that are now needed, and, alongside France, to lead efforts to establish a defensive multilateral maritime mission to reassure international shipping and support the mine clearance to enable the reopening of the strait.
Dr Andrew Murrison (South West Wiltshire) (Con)
Iran has demonstrated that it can close the strait at will, and it probably will threaten to do so in the future when it wants something, so what can we do with international partners, particularly in the region, to engineer alternative routes that will allow oil, gas and fertiliser to exit the Gulf overland, thus neutralising the strait?
Yvette Cooper
The right hon. Member makes a really important point, because economic security is something that all countries need to take much more seriously. The UK needs to take it more seriously. The Gulf countries are certainly taking it much more seriously and looking at ways to develop new infrastructure to provide different kinds of supply lines and opportunities. We are keen to work with them and we have been involved in discussions with them on that, but we also need to ensure that the strait of Hormuz opens. It is in line with international maritime law to open the strait fully, with no restrictions and no tolls, keeping it open for all.
Calum Miller (Bicester and Woodstock) (LD)
The terms of the US-Iran deal that have been briefed to the press look like a huge win for Iran. Above all, Iran has strengthened her position by showing the impact of closing the strait of Hormuz. This spectacular failure of Trump’s foreign policy has made us poorer and less secure, so what plans does the UK have to work with reliable allies to contain Iran’s malign influence, and will Ministers back the Liberal Democrat amendment to the National Security (State Threats) Bill, which would ensure that the Islamic Revolutionary Guard Corps is proscribed without delay?
Yvette Cooper
The hon. Member will know that we are taking action to strengthen the legislation on state-backed threats in the UK, and that I have been strongly involved in that and have strongly championed it. We have to ensure that any attempt to restrict or put tolls on the strait of Hormuz is never agreed to. It must be a fundamental principle that international shipping should be able to move through an international waterway. That is what we do in the strait of Dover; it is what needs to happen in the strait of Hormuz.
Anna Dixon (Shipley) (Lab)
The Secretary of State for Foreign, Commonwealth and Development Affairs (Yvette Cooper)
I have made violence against women and girls a priority for the Foreign Office. Last month, I had the privilege of launching the international coalition to end violence against women and girls, working with Spain, Australia, South Africa, Brazil, Jamaica, Morocco, and Bosnia and Herzegovina. We know that countries can work together and learn from each other on this crucial issue, which affects women worldwide.
Anna Dixon
I was moved to hear about Jo Cox’s life and the impact of her work on women globally in last week’s debate. She was a strong advocate for women’s rights and overseas development aid. Will the Secretary of State assure me that recent cuts to aid will not have an adverse impact on projects such as those I saw in Zimbabwe last year, which are helping to reduce the incidence of violence against women and girls?
Yvette Cooper
I welcome my hon. Friend’s point. Jo was a tireless champion for women’s equality and opportunity in the UK, but she carried that with her all around the world, standing up for women’s opportunities and tackling issues internationally. My hon. Friend makes an important point. We have been clear that as part of the changes to overseas development, we will maintain and strengthen the priority of women and girls, so that by 2030 at least 90% of UK bilateral aid will support issues relating to women and girls.
Caroline Voaden (South Devon) (LD)
A UN report from March last year laid bare the evidence of Israel’s systematic use of rape and sexual violence in the Occupied Palestinian Territories. Israeli settlers are committing sexual violence in sight of Israeli forces, according to a recent report by the West Bank Protection Consortium. Given the Government’s commitment to the safety of women and girls, will the Secretary of State commit to publishing a response to both of those reports?
Yvette Cooper
I can tell the hon. Member that we take the abuse of and violence against women and girls in situations of conflict immensely seriously. That includes looking at issues that have been raised with us, including those relating to the west bank and other parts of the world. The UK was responsible for the UN resolution on women, peace and security 25 years ago; we are putting new energy behind that and raising it in every area of conflict.
Priti Patel (Witham) (Con)
What steps are being taken to investigate Daesh fighters who have returned to Britain and prosecute them for their crimes, including sexual violence and rape against the Yazidis and others? Given the importance of ensuring that there is accountability and reform of institutions to root out the risk of exploitation from the UN, charities and even the Foreign, Commonwealth and Development Office, what is the Government’s response to the suspension of Karim Khan from the International Criminal Court for allegations of sexual misconduct?
Yvette Cooper
The shadow Foreign Secretary will understand that I cannot comment in detail on individual cases, but we do take allegations extremely seriously in any institution. I can also tell her that we expect to see accountability for crimes of sexual violence, whether that is by individuals who come to the UK or issues across the world. We are also supporting expert evidence gathering, including in areas of conflict, so that there cannot be impunity for crimes against women and girls.
John Whitby (Derbyshire Dales) (Lab)
The Secretary of State for Foreign, Commonwealth and Development Affairs (Yvette Cooper)
I want to formally welcome the fact that an agreement has been announced between the United States and Iran. We should be clear that this is an important diplomatic breakthrough, but it is still just the beginning of further discussions and negotiations that will be important to de-escalate tensions, restore regional stability and reopen the strait of Hormuz. I commend the Government of Pakistan, alongside Qatar and others, who supported the mediation.
Now there must be full implementation and further work, including the restoration of toll-free freedom of navigation through the strait, where the UK stands ready to provide support. We also stand ready to contribute to vital technical work to ensure that Iran never has a nuclear weapon and that there can be containment that restores regional security. It is vital that alongside this, all sides support a ceasefire and peace in Lebanon. We will work tirelessly alongside regional and international partners, including through the G7 and the United Nations and with our European partners, with sustained UK diplomacy to restore regional security and support for the global economy.
John Whitby
At COP29, an agreement was reached to provide $300 billion of international climate finance annually to developing countries by 2035 to help them pursue green growth pathways, access clean energy, reduce deforestation and so on. What steps is the Department taking to ensure that this commitment is delivered in full by our international partners, and will the Government press for that finance to be provided predominantly as grants rather than loans to avoid increasing debt burdens on developing countries?
Yvette Cooper
My hon. Friend is right to raise the importance of this issue. Tackling climate change across the world helps in those countries, but it also helps us here at home. That is why we are supporting climate finance internationally, because we can multiply the impact we have by working through international climate finance and funds. As well as the billions of pounds of investment that the UK will be providing, we are mobilising billions more in finance from the private sector. We will continue to engage internationally with all countries so that they do their bit.
Mr Speaker
Can I please just remind everyone that we are on topicals? I call the shadow Foreign Secretary.
Priti Patel (Witham) (Con)
China’s human rights record is appalling. Did the Foreign Secretary know, while she was enjoying the hospitality of the Chinese Communist party earlier this month, that Chinese slave labour is being used to supply solar panels across UK schools and hospitals to meet Labour’s net zero targets? How has the Foreign Secretary allowed this to happen, and does she think it is acceptable for her Government to be turning a blind eye to Chinese slave labour and these awful human rights abuses?
Yvette Cooper
I can be clear that this Government maintain high standards across our supply chains and are strengthening action against abuse within supply chains. While in China earlier this month, I raised issues around human rights and security. China is our third biggest trading partner and a permanent member of the Security Council. That is why we also discussed with it global security, and I think that the right hon. Lady should agree that it would be wrong to simply refuse to talk to China.
Priti Patel
The Foreign Secretary will know that a secret camera was found in an office block where the plans for the Chinese spy hub super-embassy were approved. No one knows yet where the camera came from, but it raises serious questions for the Government about their approval of this Chinese spy embassy. Can she say whether this act of foreign espionage will be investigated, and does this incident not once again highlight why China must be placed on the enhanced tier of the foreign influence registration scheme?
Yvette Cooper
The shadow Foreign Secretary and I are both former Home Secretaries who take any security threats immensely seriously. That is why the Government are strengthening the legislation on state-backed threats—because we take security issues so seriously. As she will know, the UK has plans for new embassy facilities in Beijing, because it is important that we have international standard and secure facilities in order to be able to engage, including on security. That is why we have to talk to the biggest countries in the world.
Daniel Francis (Bexleyheath and Crayford) (Lab)
The Parliamentary Under-Secretary of State for Foreign, Commonwealth and Development Affairs (Seema Malhotra)
We recognise the strength of feeling among diaspora communities and continue to press the Sri Lankan Government bilaterally and at the United Nations Human Rights Council for meaningful progress to improve the human rights situation. That includes securing truth, justice and accountability for past abuses affecting all communities, including Tamils. We have consistently raised concerns about the Prevention of Terrorism Act and its ongoing use, and we will continue to urge its repeal and replacement, in line with international law.
Edward Morello (West Dorset) (LD)
Yvette Cooper
I met with European partners and others in Paris on Friday to discuss the importance of providing new energy behind not just the two-state solution but, specifically, the Gaza 20-point plan. That is why we have announced the international peace fund, but we need that new commitment, because there is a serious risk that the 20-point plan is going backwards and into the ground. We need that international commitment.
Mr Luke Charters (York Outer) (Lab)
Seema Malhotra
Anthropic’s Fable 5 and Mythos 5 models have been withdrawn worldwide, including in the US. We respect that this is a decision for the US Government and are in direct contact with US Government officials as this develops. It reinforces the importance of Britain having greater sovereign control over critical technology and maintaining our national capabilities for us and our allies. The AI Security Institute is one of the best resourced teams of its kind anywhere in the world. Protecting our national security is central to this Government’s approach to AI.
Clive Jones (Wokingham) (LD)
Seema Malhotra
We are very clear that the UK will not tolerate any attempts by foreign states to intimidate, harass or harm individuals or communities in the United Kingdom. That continues to be our position.
Jessica Morden (Newport East) (Lab)
The Minister of State, Foreign, Commonwealth and Development Office (Stephen Doughty)
I congratulate my hon. Friend on her damehood, which is well deserved, and on her consistent advocacy in relation to Armenia. I can assure her that we are monitoring the concerning situation regarding Russian economic pressure on Armenia. We are developing our strategic partnership further. In fact, I was discussing Armenia with both US and EU counterparts in recent days, and we will work closely with international partners to ensure Armenia is robust and able to pursue its own future.
Wendy Chamberlain (North East Fife) (LD)
The Parliamentary Under-Secretary of State for Foreign, Commonwealth and Development Affairs (Chris Elmore)
We call on the Taliban to respect the rights of women and girls, including the right to education, and condemn any ongoing restrictions. I will raise the hon. Member’s question with the Under-Secretary of State for Foreign, Commonwealth and Development Affairs (Mr Falconer), who is travelling, and ensure that she gets a full written answer.
Sarah Edwards (Tamworth) (Lab)
Seema Malhotra
We are building long-term partnerships between UK regions and our global network to support local growth, including in the west midlands and with more ministerial and head of mission visits across the UK this year. Our diplomatic advisory hub, delivered with the British Chambers of Commerce, is also supporting businesses to build geopolitical insight and to grow internationally, and we are working with the Department for Business and Trade to ensure that businesses seize opportunities from our trade agreements. Supporting growth at home is a priority for the whole Government.
Afzal Khan (Manchester Rusholme) (Lab)
The International Court of Justice directed third states not to enter into trade dealings with Israel in the Occupied Palestinian Territories two years ago, but the Government have still not responded to that—why? Does the Secretary of State recognise the UK’s obligations to the ICJ, and will it comply?
Seema Malhotra
The UK reiterates the call in the ICJ’s advisory opinion that Israel should end its occupation of Palestine as rapidly as possible and in line with our goal of a two-state solution. There was a great deal in the advisory opinion with which we agree: the settlements are illegal, and we should distinguish in everything we do between Israel within its 1967 borders, and Palestinian territory that has been occupied since 1967.
Gareth Bacon (Orpington) (Con)
I refer the House to my entry in the Register of Members’ Financial Interests. The Government have previously stated that Hamas must voluntarily disarm in accordance with the 20-point peace plan, but that is clearly not happening. What is the Government’s practical strategy to ensure that Hamas is compelled to give up its weapons, cannot rebuild its military capabilities, and does not divert humanitarian aid?
Seema Malhotra
Hamas is a terrorist organisation, and we have been clear that it must decommission its weaponry and no longer be allowed to pose a threat to Israel’s security. The UK is committed to supporting the implementation of the 20-point Gaza peace plan in full. As part of that transition process, set out in phase two of the peace plan, we will continue to support those international efforts and a credible plan to achieve those goals.
Anneliese Dodds (Oxford East) (Lab/Co-op)
I recently visited Chad with the all-party group for Sudan and South Sudan, and in that connection we will shortly be registering an interest. Like the Foreign Secretary, I was moved by Chad’s willingness to accept 1.3 million refugees, but disturbed by the horrific scale of the crisis. Will the Prime Minister be raising the Sudan crisis at the G7, because it must be raised at every international gathering? Is the UK advocating for countries such as Chad to be included in international talks?
Yvette Cooper
I welcome my right hon. Friend visiting Chad and raising this issue, and I assure her that I have already raised it as part of the G7, when the G7 Foreign Ministers had a significant discussion. We will continue to raise the issue at every level, and pursue the possibility of comments around what is happening in Sudan at every level, including G7 communiques.
Bob Blackman (Harrow East) (Con)
In Pakistan-occupied Kashmir, Pakistani security forces have fired on peaceful demonstrators who were standing for human rights, and the right to food and proper security in their area. More than 30 people were killed, and more than 200 injured, including British nationals. What action has the Secretary of State taken to call in the Pakistani high commissioner and say not only that that is unacceptable, but ask what action is being taken to protect innocent bystanders?
Seema Malhotra
We are concerned about developments in Pakistan-administered Kashmir, including the loss of life of security personnel and civilians. We recognise that it is an internal matter for the authorities, but the hon. Gentleman will know that on 6 June we changed our travel advice to advise against all but essential travel to the Azad Jammu and Kashmir region of Pakistan-administered Kashmir, due to the ongoing situation. He will also know that we continue closely to monitor the situation, including the impact on British nationals, engaging with the Government of Pakistan as appropriate.
Adam Jogee (Newcastle-under-Lyme) (Lab)
Next January, the United Kingdom will take the chair of the G20, providing our country with a real platform to lead international conversations and to deliver here at home. Will the Minister tell the House what our priorities will be when we take the chair and what plans we have across Government to make the most of this unique position?
Chris Elmore
My hon. Friend is right to raise the importance of the G20 summit, not only this year but when the UK is hosting from January. I can confirm that tackling structural imbalances, future industries, open trade and reforming global economic systems to support developing countries will be our focus as we move into chairing the G20. He is right that this is a crucial moment for the United Kingdom. The FCDO will play an important part co-ordinating the work across Government, via the Cabinet Office.
Mr Gregory Campbell (East Londonderry) (DUP)
Will the Secretary of State join me in recommending that people visit the “06:29AM—The Moment Music Stood Still” exhibition that I and colleagues visited this morning in London, which shows examples of what happened on 7 October, so that we may all get more rounded information on why there is such a scale of horrendous murder in Israel and the middle east more generally?
Yvette Cooper
We continue to condemn the horrendous attacks on 7 October, which were an act of the most barbaric terrorism by Hamas and left deep scars for families who lost loved ones. Huge trauma was instigated as a result and it was the worst attack on the Jewish people since the Holocaust. We remember with sadness all those who lost their lives.
Lloyd Hatton (South Dorset) (Lab)
Every year, billions of pounds never make their way to the Treasury coffers because of British tax havens, such as the British Virgin Islands. The upcoming illicit finance summit offers us a real opportunity to tackle tax evasion and dirty money in these havens. Ahead of the summit, does the Minister agree that we must ensure that these havens finally throw open their books, and that tackling tax dodging must be top of the agenda?
Stephen Doughty
The illicit finance summit will convene a broad coalition to tackle dirty money globally and focus on financial transparency, property, crypto and illicit gold. The Crown dependencies and overseas territories with financial centres have committed to upholding international tax standards, but we work closely with them on upholding those international standards and on wider transparency, including in relation to beneficial ownership.
Greg Smith (Mid Buckinghamshire) (Con)
My right hon. Friend the shadow Foreign Secretary rightly challenged the Government on the use of Chinese slave labour in the manufacture of solar panels. Chinese companies also dominate the mining companies using slave labour to extract cobalt in the Democratic Republic of the Congo, so how much more needs to happen for the Government to challenge this evil use of slave labour, particularly by the Chinese state?
Seema Malhotra
Following on from the Foreign Secretary’s comments, the hon. Gentleman will know that we stand resolute in the support of human rights around the world, including in supply chains. We continue to raise the issue with Governments and the international community at every available opportunity.
Ben Goldsborough (South Norfolk) (Lab)
The incarceration of Jimmy Lai and the persecution of Hongkongers in the United Kingdom by China is deeply wrong and disturbing. Will the Secretary of State set out what action the UK will be taking to ensure our concerns are heard and action is taken to protect Hongkongers living in the United Kingdom?
Yvette Cooper
I raised the case of Jimmy Lai during my meetings in China and we will continue to raise the case, because it is immensely important to us and we believe that he needs to be released as swiftly as possible. My hon. Friend will know that we take the safety of Hongkongers across the UK immensely seriously, and we will always stand firm against any kind of transnational repression.
Christine Jardine (Edinburgh West) (LD)
Watching coverage of the football in America, it may be difficult to believe that a great number of Scottish football fans were refused ESTAs—the electronic system for travel authorisation—at the last minute, after they had previously been approved, costing them thousands of pounds in cancelled airfares and hotels. Will the Minister tell us whether there have been conversations with the American authorities about how this has happened and how to avoid it, and will she impress on them the economic loss that they will face from all those missed alcohol sales?
Stephen Doughty
We wish Scotland very well and congratulate the team on their success against Haiti.
The hon. Lady raises an important point. I have raised these issues with the US Government, as has our embassy in Washington. Obviously I cannot comment on specific cases, but I urge all constituents who are travelling to the United States for the world cup to follow the US guidance online. If they encounter any challenges, I urge them to speak to the US embassy.
Imran Hussain (Bradford East) (Lab)
I am the chair of the all-party parliamentary group on Kashmir. The Foreign Secretary will know that I have written to her with the support of more than 60 parliamentarians to raise concerns around the serious escalation in tensions in Azad Kashmir, including reports of bloodshed, arbitrary arrests and food blockages. Will she reassure this House that she will use all diplomatic levers open to her to push for peace and justice in Kashmir? That includes the lifting of the lockdown, the restoration of all communications and the immediate resumption of peaceful table talks, at the heart of which must remain respect for Kashmiri human rights.
Seema Malhotra
My hon. Friend will know how seriously we take this situation. We continue to monitor it closely—including, as has been raised, the impact on British nationals—and to ensure that we continue to engage with the Government of Pakistan where appropriate. We want to see this situation come to an end.
Martin Vickers (Brigg and Immingham) (Con)
Last month, along with other members of the all-party parliamentary group on Gibraltar, I visited the Rock in order to assess responses to the proposed treaty at first hand. Will the Minister give us an update? When does he anticipate that the treaty will be finalised?
Stephen Doughty
I thank the hon. Gentleman for his consistent advocacy on Gibraltar. We are committed to finalising this treaty imminently. The draft treaty text is undergoing its final legal checks, and as he will know, a draft was previously deposited in the House with a summary on 26 February. We look forward to signature imminently, and the provisional application is expected on 15 July.
Douglas McAllister (West Dunbartonshire) (Lab)
I thank the Foreign Secretary for raising the case of my constituent Jagtar Singh Johal during her recent visit to India. Will she update the House on whether her discussions were positive? Are we any closer to securing Jagtar’s release and return home to West Dunbartonshire?
Yvette Cooper
My hon. Friend is right. I raised this while I was in India, and I know how much he has been championing his constituent’s case. There is concern about the length of time without a resolution, and we will continue to raise it.
Monica Harding (Esher and Walton) (LD)
The world has failed Sudan. We know that the international fact-finding mission has noted evidence of a genocide following the fall of El Fasher. What is the UK doing as penholder at the UN to ensure that the belligerents responsible are being held to account, as well as the state actors aiding and abetting them?
Yvette Cooper
I continue to raise Sudan in every international forum. We have to keep a spotlight on what is the worst humanitarian crisis of the 21st century. That includes shining a spotlight on international arms flows—more than a dozen countries are involved—and it involves pressure on the parties involved to agree some kind of ceasefire or humanitarian truce so that we can get humanitarian support in and start to build a better future for Sudan.
Andy McDonald (Middlesbrough and Thornaby East) (Lab)
On a point of order, Mr Speaker.
Thames Water
(1 day, 4 hours ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
The Secretary of State for Environment, Food and Rural Affairs (Emma Reynolds)
Before I begin, let me say that this is a solemn day, as we remember our dear friend and colleague Jo Cox—I got to know her when we were living in Brussels in our 20s. I pay tribute to her formidable sister and their family for all their vital work to honour her memory.
I will make a statement regarding the position of Thames Water and the proposed recapitalisation package under consideration. This Government were elected with a clear mandate to clean up our rivers, lakes and seas, having inherited record levels of pollution incidents from water companies. Thames Water has underperformed for 15 years. It has regularly missed performance targets, it has unacceptable levels of serious pollution incidents, and the company is heavily indebted. This situation, which delivers poor outcomes for consumers and the environment, cannot continue.
To fix this, over the course of the past two years, the company has been undertaking a recapitalisation process to seek vital long-term funding. The Government have been clear throughout that any investor will need to have a credible and robust turnaround plan, the implementation of which must be monitored by regulators and must restore the company’s financial resilience and operational performance. Ofwat, with the support of Government, have been in discussions with the London and Valley Water consortium—a group of Thames Water’s creditors—regarding the terms of a proposal. On 6 March, the consortium presented its proposal for Thames Water to both Ofwat and the Government. Ofwat has been continuing its discussions with the consortium since then, and I wanted to update the House on the next stage of the process.
Ofwat is currently evaluating the consortium’s proposal and, as the independent regulator, is responsible for deciding whether to accept it. If Ofwat decides to accept the proposal, this would be subject to a public consultation and a court-sanctioned restructuring process. A recapitalisation process of this size is complex and will take time. As the Environment Secretary, I have several duties, set out in section 2 of the Water Industry Act 1991. These include protecting consumers, securing the proper delivery of water and sewerage services, and ensuring that companies can finance those services and that statutory obligations are properly carried out. Today, I can confirm that I have sent a letter to Iain Coucher, Ofwat’s chair, outlining my early views on the proposal linked to my section 2 duties. These should not be taken as, nor do they constitute, a direction from Government to Ofwat.
I do not believe that the current proposal goes far enough to protect customers and the environment. I have three particular concerns about the proposal: the unfair cost to customers, delays to vital infrastructure investments, and delays to environmental improvements. The 16 million Thames Water customers are front and centre of my consideration, and I am primarily worried about the impact on them. There is an expectation in the proposal that customers will fund—and therefore bear an undue cost for—investment in the company.
In addition, I am not convinced about the proposal’s request to reduce performance standards, nor about the significant delay to vital infrastructure investments. This would mean delays to environmental improvements, particularly those related to waste-water treatments linked to statutory requirements, as well as to projects that are important for drinking water safety and supply. I am therefore concerned that the long-term resilience of the water and waste-water systems may not be adequately protected. The Government will always act in the national interest, and my priority as Environment Secretary is protecting customers and the environment. We will stand ready for all eventualities.
I conclude by emphasising this Government’s commitment to turning around the water sector. In under two years, we have taken swift, decisive action. We have introduced the Water (Special Measures) Act 2025 to raise standards, enforce accountability, and make pollution cover-ups a criminal offence. We have banned more than £4 million in bonuses for polluting water bosses; we have unlocked £104 billion of private investment to rebuild vital infrastructure; and we have commissioned Sir Jon Cunliffe to lead the most comprehensive independent review of the water sector since privatisation. Together, those steps have paved the way for the landmark clean water Bill announced in the King’s Speech. The Bill fulfils the commitments we set out in the water White Paper earlier this year and will deliver the fundamental reforms that are so desperately needed. This once-in-a-generation Bill will create a single powerful water regulator, moving away from a system where water companies mark their own homework by putting in place stronger, active supervision. This will strengthen water companies’ financial resilience and the long-term stability of the sector, with modernised economic regulation and new powers to drive turnaround where companies perform poorly.
Additionally, the reforms will strengthen the consumer advocate, providing a more independent, authoritative voice that can challenge the system, drive improvements in outcomes and ensure that customers’ interests are put first. We will also improve water quality by cutting pollution at its source. Finally, we will avoid the situation we are discussing today happening again: our reforms will give the new regulator the powers to ensure water companies do not accumulate unmanageable levels of debt. More broadly, they will secure the long-term stability of the sector and ensure that companies are financially resilient. Put simply, our reforms will deliver better outcomes for customers and the environment.
I commend this statement to the House.
Mr Speaker
I thank the Secretary of State for coming to the House at the earliest opportunity to update Members before making announcements elsewhere. She is a shining example to her Cabinet colleagues of how this House should be treated.
I call the shadow Secretary of State.
Victoria Atkins (Louth and Horncastle) (Con)
First, I echo the Secretary of State’s comments in remembrance of her dear colleague Jo Cox. Her loss was felt across the House and across party political lines, and I send all of our very best wishes to her loved ones and friends.
I thank you, Mr Speaker, and I thank the Secretary of State for advance sight of her statement and for a briefing call on this announcement. As you know, I have been trying for months to coax the Secretary of State to the Dispatch Box to explain major events within her portfolio, from the Government’s EU handover negotiations to their lack of support for farmers. Finally, she emerges into the light. We all assumed that it would be to announce progress towards resolving the many issues facing Thames Water and its customers; instead, it is to make a statement about a letter to the regulator. There is nothing new in this statement—no change in the situation of Thames Water, and still no certainty for billpayers.
Thames Water has repeatedly failed its customers and the environment with a record of pollution, leakage and chronic under-investment. The latest figures lay this bare. The company is responsible for around a third of the nation’s worst pollution incidents, even as billpayers face steep increases in their bills. These are not abstract failures; untreated sewage has been poured into the rivers and chalk streams that local communities cherish, while customers are asked to pay more for less. The priority now must be a financial arrangement that keeps the company afloat and protects billpayers and taxpayers. While the Secretary of State’s Government are in chaos, paralysed by the Prime Minister’s weakness and the Mayor of Greater Manchester’s leadership ambitions, Thames Water continues to fail. If no deal is reached, Thames Water could collapse—again, at enormous cost to taxpayers.
The Secretary of State has said that she does not want a scenario where customers
“pick up the bill for the company’s failures”,
but when the Conservatives tried to amend the Water (Special Measures) Act to prevent consumers from being on the hook in the event of a company going into special administration and tried to impose a lending ratio limit on water companies to prevent this situation from happening again, Labour voted it down. Why? I also remember that under the former Secretary of State, the right hon. Member for Streatham and Croydon North (Steve Reed), an investor pulled out of a previous rescue deal, partly due to political risk—in other words, the former Secretary of State had talked himself out of a deal. How is the current Secretary of State avoiding the failures of the now Secretary of State for Housing?
There are those who are urging nationalisation, a word that is thrown around carelessly by Labour Back Benchers and by Reform—in fact, I think I heard it just now. None of them ever explains that nationalisation would be extremely expensive, potentially costing the taxpayer up to £20 billion. For those who are wondering what that means, it is roughly equivalent to the defence funding shortfall we have heard so much about in recent days. However, there are reasonable concerns about how Thames Water’s failures will be managed during the Government’s restructuring of the sector and the abolition of Ofwat, so can the Secretary of State please confirm that the existing penalty regime will not be downgraded or diluted, which has been briefed to the newspapers? What safeguards will be put in place to ensure Thames Water remains fully responsible for its environmental and operational failures? How will the Government ensure that billpayers are not left bearing the cost of past mismanagement, and have they offered or begun any process to recommend an alternative deal? Ministers have still not explained how investment in the sector will actually be paid for. Indeed, the Secretary of State’s predecessor had to admit that so-called private water industry investment is in reality paid for by higher bills, and the Secretary of State has repeated that today. Families already struggling with the cost of living should not become the safety net for a company that rewarded its executives while letting its infrastructure crumble. This is an important moment for the Government to show that they can balance financial stability with strong regulatory oversight and put accountability and the interests of billpayers and the environment at the heart of water reform. The Government must now deliver on the big promises they made during the election for the water sector.
Public trust in the water industry is already at rock bottom.
Emma Reynolds
I am always happy to receive brownie points, Mr Speaker, so thank you for what you said.
The shadow Secretary of State rightly says that untreated sewage has poured into our waterways, and it did, in the long years that her party was in government. They cut the Environment Agency’s enforcement budget and moved to an approach where water companies marked their own homework—the so-called self-monitoring approach. She has some brass neck in lecturing us when we saw a series of failures under her Government.
We are here today, and we as a Government inherited record levels of pollution in our waterways, because of the failure by the Government of the right hon. Lady to see what was happening before their eyes. It was a failure of regulation, a failure of the regulators and a failure of the previous Government.
I am proud of what we have achieved in the two short years that we have been in power. I am proud of the Water (Special Measures) Act 2025. When did the Conservatives ever cap polluting water bosses’ bonuses? Never. The right hon. Lady lectures me about amendments to our Act. Our Act did more in less than a year than her party did in 14 years to ensure a fairer deal for customers and a better deal for the environment.
The right hon. Lady asks about nationalisation. I gently say that a special administration regime is not the same as nationalisation. [Interruption.] I am just clarifying for the House; I do not wish to have an exchange with her across the ballot box—sorry, the Dispatch Box—if I can possibly help it. The ballot box might be at some other point. There is a difference between nationalisation and a special administration regime. With nationalisation, the Government would be taking ownership of the company. With a special administration regime, the Government would finance a special administrator appointed by the courts to run the company.
The right hon. Lady talks about public trust in our water sector being at record lows. All I can say is that we are clearing up her party’s mess. [Interruption.] It was under her Government that Thames Water was plunged into unmanageable levels of debt.
Mr Speaker
Order. Can I just say to the shadow Secretary of State that I want to hear the Secretary of State? We do not need a running commentary all the way through. I made sure that those on the Government Front Bench listened to her.
Emma Reynolds
I am not surprised that there are not many Opposition Back Benchers here, given the Conservatives’ terrible record on the water industry. In our clean water Bill, which we will introduce later in the Session, we will take forward a desperately needed, once-in-a-generation reform of the water sector to introduce a powerful single regulator that holds water companies to account.
Mr Toby Perkins (Chesterfield) (Lab)
Thames Water customers are paying the price for the incompetent regulation that allowed Macquarie to saddle the company with eye-watering debts at the same time as its environmental performance was so disgraceful. That debt ultimately led to shareholders writing the equity value down to zero. Those who bought the debt are now making this proposal. I entirely understand why the Secretary of State would not want customers to receive a service that was failing in its environmental responsibilities while they paid higher bills, but what assessment has she made as to whether Thames Water is a viable business? We have been told that this is the final offer from the company. Is there a viable business there that will deliver long-term investment within a reasonable cost window for billpayers? If there is not, at what point does public administration become inevitable?
Emma Reynolds
As I set out in my letter to the regulator, Ofwat, I am concerned that the proposal will mean delays to environmental improvements and to improvements to water infrastructure, with, as my hon. Friend rightly says, unfair cost being laid at the door of Thames Water customers. He asks whether it is a viable business and about next steps. This is a stage in the process where I have given my early views on this proposal. It is now for Ofwat to decide what to do next, and we wait to see what happens.
Tim Farron (Westmorland and Lonsdale) (LD)
I start by associating myself closely with the Secretary of State’s remarks about Jo Cox. It was a privilege to serve alongside her in this place, and we still miss her deeply.
I am grateful to the Secretary of State for advance sight of the statement and for the helpful briefing that I received earlier. Since Conservative privatisation more than 35 years ago, some £85 billion of billpayers’ money has flowed out like a torrent into the pockets of mostly overseas shareholders and executives paying themselves unearned bonuses. That money could and should have gone into cleaning up our waterways and modernising infrastructure. Instead, sewage was released into our lakes, rivers and seas for 1.8 million hours last year, and more than 100,000 of those were in the Thames region alone. Some 20% of our water leaks out of its pipes before it even reaches our homes. For Thames Water, the figure is even worse, with 25% of that water wasted.
Now Thames Water’s investors are asking for more time for more opportunity to take money before they inevitably run. The Secretary of State is right, then, that the creditors’ offer is a disgrace. They get to keep making money, and Thames Water billpayers get to pay even more to keep them going, while getting the privilege of seeing long-overdue infrastructure improvements delayed for yet another decade. Thames Water is taking the mickey. The Liberal Democrats say, “No more, and no thanks.”
It is clear that Thames Water has failed in its basic performance as a water company, and that gives the Secretary of State all the reason she needs to place it into special administration, so why is she not doing that instead? Her letter to Ofwat is, I am afraid, a sign of dreadful weakness. She has to beg an equally weak Ofwat to show a resolve that it institutionally lacks. Thames has failed in its performance, so just put it into special administration and migrate the company to a mutually owned model, where the billpayers own the company and call the shots. That way, investment will be made, sewage spills will stop and water leaks will cease. By doing that, she could begin the process whereby all our water companies are owned not by private equity, overseas investors or the sluggish state, but by the people. If she did that, she would win the favour of people from Witney to Windermere. Why does she not stop faffing about and do that instead?
Emma Reynolds
I thank the hon. Gentleman, I think, for his support for my statement today, although it was slightly half-hearted. He is right to say that there have been serious pollution incidents in different water companies, but especially in the Thames, and that is of grave concern to the public and to Thames Water’s customers in particular. I point out to him that there are two types of special administration regime. An insolvency SAR is an insolvency process and is for the company directors to determine. A performance SAR would be triggered if a company was in serious breach of its statutory duties or if the company breaches an enforcement order in a way that is so serious that it is inappropriate for the company to retain its licence. The Government stand ready for all eventualities, including a SAR.
Barry Gardiner (Brent West) (Lab)
Will the Secretary of State confirm that, in the event of a special administration regime, any compensation would be based on appropriate value as set out in the case of Lithgow v. the UK, not on regulated capital value, as suggested by the shadow Secretary of State. For Thames Water, appropriate value would take account of the £23 billion in infrastructure repairs needed to meet condition P of its licence and comply with its statutory obligation, as well as the £13 billion of dividend and debt interest already paid to creditors. Appropriate value would therefore be nil. The Secretary of State said that Ofwat is responsible for taking the decision to modify the licence. I urge her to read section 12A(7) of the Water Industry Act 1991, because she has the power to overrule.
Emma Reynolds
I think there were a number of questions there. As I have said, there is obviously a difference between a special administration regime and nationalisation. My hon. Friend refers to regulatory capital value, and he is right to suggest that the price of any company is a complicated matter, but in the event of a special administration regime, the state would seek to recoup the investment it had made upon SAR exit. Nationalisation would be a different matter.
Mr Louie French (Old Bexley and Sidcup) (Con)
What assurances can the Government give my constituents across Bexley that the £88 million of investment that is under way in our community to secure our fresh drinking water supply for the next 50 years is not derailed by this Government announcement, which means further uncertainty for Thames Water and its customers?
Emma Reynolds
I think it is right that both the regulator and the Government hold Thames Water to account, and I find the hon. Gentleman’s question slightly bizarre. I can reassure his constituents, and other customers of Thames Water, that the Government will always ensure continuity of service, but I make no apology for ensuring that customers are at the front and centre of my consideration of this proposal.
Jas Athwal (Ilford South) (Lab)
I thank the Secretary of State for her statement. Thames Water is by far the worst water company when it comes to sewage spills, pollution incidents, flooding across overloaded sewer systems, customer complaints, regulatory penalties—the list goes on. The establishment of a robust, proactive regulator is a step in the right direction, but should not a company as bad as Thames Water be taken over by being put into special measures so that it can start again and work in favour of residents rather than shareholders, as an example to others that enough is enough?
Emma Reynolds
My hon. Friend is right to say that Thames Water has a terrible record going back—as I said in my statement—at least 15 years. He is also right to say that sewage spills in the Thames Water area are completely unacceptable. As I have said, the Government stand ready for all eventualities, including a special administration regime.
Bob Blackman (Harrow East) (Con)
The Secretary of State is absolutely right to put customers at the forefront, but the problem, as she said in her statement, is that this will all take rather a long time to unwind. At present, uncertainty is the real concern for customers, especially the uncertainty about whether they will be charged extra on their bills. The Secretary of State has given a letter to Ofwat, but what specific changes does she want to see in the deal to encourage her to agree to it, so that we can move forward rather than having uncertainty?
Emma Reynolds
Quite simply, I do not want customers to pick up the bill for the repeated failures of Thames Water, but I hear the hon. Gentleman’s concerns about uncertainty, and I would like to see this situation resolved.
Emily Thornberry (Islington South and Finsbury) (Lab)
If Members google “Caledonian Road”, which is in my constituency, they might think it is a river, but it is not. Over the past decade, Thames Water has delivered to Islington seven major floods. Since privatisation, it has delivered to shareholders £7 billion. Last year, it delivered to my constituents a 31% increase in water rates. Residents are fed up, businesses are fed up, I am fed up, and I am sure that the Government are fed up. How much more do we have to take before Thames Water is finally given the boot?
Emma Reynolds
My right hon. Friend is absolutely right to emphasise the appalling record of Thames Water, and the impact that it is having not just on her constituents but on businesses in her constituency. As I have said, there are two different options for a special administration regime, and we remain open to all eventualities.
Freddie van Mierlo (Henley and Thame) (LD)
Ten months ago, the Government appointed FTI Consulting to advise them on taking Thames Water into special administration. Can the Secretary of State update the House on the outputs of that work and how much it has cost to date?
Emma Reynolds
We appointed FTI Consulting because, in the event of a special administration regime, it is right to have prepared for that eventuality and to have that contingency arrangement in place, but I am afraid that the figure for which the hon. Gentleman has asked is not at my disposal.
Danny Beales (Uxbridge and South Ruislip) (Lab)
The Secretary of State is absolutely right: Thames Water has let down my constituents and Londoners more broadly with years of chronic under-investment, while paying record levels of bonuses and dividends. I recently visited my local sewage treatment works, and saw proposed improvements to increase storm surge capacity on site and to improve filtration levels to clean up our waterways. Will the Secretary of State assure me and my constituents that those much-needed planned improvements will not be further delayed by ongoing institutional uncertainty about the future of Thames Water, so that we can finally turn the page on 14 years of Tory neglect of our waterways?
Emma Reynolds
I certainly want to turn the page on the failures of this company that have affected my hon. Friend’s constituents and those of other Members. Thanks to the Water (Special Measures) Act 2025, for which my hon. Friend voted, polluting water companies do not now receive bonuses. However, he is right to suggest that we need to resolve this situation and ensure that the improvements he has mentioned take place, and I have expressed my early concerns about this proposal because I do not want to see significant delays in such improvements.
Sir Julian Lewis (New Forest East) (Con)
It is tempting to say that there is a particularly bad smell about this company, but that would be a statement of the obvious. Although I am not normally a friend of nationalisation, I have a feeling that this company is on a one-way journey to bankruptcy. Am I right in presuming that if that point ever arose, there would be no question of compensating shareholders for a bankrupt company that eventually had to be taken over by the state?
Emma Reynolds
The company remains solvent, but if it were to become insolvent it would be for the directors to apply to the court for an insolvency special administration regime, and then those questions would be on the table.
Catherine West (Hornsey and Friern Barnet) (Lab)
What reassurances can the Secretary of State provide about basic customer services? For example, Turnpike Lane tube station in my constituency has been closed since last August, because Transport for London cannot reopen it owing to the leaks and other problems that Thames Water is far too incompetent to fix. Will today’s statement lead to better customer service?
Emma Reynolds
I am very sorry to hear about the circumstances in my hon. Friend’s constituency, and I will happily raise them with the regulator. We need to get that fixed as soon as possible.
Layla Moran (Oxford West and Abingdon) (LD)
In recent months, 35,000 houses in West Oxford have had their water pressure cut by Thames Water, in some cases by as much as 50%. Veronica in Osney Island says that her upstairs shower is now nothing but a dribble, and is barely usable. This is not a service; it is a scam, and my constituents are having to foot the bill for it. Their bills were put up last year. Can the Secretary of State explain to them what we are waiting for? Why can we not just let this failed company fail, and start again?
Emma Reynolds
I entirely understand why the hon. Lady and her constituents are fed up with the company’s poor performance, and I have written to Ofwat expressing my concerns. I do not want her constituents to pick up the bill for that poor performance.
Jim Dickson (Dartford) (Lab)
For far too long, Dartford residents have put up with very poor performance and high water bills. It is extremely likely that Thames Water leaks contributed to the collapse of the Galley Hill road in 2023, as a result of which Swanscombe residents have been pretty much trapped in their town over the past three years. As the Secretary of State has said, it is vital that the company does not have its performance standards diluted or receives protection from fines as a consequence of the deal that is on the table. Does she agree that any deal must put consumers and environmental protections first, and that investors should not benefit at the expense of billpayers and vital infrastructure improvements?
Emma Reynolds
As I said in my statement, customers are at the front and centre of my consideration of this serious issue. The Environment Agency will continue to investigate any pollution incident and any breach of statutory obligations of any water company, including Thames Water, and will continue to take enforcement action against those companies, including the imposition of fines.
Greg Smith (Mid Buckinghamshire) (Con)
I have a huge list of complaints about Thames Water across Mid Buckinghamshire, and I am sure it is identical to that of the Secretary of State next door in Wycombe, so I add my voice to my hon. Friends’ calls for real detail about the plan, rather than just ambition. In the meantime, there is something that is causing Thames Water and every other water company to chase their tails: their inability to have a proper voice in the planning system. When a village such as Ickford in my constituency, which already has its sewage pumped away by road in tankers because the system just cannot cope, is told that it has to connect another 90, 100 or 150 properties, it is never going to work. Given the huge demand for house building and data centres in Buckinghamshire, what action will the Secretary of State take to ensure that the water companies can have their say and say no when they cannot connect areas?
Emma Reynolds
I thank my constituency neighbour for his question. Like him, I have had complaints about Thames Water in my constituency. With regard to his broader question, I reassure him that when we bring the clean water Bill to the House, there will be provisions for more intense regional planning, which involves water companies, local authorities and other stakeholders, so that we can avoid the sort of situation that he talks about.
Helen Hayes (Dulwich and West Norwood) (Lab)
My constituents have been catastrophically failed by Thames Water over many years by major floods that have closed local businesses, constant leaks and bursts, traffic disruption, loss of supply and terrible support for vulnerable customers. This is the consequence of shocking negligence by asset-stripping investors, and there is no evidence that Thames Water can recover itself or that it will ever have a credible plan to deliver. I welcome the Secretary of State’s statement and ask her for further detail on the timescale for resolving the situation. When does she expect Ofwat to reach a decision on the offer from investors? How will she ensure that, following such a decision, action is taken swiftly to bring this scandal to an end and to bring Thames Water back into special administration, so that it can be run for the public good and for the good of the environment?
Emma Reynolds
My hon. Friend is right to raise the impact of this issue on local businesses as well as residents in her constituency. I spoke to the chair of Ofwat yesterday evening, as well as sending the letter, and I know that he and the board of Ofwat are considering the proposal in great detail. I suspect that we will hear from them soon.
Richard Tice (Boston and Skegness) (Reform)
Enough is enough. Frankly, the sight of US hedge funds picking over the carcase of Thames Water’s pipe network is revolting—it stinks. The plan includes three quarters of a billion pounds of payments to hedge funds, shareholders, debt holders and bankers. It is completely unacceptable. Thames Water is bust: it is insolvent. Now is the time to put it into special administration. It cannot meet its financial obligations, and it cannot meet its performance obligations. I urge the Secretary of State to get on with it, put Thames Water into a special administration regime, and then buy it out for a pound. That would be a good deal for the taxpayer.
Emma Reynolds
May I welcome the hon. Gentleman to the party? It was a long time coming. I do not remember any mention of the sewage crisis in the Reform manifesto at the last election.
Daniel Francis (Bexleyheath and Crayford) (Lab)
I think some Opposition Members are suffering from amnesia and have forgotten the asset stripping that happened, which has led to infrastructure failing across Bexleyheath and Crayford, and to the 30% increase in bills last year. We have tried every option to keep Thames Water organisationally solvent, but my patience, and that of my constituents across Bexleyheath and Crayford, is running out. Will the Secretary of State outline how ready we are as a Government if we need to take the company into special administration? In Bexleyheath and Crayford, our patience is running out.
Emma Reynolds
We have seen really poor performance over a number of years, and I absolutely appreciate my hon. Friend’s impatience on behalf of his constituents—he is right to express that. One of the problems that we have had with the regulatory regime is that the current economic regulator did not step in and stop Thames Water going into unmanageable levels of debt. As I said in my statement, our water White Paper and the clean water Bill set out that the new regulator will have new powers and responsibilities to ensure that companies do not get into that situation in the first place.
Sarah Green (Chesham and Amersham) (LD)
Communities such as Chalfont St Peter have suffered appalling circumstances in recent years, including flooding and sewage bubbling up through the drains. Thames Water has promised capital investment to address these issues. What assurances can the Secretary of State give that customers will not be asked to pay the price for years of financial mismanagement through higher bills, and that any future restructure or special administration regime will not mean that existing capital investment commitments are lost?
Emma Reynolds
I thank my constituency neighbour for her question. She is right to talk about the problems in her constituency, which I know very well. I sent my letter yesterday evening precisely because of the issue that she mentions. I do not want to see severe delays to the capital investment that is necessary to improve the situation, as she has suggested, and I do not want customers to pick up the bill for it.
Fleur Anderson (Putney) (Lab)
I echo the tributes to Jo Cox, whom I worked with when she was at Oxfam. We miss her greatly.
My constituents in Putney, Roehampton, Southfields and Wandsworth Town have been let down by Thames Water for years. The Tories lost a grip of the situation and cut back the Environment Agency. In 2025, Thames Water dumped sewage in the Thames for over 107,000 hours, but bills are rising and I get constant emails from constituents because there is nothing to show for it. They are paying the price, so I welcome the Secretary of State’s standing up for customers and the environment. What would she say to my constituents to assure them that they will not have to pay any more for this investment fund masquerading as a public service?
Emma Reynolds
My hon. Friend puts her finger on the issue. As I said in my statement, there are three principal reasons why I sent Ofwat my early concerns about the proposal, and one of those reasons is the delay of the investment that we need to ensure that there are improvements to environmental performance, which I know is an issue of concern across the House. I do not want customers to pick up the tab for that delay.
Jeremy Corbyn (Islington North) (Your Party)
Is it not clear that 30 years of the regulatory system has absolutely failed in the face of the greed, incompetence and profit taking of Thames Water? Surely to goodness it is time that Thames Water stopped being allowed to continue with this disastrous policy. The company was brought into public ownership, but it is public ownership with a difference, because it includes local authorities, local communities and the workforce—rather than the directors—who know something about water delivery. We need an efficient supply, an end to the flooding that happens in my constituency and others, and an end to the abominable polluting of the Thames and the seas around this country, which is caused by the greed of the directors of Thames Water.
Emma Reynolds
I do not always agree with the right hon. Gentleman, but I do so on this issue. There has been real regulatory failure here—there has been a failure of the regulators, and a failure of the regulation itself. The Conservatives decided to cut the enforcement budget of the Environment Agency, and there has been a shift towards self-monitoring, which essentially means that the water companies have been marking their own homework. It is like telling Ofsted not to visit any schools—that is the equivalent of the regime that we saw under the Conservatives. The right hon. Gentleman is right to say that customers and the environment need to be at the heart of the solution to this issue.
Laura Kyrke-Smith (Aylesbury) (Lab)
We all have examples of Thames Water letting our residents down. Just last week I heard from one of my farmers, who has had Thames Water discharging raw sewage into the ditch next to his fields. It has flooded his fields and contaminated the land, which is no longer in use. I welcome the progress made by the Secretary of State, but as she acknowledges, more may well be needed. Will she reassure my constituents that she will always put the interests of consumers, the environment and public health ahead of the interests of investors?
Emma Reynolds
Absolutely, and I could not agree more with my hon. Friend. As I said in my statement, customers are front and centre in my consideration of this issue. It is completely unacceptable that farmers are suffering the consequences of the raw sewage crisis in our country, and they should not have their land contaminated. That is their livelihood, and it takes a great deal of work and cost to decontaminate the land.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
Will the Secretary of State guarantee that no taxpayer money will be used to bail out Thames Water or its shareholders?
Emma Reynolds
Well, we have to see. I have sent a letter to express my early concerns about the situation, and the Government remain open to all eventualities. If there was a special administration regime, which some people are calling for, then the Government would obviously be financing a special administrator to run the company. That would have to happen, because we would have to have continuity of service. If the hon. Gentleman does not want that to happen, he has to suggest an alternative.
Matt Rodda (Reading Central) (Lab)
I thank the Secretary of State for her statement and for robust way in which she is standing up for residents and the environment on this very important issue. My constituents are appalled by the sewage pollution in the River Thames and by the poor quality of customer service offered by Thames Water. We have had numerous breaks in supply and there was an issue with subsidence that closed a road in Reading. Can she tell me more about the process that will be followed by Ofwat and the action she will take through the clean water Bill?
Emma Reynolds
The clean water Bill will introduce a supervisory regime whereby the new regulator, which will have more teeth, will have a team of people for each and every water company, really getting a grip on the performance of each water company and holding it to account. What we have seen up until now, as I said to the right hon. Member for Islington North (Jeremy Corbyn), is the shift we saw 15 years ago towards a system where companies were basically marking their own homework. That cannot be right; that is not a proper regulatory system. That is just laissez-faire and letting companies get away with the sorts of pollution incidents that we have seen.
Helen Maguire (Epsom and Ewell) (LD)
Thames Water is in crisis, so I thank the Secretary of State for not approving the deal. It is sinking under £20 billion of debt. It is like a leaky ship that cannot stay afloat. Last year, my constituents were, on average, paying an additional £203 a year. They simply cannot continue to pay the price for this failure. When will she stop pouring money into this leaky ship, put Thames Water into special administration and put everyone out of their misery?
Emma Reynolds
I thank the hon. Lady for welcoming the fact that I have sent the letter with my early concerns. As I said, there are two different ways for a special administration regime. One is insolvency, which is a matter for the directors of the company and would have to go through the courts. The other is the performance tsar.
Helena Dollimore (Hastings and Rye) (Lab/Co-op)
Thames Water is clearly failing its customers and the environment. I thank the Government for their action this week, which makes it very clear to Thames Water that it will not be allowed off the hook for fines, it will not be allowed off the hook for performance targets, and it must not be allowed to mark its own homework. I want to probe the Secretary of State on a specific aspect of its failure. We on the Environment, Food and Rural Affairs Committee asked Thames Water how much it had spent on the legal proceedings to try to avoid a special administration regime. The company replied:
“we estimate that our legal fees for work done in connection with our liquidity extension transaction, as implemented through the interim restructuring plan at the High Court and Court of Appeal, was approximately £67.6 million”.
That was last June. I will be writing to Thames Water to ask for an update on those costs. Given that shocking amount being wasted on legal fees—almost 3% of what customers are paying in bills—does the Secretary of State agree that Thames Water must spend its money on fixing broken pipes, not bonuses and not bumper legal payouts?
Emma Reynolds
Yes, we want Thames Water’s priority to be investing in the water infrastructure needed to improve the service it gives its customers and to drive environmental improvement.
Dr Ellie Chowns (North Herefordshire) (Green)
As the Secretary of State pointed out, Thames Water has 16 million customers. It does not serve them; it fails them. That is nearly a quarter of the entire UK population and they do not get any choice—this is a natural monopoly. We are all stuck with the water company that supposedly serves the area we live in, but what do customers get? They get bills going up through the roof, pollution in our rivers and seas, and crumbling infrastructure. In her statement, the Secretary of State nodded towards special administration, which would be an improvement on the status quo, but is it not time to come clean with the British people and admit that the privatisation experiment has totally failed, and to take this struggling, failing company back into public ownership, where it belongs?
Emma Reynolds
The hon. Lady is right to point out that these are natural monopolies and that there is no competition. I do not think nationalisation is a silver bullet in this regard. I point out to her that the Government are facing big fiscal pressures in all sorts of other areas, but we stand ready for all eventualities.
Peter Swallow (Bracknell) (Lab)
Thames Water was responsible for a third of all major pollution incidents in 2025. Now its creditors want to jack up my constituents’ bills, delay improvements to infrastructure and dodge future fines. My constituents are being failed. I welcome the action the Secretary of State has taken today, but I urge her to go even further and put Thames Water under special measures.
Emma Reynolds
It is because of my concern about the delays to improvements in infrastructure and the environment that I sent the letter to Ofwat. Can I reassure my hon. Friend on one point? I have never even considered the idea that the Environment Agency would let this company off any fines. The agency will continue to perform its duties in holding Thames Water and all other water companies to account, and will enforce against them should they breach their statutory obligations.
Monica Harding (Esher and Walton) (LD)
My constituents are facing an average water bill of £658 a year, yet Thames Water continues to fail them. Sewage has poured into the River Mole, which runs through my constituency. The rec next to the Esher treatment works, where children play, has had sewage in it. I told the House last week that there was sewage outside the local primary school in Thames Ditton, as well as in the middle of the village. Will the Government get a grip on this regulatory and state failure, put the company into special administration, and create a public interest company that serves my constituents properly?
Emma Reynolds
I am really sorry to hear about the sewage incident outside a local primary school. If the hon. Lady would like to take that up with me separately, I would be happy to follow it up. The Government are concerned about the underperformance of the company, which is why I expressed early concerns about this proposal. She is right to say that we need a solution that delivers for customers and the environment.
Josh Dean (Hertford and Stortford) (Lab)
My residents are rightly angry that Thames Water has discharged sewage into the River Stort, one of our rare and precious chalk streams, for hundreds of hours. I have raised the issue in this House before, and Thames Water told me that its improvement plan will not be in place until 2028. That is clearly not good enough. Does the Secretary of State agree that this is the latest in a litany of failures by Thames Water? What assurances will she give my constituents that she will ensure that the need to protect our precious chalk streams will be a priority future consideration in the future of Thames Water?
Emma Reynolds
My hon. Friend is right to say there have been 15 years of failure, with the company letting down customers and businesses in his constituency. Chalk streams are an absolute priority for me, both as a Member representing a constituency in the Chilterns and as Environment Secretary.
Olly Glover (Didcot and Wantage) (LD)
The Government have been very clear in their support for Thames Water’s proposed £5.7 billion White Horse reservoir in Oxfordshire. Given that Thames Water may run out of money in months, what assessment has the Secretary of State made of the risk that a collapse could lead to the Government having to bear the cost of the reservoir?
Emma Reynolds
As a country, we have failed to build a reservoir for 30 years. That cannot be right. On the specific reservoir to which the hon. Gentleman refers, we will have to look at the details, but as it stands the company is ongoing; it is a solvent company and it should continue to complete the projects that it started.
Chris Vince (Harlow) (Lab/Co-op)
I thank the Secretary of State for her statement, and my hon. Friend the Member for Hertford and Stortford (Josh Dean) for raising his concerns about the River Stort, which goes past my constituency. I spend many hours running alongside it, so I know what a beautiful area it is and that it needs to be protected. Mr Speaker, I cannot tell you the number of people—not just in Harlow but everywhere I go—who raise with me their dissatisfaction with Thames Water. I thank the Secretary of State for what she is doing to raise standards, but I am dubious that Thames Water is going to be able to reach them. If it does not reach those high standards, what is she going to do? People in Harlow do not want us to prop up a company whose failures hit the pockets of the public.
Emma Reynolds
I thank my hon. Friend for conveying the concerns of his constituency of Harlow. [Interruption.] The Minister for Harlow? I did not know that we had created that position!
The Government are prepared for all eventualities, and I reassure my hon. Friend that whatever happens, the Government will ensure continuity of service for his constituents with regard to water supply and waste water services.
Several hon. Members rose—
Mr Speaker
Order. I am only going to call Members whose constituencies have Thames Water. Clive Jones, I think you are one of those Members.
Clive Jones (Wokingham) (LD)
Thank you very much, Mr Speaker. Residents in Wokingham have endured years of sewage dumping by Thames Water and ever-rising bills, while stakeholders have lined their pockets. The current ownership model is unsustainable, so will the Minister consider the Liberal Democrats’ call for water companies to be mutually-owned public benefit corporations, putting customers and the environment first, rather than prioritising the interests of creditors and financial institutions?
Emma Reynolds
When I served as the Economic Secretary to the Treasury, I worked on our plan to double the number of mutuals across the economy. More broadly, not just with regard to Thames Water, I would be happy to see more mutual ownership of water companies, but the question is how we get there.
Chris Hinchliff (North East Hertfordshire) (Lab)
The Secretary of State has made the right decision in seeking to protect billpayers and opposing giving Thames Water a free pass to continue polluting our rivers. The thousands of hours of sewage spills into chalk streams and their tributaries across North East Hertfordshire that Thames Water has continued to oversee are unforgiveable, if not technically illegal. Thames Water is failing in practically every possible way. The level of incompetence is staggering, given that it has 16 million captive customers. My constituents are not interested in Thames Water being given any more chances—[Interruption.]
Mr Speaker
Order. What is the hon. Member for Caerphilly (Chris Evans) doing, on his feet while another Member is speaking? Come on, Chris, you should know better than anybody!
Chris Hinchliff
Will the Secretary of State put an end to this unholy mess and rid us of this frankly parasitic company once and for all?
Emma Reynolds
I thank my hon. Friend for mentioning chalk streams. Like my hon. Friend the Member for Hertford and Stortford (Josh Dean), I have chalk streams in my constituency, and they are close to my heart. My hon. Friend the Member for North East Hertfordshire (Chris Hinchliff) is right to say that Thames Water is the biggest water company in the country, with 16 million customers. The Government stand ready for all eventualities, including a special administration regime. The customers are at front and centre of my consideration of this issue.
Victoria Collins (Harpenden and Berkhamsted) (LD)
My very first letter as a Member of Parliament was to Thames Water, following the unacceptable fact that thousands of hours of sewage had been released into the River Ver, one of our precious chalk streams. Whatever the future structure of Thames Water, what guarantees can the Minister put in place that the environmental obligations will be strengthened rather than weakened?
Emma Reynolds
As I have said previously, regardless of how the situation develops, the Environment Agency will continue to investigate pollution incidents and take enforcement proceedings against any company involved, including Thames Water.
Calum Miller (Bicester and Woodstock) (LD)
In March, my constituents in North Leigh and Eynsham went without water for nearly three days due to the collapse of a major waterpipe. They are angry that one third of their bill payments go towards Thames Water’s ballooning debt, and to paying vulture funds, like Elliott Associates, instead of maintaining and replacing ageing infrastructure. My hon. Friend the Member for Witney (Charlie Maynard) was right to challenge further borrowing by Thames Water in the Supreme Court. Does the Secretary of State now agree with the Liberal Democrats that Thames Water’s financial model is broken?
Emma Reynolds
As I said in answer to a previous question, through the clean water Bill the Government will seek to ensure that the new water regulator—which will be integrating the functions of Ofwat, the EA, the Drinking Water Inspectorate and Natural England—does not allow companies to get into the sorts of unmanageable levels of debt that we have seen.
Charlie Maynard (Witney) (LD)
It is clear that the creditors’ consortium has material influence over Thames Water, as it is funding the company and bilaterally negotiating with the Government. Material influence means that the consortium meets the defined criteria of being an ultimate controller. Will the Secretary of State finally acknowledge that fact and work with Ofwat to enforce it?
Emma Reynolds
We are working closely with Ofwat, which has been talking to the consortium of investors for two years. Through my officials, the Government have been in discussions with the consortium alongside Ofwat since November. I thank all the officials who have been involved in those discussions. We need to find a way forward that puts customers and the environment at its heart.
Personal Statements
(1 day, 4 hours ago)
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John Healey (Rawmarsh and Conisbrough) (Lab)
With your permission, Mr Speaker, I will make a personal statement on my resignation as the UK Defence Secretary. Many in the media have pressed me to say more since Thursday, but I am a proud parliamentarian, and I wanted first to speak in this House, as I take my seat on the Back Benches for the first time in more than 10 years.
I took the decision to resign with the greatest regret and reluctance. I continue to be certain about the decision. In time, I believe it will be seen as necessary in securing the future of our armed forces and alliances. It has been the privilege of my life to work alongside the exceptional people who serve this country in Defence—military and civilian alike. They work 24/7, so often unseen, and are the very best of Britain. They, and the new Defence Secretary, have my fullest support.
I have been a Labour MP for nearly 30 years, a Labour member for 45 years and a trade unionist for longer still. It is my family—literally. Jackie, my wife, worked for Labour HQ. We met at a union conference. Two weeks later, we were engaged. All of us in politics ask so much of our partners. We only ever wanted a successful Labour Government leading a stronger Britain. My decision last week was about country, not career.
I loved the job, though I will not miss going to bed with three phones or the 3 am phone calls. I am proud of what we have done in less than two years as a Labour Government. We stepped up international leadership for Ukraine, raised defence investment three years earlier than anyone expected, won record defence export deals, gave the armed forces their biggest pay rise for 20 years, brought 36,000 forces family homes back into public ownership, and signed major defence agreements with Germany, Norway, France and the European Union. Delivering for defence; delivering for Britain.
The Prime Minister has led that drive, rightly earning respect at home and abroad. He and I jointly commissioned the first-of-its-kind strategic defence review, which has set the vision to transform our armed forces to make our military more warfighting ready and better able to deter. We have been doing exactly that in the 12 months since the SDR was published. We are delivering in a different way: investment with deep reforms to get a grip on budgets, procurement and delivery; investment so that every taxpayer’s pound works twice, once for national security and once to back British industry and create British jobs; investment in new defence tech—drones and AI—that draws lessons from Ukraine for our UK forces.
I will always seek cross-party common ground on defence, but I will not let the Conservatives forget their record in government or the hollowed-out legacy they left in our armed forces.
Since the SDR, we have seen the world changing still faster, with threats increasing and demands on defence rising: conflict in the middle east, new NATO missions in the High North, the US moving forces away from Europe, intensifying attacks in Ukraine and increasing Russian aggression towards the UK. NATO has now said that we must prepare for war with Russia within the next five years. This is the age of hard power and rising threat. This is not the moment for calibration or incremental change. This means bigger politics, bolder priorities and harder choices. Britain’s challenge now is the transformation and rearmament of our armed forces.
The Prime Minister knows what the country needs for defence. He spelled out the threat this month when he said:
“it is our intelligence assessment, and the assessment of other countries in NATO, that there could be an attack by Russia on NATO as soon as 2030.”
Britain must set the headmark of spending 3% on defence in 2030 and a clear path to 3.5% in 2035—the commitment all NATO nations have made to each other and to their people. I believe that this would command wide cross-party support.
Our predecessors in this House experienced what happens when deterrence fails. They entrusted us with institutions such as NATO that they created to keep us safe. We do not choose the circumstances in which we serve or the responsibilities that fall upon us, either in this House or in government. It is the duty of our political generation to ready Britain for the uncertainties of the years to come. The decisions that we make in the months ahead will be judged by those who follow us.
At this dangerous time, I see the current defence investment plans falling well short of what is required: a rise of 0.08% from next year to 2030, no date for reaching 3%, and no path to 3.5%. By 2030, well over half of NATO members will be spending 3% or more. When allies are looking for British leadership, we must not fall behind. When NATO needs European nations to step up, we must not fall short.
Our adversaries do not follow timetables set by the Treasury. I appreciate how hard this is for Cabinet colleagues, and I am very grateful to those who support what is required, but not all needs to be done by cutbacks elsewhere. There are credible ways of meeting the mid-term funding challenges, working multinationally and as other nations in Europe are doing, that could allow us to protect the ability to deliver our Labour missions across Government.
Beyond that, we need a bigger view of national security. It is not just a job for Defence or the agencies; every Department has a part to play in national security and national resilience. From Energy to Transport to Health, security must run through the Government like letters through a stick of rock. Security must be felt in communities right across Britain, reversing long-term decline and bringing new jobs and new hope.
For now, Jackie is just grateful that I no longer carry three phones in my bag, although I do still have my bottle of HP sauce.
Al Carns (Birmingham Selly Oak) (Lab)
With your permission, Mr Speaker, I would like to make a speech on my resignation.
I start by echoing the remarks of so many in the House on the 10th anniversary of the death of Jo Cox. While I did not know Jo, I know what she stood for. Her unwavering commitment to equality has left a lasting legacy, and her words—we have more in common than that which divides us—still ring true and are still worth fighting for. I also pay tribute to my right hon. Friend the Member for Rawmarsh and Conisbrough (John Healey). This is the second time I have followed him in the last week, and it is a privilege to do so.
Last week, I resigned as Minister for the Armed Forces. It was an exceptionally difficult decision. I have never quit anything in my life, as my mother will confirm; she tried to get me to quit the Marines for 24 years, but failed many times. I spent those 24 years in uniform, serving in operations around the world. I commanded men and women in combat and carried responsibility for their lives; I buried friends and stood beside families receiving the worst news imaginable. When I accepted ministerial office, I did so with a simple purpose: to serve those who serve us. I remain grateful to the Prime Minister for the opportunity to do so. I thank my ministerial colleagues, my hon. Friends on the Labour Benches, civil servants and, above all, the servicemen and women I have had the privilege to represent. But there comes a point when honesty requires action, and for me, that point came last week.
As hon. Members know, I came into politics for one reason: to enact change. In order to work out where we are going, we must realise where we have come from. The Labour party that I joined was chiselled out of the mines of the north-east, hammered out of the shipyards of Govan, Liverpool and Belfast, and forged in the factories of the industrial revolution by people with calloused hands and sore backs—people who did a hard day’s graft and asked for one thing in return: a Government who have their back. That is the tradition in which I serve in this House, and it is the tradition that shaped the decision I took last week.
I resigned for several reasons—first, because I no longer believe that the defence investment plan is preparing us for the wars we are most likely to fight. The character of warfare is changing at exceptional speed. In Ukraine, a navy without a ship has destroyed a navy. A drone costing thousands can destroy a tank costing millions. A drone can now strike 2,000 km into Russia at a fraction of the cost of a fighter jet. It is not either/or; it is an equitable mix of high-end sophistication coupled with low-end mass. That is the balance we must seek. In my view, the defence investment plan does not strike that balance for various reasons.
I want to give just a small example to bring home that point, because it can often get lost. In a town in Ukraine the size of Hereford, there were 12,000 drones in the air in one day. Just comprehend that: 12,000 drones in the air. Some 90% of all casualties are from drones—not the rifle, the grenade, the tank or the artillery, but the drone. I ask the House: what will it take to realise that these figures are not fiction? They are not an embellishment of the truth, but a hard fact born out of the blood and steel of a hot war. That is the maths of modern war: millions of drones against high-end, sophisticated systems that deliver late, with huge levels of inflation, and, importantly, cannot be reproduced at the pace required to sustain a conflict against a major adversary. What will it take to learn that lesson? Do we need to rerun the Snatch Land Rover? Do we need to rerun the lack of body armour? Do we need to rerun the lack of protected vehicles in Afghanistan, which I saw impact men and women on the frontline? We do not, and we should not.
Moreover, as the clouds of war darken Europe’s borders once more, do we need to learn the lessons our forefathers learned in world war two, or indeed the cold war? This is not about individual items of equipment or bespoke defence funding lines, but about preparedness, unity of purpose, prioritisation and national resilience. We are no longer packaging up our military to deploy to a foreign field; we must be ready to fight from here—from the home base—for democracy, for the right to self-determination and for European security. The reality is that we are spending too much time preparing for last year’s war, not tomorrow’s. I urge the House to push hard for transformation and to push for delivery this side of 2030.
Secondly, I resigned because even if the plan had been right, it was not adequately funded. I do not lay all the blame at the door of No. 10 or No. 11; we failed—I failed—to make that argument. But national security and economic security are not competing priorities; they are the same priority. A country that cannot defend itself will not stay prosperous for long. Put simply, a country that cannot defend itself will struggle to protect its prosperity.
Thirdly, I left because I could no longer ignore the continued failure to address the treatment of our veterans in Northern Ireland. It is a difficult issue, and I cannot describe how difficult this fight has been. Whatever people’s view of the troubles, a country owes a duty to those it sent into harm’s way under lawful orders, and that duty does not end when the uniform comes off. The labour movement was built on a simple idea—that the people who do the hard work that this country asks of them deserve the backing of the state in return. Too many veterans have carried uncertainty for too long, while others have benefited from political accommodations that were never available to those who served. I could not reconcile that with my own understanding of duty.
To go into slightly more detail, the IRA failed to achieve its political ends through the use of terrorist tactics, and we must be exceptionally careful that we do not help them achieve those ends through other means. Constant, never-ending legal wranglings that undermine the contract between the nation and those who serve is neither a good use of taxpayer money nor an effective execution of strategy. Having inquests, inquiries and an independent commission creates a hierarchy of truth. It will cost us hundreds of millions for 15 years, painting the state as an aggressor, supporting our adversaries, leading to political objections and causing untold anguish for those who only ever deployed to protect us. We have neither the political capital nor the resources to spare for this unjust journey.
In broader terms, in 2026 security means more than military strength alone. It means secure borders, secure energy, secure jobs and secure communities. It means people knowing that if they work hard and contribute, one unexpected bill will not push their family into crisis; it means knowing that their children will have opportunities that they did not. These things are absolutely connected. The cost of living is shaped by conflict thousands of miles from here. Hostile states target our infrastructure, supply chains and democracy. Energy security shapes economic security. Economic security shapes social cohesion. Importantly, above all else, social cohesion shapes national resilience.
The old line between domestic policy and national security is breaking down in front of us, but our history points the way. In 1945, Britain was exhausted and in debt. Our cities had been bombed, and rationing went on for years. Yet Attlee’s Government did not conclude that Britain could afford only one priority. They built the NHS, expanded the welfare state and invested in housing. They took the decision that Britain would become a nuclear power. Those decisions came from the same understanding of what this Government and Labour are for. A country worth defending should look after its people. A country that wants to look after its people must be secure enough to do so. That is the Labour tradition.
It is also, I would argue, the British tradition at its very best, but somewhere along the way we stopped thinking like that. We began treating defence, growth, energy, public services and social mobility as separate conversations. They are not. They are different parts of the same challenge: whether Britain can still provide security, opportunity and resilience for its people in a more dangerous world. That is why I ultimately concluded that I could no longer remain in Government. The issue was never simply a defence budget. It was whether the Government were moving with the urgency that the moment demands.
Nearly a million young people are outside education, employment and training. Poor mental health costs this country hundreds of billions. We know that our armed forces need modernising. We know that our adversaries are becoming more aggressive. We know that our energy system remains exposed. We inherited a mess, but the population is fed up of us pointing the finger. They are looking to us for courage, clarity and conviction to make changes at the scale and, importantly, the speed that the nation requires.
I have seen what our country can do. I have seen it in uniform. I have seen it in the communities across the nation. I have seen it on these Benches, where we are at our very best. The talent, the ideas, the passion, the courage—it is all here. Indeed, we have it all. I resigned because I believe that Britain and this Labour Government can deliver. I believe that we can think longer term and act earlier. I believe that we can once again build a country that provides security in the broadest sense of the word—security for our nation, communities, working families and the next generation. That is the debate that I am confident my resignation has started.
Point of Order
(1 day, 4 hours ago)
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Sarah Owen (Luton North) (Lab)
On a point of order, Madam Deputy Speaker. In February, the Women and Equalities Committee concluded an inquiry into the health impacts of breast implants and harmful cosmetic procedures. We sent our report to the Department of Health and Social Care on 18 February, expecting a response by 18 April. Four months on from sending that report, the official response is now two months overdue. We are still waiting on the Government.
Madam Deputy Speaker, I seek your guidance on what we can do to address this grave delay, which is a significant disrespect not only to my Committee members and the House of Commons staff who worked on the report but to the victims of harmful cosmetic procedures—people like Sasha who nearly died and who gave brave, vulnerable testimony publicly only to be ignored by the Department of Health and Social Care and Ministers.
Madam Deputy Speaker (Judith Cummins)
I am grateful to the hon. Member for giving notice of her point of order. There is a long-standing and well-understood convention that the Government respond to Select Committee reports within two months. Where that is not possible, the Department should engage with the Committee to explain why. I have no power to compel the Department to produce a response, but the Table Office will be able to advise her on how she might pursue the matter further.
Cyber Security and Resilience (Network and Information Systems) Bill
(1 day, 4 hours ago)
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16:07 - The House divided: - Ayes: 77 / Noes: 255 - Question accordingly negatived.
16:21 - The House divided: - Ayes: 151 / Noes: 258 - Question accordingly negatived.
16:34 - The House divided: - Ayes: 162 / Noes: 246 - Question accordingly negatived.
Victoria Collins (Harpenden and Berkhamsted) (LD)
I beg to move, That the clause be read a Second time.
Madam Deputy Speaker
With this it will be convenient to discuss the following: “Local Government Local Government The Secretary of State for Housing, Communities and Local Government” “Elections Electoral infrastructure The Electoral Commission” “Government Political parties The Secretary of State for Housing, Communities and Local Government” “Food supply Food supply chain The Secretary of State for Environment, Food and Rural Affairs (United Kingdom)”
New clause 3—Review of high-risk bodies—
“(1) The Secretary of State must, within six months of the passing of this Act, publish and lay before Parliament a review of the national security risks posed to relevant network and information systems by foreign state ownership or control of relevant bodies.
(2) A review under this section must assess—
(a) the number of relevant bodies which are owned, in whole or in part, by a foreign state or a foreign state-owned enterprise;
(b) the risk of such bodies being compelled to facilitate unauthorised access to, or surveillance of, network and information systems in the United Kingdom; and
(c) the adequacy of current powers under Part 4 (Directions for national security purposes) to mitigate such risks posed to the security and resilience of essential activities.
(3) In this section—
“relevant body” means—
(a) an operator of an essential service,
(b) a relevant digital service provider,
(c) a relevant managed service provider, or
(d) a critical supplier,
within the meaning of the NIS Regulations.
“foreign state-owned enterprise” means a body corporate in which a foreign state has a controlling interest;
“network and information systems” has the meaning given by section 24(1).”.
This new clause would require the Government to review the security risks posed by critical suppliers and essential service providers linked to foreign states and evaluate whether current powers are sufficient to address these threats.
New clause 4—Critical manufacturing and retail sectors—
“(1) The Secretary of State must, within six months of the passing of this Act, introduce regulations under section 24(3) to specify the following as essential activities—
(a) the manufacture of critical transport equipment;
(b) the industrial production and processing of food products; and
(c) the retail sale of food and essential goods via large-scale distribution chains.
(2) Regulations made under subsection (1) must designate appropriate regulatory authorities for these sectors.”.
This new clause would require the Secretary of State to designate the manufacturing of critical transport equipment and retail of food and essential goods (when part of a large-scale distribution chain) as essential activities, bringing them within the scope of Part 3 of the Bill.
New clause 5—Local authorities to be regulated as essential services—
“(1) The NIS Regulations are amended as follows.
(2) In the table in Schedule 1 (designated competent authorities), after the entry relating to the energy sector, insert—
(3) In Schedule 2 (essential services and threshold requirements), after paragraph 11 insert—
“The Local Government Sector
12 — (1) This paragraph describes the threshold requirements which apply to specified kinds of essential services in the local government subsector.
(2) For the essential service of the maintenance of electoral registers, the threshold requirement is that the entity is a local authority responsible for the maintenance of an electoral register.
(3) For the essential service of the management of social care records, the threshold requirement is that the entity is a local authority responsible for the management of social care records.
(4) In this paragraph “local authority” means—
(a) in England, a county council, a district council, a London borough council, the Common Council of the City of London or the Council of the Isles of Scilly;
(b) in Wales, a county council or a county borough council;
(c) in Scotland, a council constituted under section 2 of the Local Government etc. (Scotland) Act 1994;
(d) in Northern Ireland, a district council constituted under section 1 of the Local Government Act (Northern Ireland) 1972.”.
This new clause would bring local authorities within the scope of the NIS Regulations as operators of essential services in relation to their functions managing electoral rolls and social care records. This ensures that public sector bodies holding sensitive data such as electoral rolls and social care records are subject to the same statutory protections as other critical infrastructure.
New clause 6—Computer Misuse Act 1990: security and resilience of network and information systems—
“(1) The Secretary of State must, within twelve months of the passing of this Act, review whether amendments to the Computer Misuse Act 1990 may be conducive to ensuring, maintaining or improving the security and resilience of network and information systems used or relied upon in connection with the carrying on of essential activities.
(2) Following the conclusion of the review under subsection (1), the Secretary of State must lay before Parliament a report which outlines—
(a) the potential amendments to the Computer Misuse Act 1990 which were considered as part of the review;
(b) the review’s conclusions as to whether the potential amendments considered could be beneficial in ensuring, maintaining or improving the security and resilience of relevant network and information systems; and
(c) the Government’s intentions to make amendments to the Computer Misuse Act 1990 or act on any other recommendations of the review.”.
This new clause would require the Secretary of State to review, within 12 months, whether amending the Computer Misuse Act 1990 could improve the resilience of network and information systems, and to report the government’s intentions to Parliament.
New clause 7—Consultation on resourcing of regulatory authorities and regulated persons—
“(1) The Secretary of State must, within one year of the passing of this Act, carry out a consultation with regulatory authorities and regulated persons for the purpose of assessing—
(a) whether regulatory authorities and regulated persons have resources and capabilities adequate to fulfil their requirements under this Act; and
(b) whether further government support is needed.
(2) The Secretary of State must publish a report setting out the findings of the assessment carried out under subsection (1).”.
This new clause would require the Secretary of State to consult and report within one year on whether regulatory authorities and regulated persons have sufficient resources and capabilities to meet their statutory obligations, and whether additional government support is required.
New clause 8—Electoral infrastructure to be regulated as an essential service—
“(1) The NIS Regulations are amended as follows.
(2) In the table in Schedule 1 (designated competent authorities), after the entry relating to digital infrastructure insert—
(3) In Schedule 2 (essential services and threshold requirements), after paragraph 11 insert—
“The electoral infrastructure subsector
12 — (1) This paragraph describes the threshold requirements which apply to specified kinds of essential services in the electoral infrastructure subsector.
(2) For the essential service of the administration of an election or the maintenance of an electoral register in the United Kingdom, the threshold requirement is that the service relies on network and information systems to—
(a) maintain a register of electors containing more than 50,000 entries;
(b) issue, receive, or process postal ballots for a parliamentary or local government election; or
(c) count or aggregate votes cast in a parliamentary, mayoral or local government election.
(3) In this paragraph—
“parliamentary election” means an election of a Member to serve in the Parliament of the United Kingdom;
“network and information system” has the meaning given by section 24(1) of the Cyber Security and Resilience (Network and Information Systems) Act 2026.
(4) In regulation 8A (nomination by an OES of a person to act on its behalf in the United Kingdom), after paragraph 1(b) insert—
‘(c) provides an essential service of a kind referred to in paragraph 11 of Schedule 2 (elections sector) within the United Kingdom.’”.
This new clause would designate the administration of elections and maintenance of voter registers as an “essential service” within the meaning of the NIS Regulations.
New clause 9—Political parties to be regulated as an essential service—
“(1) The NIS Regulations are amended as follows.
(2) In the table in Schedule 1 (designated competent authorities), after the entry relating to digital infrastructure insert—
(3) In Schedule 2 (essential services and threshold requirements), after paragraph 11 insert—
“The political parties subsector
12 — (1) This paragraph describes the threshold requirements which apply to specified kinds of essential services in the political parties subsector.
(2) For the essential service of the management and operation of a registered political party in the United Kingdom, the threshold requirement is that the political party is represented by at least two Members of the House of Commons.
(3) In this paragraph—
“registered political party” means a party registered under Part 2 of the Political Parties, Elections and Referendums Act 2000.”.
This new clause would designate political parties as providing essential services for the purposes of cyber security.
New clause 10—Board oversight of security and resilience of network and information systems—
“(1) Where a relevant body is governed by a board or equivalent management body, that body must exercise oversight of arrangements relating to the security and resilience of the body’s network and information systems.
(2) In exercising oversight, the management body must—
(a) approve the approach taken by the body to the management of risks to the security and resilience of the body’s network and information systems; and
(b) satisfy itself, on a periodic basis, that appropriate and proportionate measures are in place to manage those risks.
(3) The management body may be held accountable for failures by the body to comply with duties relating to the security and resilience of its network and information systems.
(4) Members of the management body must undertake training designed to enable them to identify risks and assess appropriate risk-management practices.
(5) For the purposes of this section, a relevant body is one which is—
(a) an operator of an essential service,
(b) a relevant digital service provider,
(c) a relevant managed service provider, or
(d) a critical supplier,
within the meaning of the NIS Regulations.”.
This new clause would require active board oversight of, and accountability for, security and resilience measures, where a relevant body is governed by a board or similar body.
New clause 11—Requirement for regular testing of network and information systems—
“(1) A relevant body must undertake regular testing of the security and resilience of the network and information systems on which it relies in the provision of its services.
(2) Testing undertaken in accordance with this section must—
(a) be proportionate, having regard to the size, nature and risk profile of the business; and
(b) be conducted periodically, at intervals that are appropriate to the risks identified by the body.
(3) A relevant body must document—
(a) the outcomes of testing undertaken in accordance with this section; and
(b) any remedial actions required or taken in response to the testing.
(4) Information documented under subsection (3) must be provided to the relevant regulatory authority upon request.
(5) For the purposes of this section, a relevant body is one which is—
(a) an operator of an essential service,
(b) a relevant digital service provider,
(c) a relevant managed service provider, or
(d) a critical supplier,
within the meaning of the NIS Regulations.”.
This new clause would require bodies to carry out proportionate, periodic testing of the security and resilience of their network and information systems and provide the results to regulatory bodies upon request.
New clause 12—“Last-resort” powers in respect of data centres and AI models—
“(1) Regulations under section 29(1) may confer on the Secretary of State powers (“last-resort powers”) to direct the shutdown of—
(a) data centres, or
(b) AI systems used or deployed by a data centre,
in the event of an AI security or operational emergency.
(2) For the purposes of this section—
“data centre” has the meaning given in paragraph 11 of the NIS Regulations (as amended by this Act);
“AI system” means a machine-based system that, from the input it receives, can infer how to—
(a) generate predictions, digital content, recommendations, decisions or other similar outputs, or
(b) influence a physical or virtual environment,
with a view to achieving an explicit or implicit objective;
“used or deployed” means made available to—
(a) a substantial number of individuals within the United Kingdom; or
(b) providers and operators of essential services;
“AI security or operational emergency” means a situation where the Secretary of State has reasonable grounds to believe that—
(a) there is a security or operational compromise to one or more relevant network and information systems,
(b) this compromise is caused, or contributed to, by the use or operation of an AI system used or deployed by a data centre, whether through autonomous or non-autonomous means; and
(c) this compromise poses a catastrophic risk;
“catastrophic risk” means a risk carrying a reasonable likelihood of causing or contributing to—
(a) large-scale disruption to critical infrastructure or essential services;
(b) significant degradation of the national security, national defence, or intelligence capabilities of the United Kingdom; or
(c) severe, large-scale harm to human life;
“data centre operator” means a person who operates a data centre;
(3) As soon as reasonably practicable after, and in any event within seven days of, giving a direction under subsection (1), the Secretary of State must—
(a) lay a report before Parliament setting out the direction and the reasons for it; and
(b) take all reasonable steps to arrange for the report to be the subject of a debate in each House as soon as is reasonably practicable.
(4) Regulations relating to last-resort powers must establish requirements on data centre operators in relation to data centres used for the training, deployment or operation of AI systems, including relating to—
(a) the possession or installation of technical infrastructure necessary for compliance with last-resort powers;
(b) the provision of secure communication channels for use by the Secretary of State when utilising last-resort powers;
(c) the implementation of regular emergency exercises to ensure that a direction under this section can be received safely and implemented; and
(d) post-mortem processes to be followed before a data centre is allowed to resume operations after the use of last-resort powers, including—
(i) incident reporting; and
(ii) implementation of mitigation measures to prevent recurrence.
(5) A person commits an offence if they fail to comply with any requirement imposed by regulations made under subsection (4).
(6) Regulations relating to last-resort powers may—
(a) confer on the Secretary of State, or on a person designated by the Secretary of State, powers to act where they reasonably believe that an offence under subsection (5) is being, has been, or may be about to be committed;
(b) include, for the purposes of paragraph (a), powers to—
(i) close premises;
(ii) turn off systems or require that they be turned off;
(iii) take any other action necessary to control the risk arising from an AI security or operational emergency.
(7) Regulations must require that, where powers under subsection (6) are exercised, the Secretary of State must—
(a) give written notice of the action taken, and the reasons for the action taken, to the operator or provider as soon as reasonably practicable; and
(b) inform the operator or provider of their right to apply to the High Court for relief.
(8) The High Court may make any order it thinks fit on an application under subsection (7)(b), including—
(a) confirming, varying or cancelling the requirements;
(b) imposing additional requirements;
(c) ordering compensation.
(9) The Secretary of State must publish guidance on the use by licensing authorities, planning authorities and other public authorities of their statutory powers to facilitate compliance with regulations relating to this section.
(10) A public authority must have regard to guidance issued under subsection (9) when exercising any function to which the guidance relates.
(11) The Secretary of State must, within six months of the commencement of this section and subsequently at six-monthly intervals, prepare a report on the causes and potential causes of AI security or operational emergencies and lay a copy of the report before Parliament.
(12) The causes and potential causes of AI security or operational emergencies considered in any report under subsection (11) must include —
(a) adversarial uses of AI systems by state and non-state actors;
(b) the capabilities for cyber-attacks by autonomous AI systems; and
(c) the development of AI systems that can autonomously compromise national security, escape human oversight, and upend international stability, including systems described as “superintelligent AI”.”.
This new clause would enable the Secretary of State to be granted “last-resort powers” to ensure that the government can intervene in case of an emergency caused by AI used or deployed by a data centre which can cause large-scale harm.
New clause 13—Digital Sovereignty Strategy on risks posed by foreign interference and reliance on foreign technologies—
“(1) The Secretary of State must, within 12 months of the passing of this Act, publish a strategy (“a Digital Sovereignty Strategy”) which sets out the Government's approach to maintaining the security and resilience of relevant network and information systems by—
(a) assessing, managing and mitigating risks—
(i) associated with foreign interference,
(ii) arising from reliance on foreign-supplied technologies, and
(b) preventing over-reliance on foreign providers by building domestic capacity.
(2) For the purposes of this section, a “relevant network and information system” is a network and information system belonging to—
(a) an operator of an essential service,
(b) a relevant digital service provider,
(c) a relevant managed service provider, or
(d) a critical supplier, within the meaning of the NIS Regulations.
(3) A Digital Sovereignty Strategy published under this section must—
(a) include risks associated with—
(i) hardware,
(ii) software,
(iii) supply chains, and
(iv) procurement processes;
(b) include a specific focus on security and resilience in government digital procurement processes, detailing how the Government intends to reduce strategic dependencies on foreign-owned service providers to mitigate the risk of systemic disruption;
(c) include a commitment to prioritise the use of technologies developed in the UK by UK organisations in relevant network and information systems to reduce reliance on foreign technologies, and
(d) where risks are identified under subsection (1)(a)(i), state how the Government intends to address these risks by supporting the use of domestic technologies or systems for the purpose of ensuring the security of those systems.”.
This new clause would require the Government to publish a Digital Sovereignty Strategy setting out how it intends to address risks to relevant network and information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies.
New clause 14—Register of foreign powers for the purposes of Part 4—
“(1) For the purposes of informing action taken under Part 4 of this Act, the Secretary of State must by regulations, and within six months of the passing of this Act, establish and subsequently maintain a register of foreign powers that the Secretary of State believes present a risk to the United Kingdom’s critical network and information systems.
(2) Foreign powers determined by the Secretary of State as eligible for inclusion on the register under subsection (1) must include states which have been confirmed by GCHQ as posing a risk to the security or resilience of the network or information systems of one or more operators of an essential service or critical suppliers, including where the relevant risk is posed by state affiliated groups.
(3) Regulations under this section are subject to the affirmative resolution procedure.
(4) In this section, “foreign power” means—
(a) the sovereign or other head of a foreign state in their public capacity;
(b) a foreign government, or part of a foreign government;
(c) an agency or authority of a foreign government, or of part of a foreign government;
(d) an authority responsible for administering the affairs of an area within a foreign country or territory, or persons exercising the functions of such an authority; or
(e) a political party which is a governing political party of a foreign government. A political party is a governing political party of a foreign government if persons holding political or official posts in the foreign government or part of the foreign government—
(i) hold those posts as a result of, or in the course of, their membership of the party, or
(ii) in exercising the functions of those posts, are subject to the direction or control of, or significantly influenced by, the party.”
This new clause would require the Government to maintain a register of state actors posing a threat to UK cyber security for the purposes of exercising the Secretary of State’s powers under Part 4 of the Act, which enable the giving of directions in the interests of national security.
New clause 15—Review of the cyber security risk posed by foreign powers—
“(1) The Secretary of State must, within 12 months of the passing of this Act and annually thereafter, review the extent and nature of the risk posed by relevant foreign powers to the network and information systems of operators of essential services and critical suppliers.
(2) A review under this section must identify whether any risk arises from—
(a) activities undertaken outside of the UK, or
(b) foreign owned or controlled infrastructure or locations within the UK.
(3) For the purposes of subsection (1), “relevant foreign powers” include states which have been confirmed by GCHQ as posing a risk to the security or resilience of the network or information systems of one or more operators of an essential service or critical suppliers, including where the relevant risk is posed by state departments, state agencies or affiliate groups.
(4) Within three months of each review under subsection (1), the Secretary of State must—
(a) lay before Parliament a report containing the findings and conclusions of the review; and
(b) where information is not included in a report on the grounds of being prejudicial to the UK’s national security, send such information to the Intelligence and Security Committee of Parliament.”
This new clause would require the Government to report on the risk to relevant network and information systems posed by specified foreign powers, considering whether such risks arise from extra-territorial activities and/or UK infrastructure or premises owned or controlled by foreign powers.
New clause 16—Digital Sovereignty Strategy (relevant network and information systems)—
“(1) The Secretary of State must prepare and maintain a Digital Sovereignty Strategy (“the Strategy”) in relation to relevant network and information systems.
(2) The Strategy must—
(a) set out the Government’s assessment of the risks to relevant network and information systems arising from or related to—
(i) dependence on hardware, software, or digital services that may be subject to foreign interference;
(ii) extra-territorial legal requirements that may be imposed on non-domiciled suppliers;
(iii) vulnerabilities, undue control, or supply-chain dependency on foreign states or entities;
(b) technological developments, market concentration, or strategic dependencies that may affect the security or resilience of relevant network and information systems;
(c) set out the Government’s approach to mitigating the risks identified under subsection (2); and
(d) include an assessment of—
(i) the role of open source software, open standards, and open architectures in strengthening the resilience, transparency, and security of relevant network and information systems;
(ii) the security and maintenance needs of open source software components used, or proposed to be used, in relevant network and information systems;
(iii) the skills, capabilities, and capacity of United Kingdom-based developers, maintainers, and technical experts required to support the use of open source components in relevant network and information systems;
(iv) options to increase the use of open source components and to diversify open source suppliers, reduce strategic dependencies, and enhance domestic capability in key technologies used in relevant network and information systems;
(v) options for international collaboration in the production of open source components used in relevant network and information systems;
(vi) any legislative, regulatory, procurement, or policy measures the Government considers necessary to support digital sovereignty through open source components and reduce systemic risk in relation to relevant network and information systems.
(3) The Secretary of State must publish the Strategy and any revisions to it, subject to the redaction of information the publication of which would be reasonably likely to prejudice national security.
(4) The Strategy must be reviewed at least once in every three-year period but may be updated whenever the Secretary of State considers that significant new risks have arisen.
(5) In this section—
“relevant network and information system” means a network and information system belonging to—
(a) an operator of an essential service,
(b) a relevant digital service provider,
(c) a relevant managed service provider, or
(d) a critical supplier,
within the meaning of the Network and Information Systems Regulations 2018;
“digital sovereignty” means the ability of the United Kingdom to maintain secure, resilient, and reliable access to and control over the hardware, software, data, and digital services on which relevant network and information systems depend;
“open source” has the meaning given to it in the definition published by the Open Source Initiative.”
New clause 18—Review of the number of bodies providing cloud computing services—
“(1) The Secretary of State must, within six months of the passing of this Act, publish and lay before Parliament a review of the risks posed to relevant network and information systems by the number of different bodies providing or supplying cloud computing services.
(2) For the purposes of this section, “cloud computing services” has the meaning given in paragraph 1 of the NIS Regulations.”
This new clause would require the Government to review the risks posed to relevant network and information systems by the number of different bodies providing or supplying cloud computing services.
New clause 19—Review of risks posed by foreign state ownership or control of providers of cellular Internet of Things modules—
“(1) The Secretary of State must, within six months of the passing of this Act, publish and lay before Parliament a review of the risks posed to relevant network and information systems by foreign state ownership or control of providers of cellular Internet of Things modules.
(2) For the purposes of this section–
“cellular Internet of Things modules” means devices that communicate over public mobile networks for the purposes of enabling autonomous machine to machine communication;”.
This new clause would require the Government to review the risks posed to relevant network and information systems by providers of cellular Internet of Things modules owned or controlled by foreign states.
New clause 20—Specification of retail commerce as an essential activity—
“(1) The Secretary of State must, within six months of the passing of this Act, introduce regulations under section 24(3) to specify as an essential activity retail commerce carried out by companies with an annual turnover in excess of £12 billion.
(2) Regulations introduced under subsection (1) must designate appropriate regulatory authorities for this sector.”
This new clause would require the Secretary of State to designate retail commerce carried out by companies with an annual turnover in excess of £12 billion as an essential activity, bringing it within the scope of Part 3 of the Bill.
New clause 21—Food supply chain to be regulated as an essential service—
“(1) The NIS Regulations are amended as follows.
(2) In the table in Schedule 1 (designated competent authorities), after the entry relating to digital infrastructure insert—
(3) In Schedule 2 (essential services and threshold requirements), after paragraph 11 insert—
“The food supply chain subsector
12 — (1) This paragraph describes the threshold requirements which apply to essential services in the food supply chain subsector.
(2) For the essential service of the food supply chain in the United Kingdom the threshold requirement is that the person is in the food supply chain and does not qualify as small or a micro-entity (or is excluded) within the meaning of Part 15 of the Companies Act 2006.
(3) For the purposes of this paragraph—
(a) a “food supply chain” is a supply chain for providing individuals with items of food or drink for personal consumption, where the items consist of or include, or have been produced to any extent using—
(i) anything grown or otherwise produced in carrying on agriculture, or
(ii) anything taken, grown or otherwise produced in carrying on fishing or aquaculture;
(b) a person is “in” a food supply chain if that person is a producer or an intermediary in a food supply chain.
(4) In paragraph (3)(b)—
(a) “producer” means a person who is carrying on agriculture, fishing or aquaculture;
(b) “intermediary” means a person in the food supply chain between a producer and the individuals referred to in paragraph (3)(a).
(5) In this paragraph—
“agriculture” includes any growing of plants, and any keeping of animals, for the production of food or drink;
“aquaculture” means the breeding, rearing, growing or cultivation of—
(a) any fish or other aquatic animal,
(b) seaweed or any other aquatic plant, or
(c) any other aquatic organism.
“plants” includes fungi.
(6) In regulation 8A of the NIS Regulations (nomination by an OES of a person to act on its behalf in the United Kingdom), after paragraph 1(b) insert—
‘(c) provides an essential service of a kind referred to in paragraph 12 of Schedule 2 (food supply chain sector) within the United Kingdom.’”
This new clause would designate those in the food supply chain that rely on network and information systems as “operators of essential services” within the meaning of the Network and Information Systems Regulations 2018, thereby placing them under duties to manage risks to those systems and to provide notification regarding any incidents that have an impact on the food supply chain.
Amendment 1, in clause 8, page 7, line 36, at end insert—
“(1A) In paragraph (1), after “risks” insert “, including risks arising from fraud,””.
This amendment would explicitly include fraud as one of the risks to the security of network and information systems that relevant digital service providers must identify and manage.
Amendment 28, in clause 10, page 9, line 33, at end insert—
“(2A) The measures taken by an RMSP under paragraph (1) must ensure that the number of customers to whom the RMSP provides services does not exceed the critical risk threshold.
(2B) In paragraph (2A), the “critical risk threshold” is the number of customers within a sector or subsector where an incident affecting the provision of services to those customers by the RMSP would result in disruption that is likely to have a significant impact on the economy or the day-to-day functioning of society in the whole or any part of the United Kingdom.
(2C) Paragraph (2D) applies where the number of customers to whom an RMSP provides services exceeds the critical risk threshold by virtue of contracts entered into before the coming into force of section 10 of the Cyber Security and Resilience (Network and Information Systems) Act 2026.
(2D) The RMSP must take steps to reduce the number of customers to below the critical risk threshold, including exercising any right to terminate a contract or vary the terms of a contract.”
This amendment would place a duty on relevant managed service providers (“RMSPs”) to ensure that they do not provide services to manage the technology systems for a number of customers that exceeds a critical risk threshold, such that an incident affecting those services would be likely to result in significant disruption in the United Kingdom. This would prevent an RMSP managing the technology systems for a whole sector or subsector. Provision is also made for a situation where an RMSP is in breach of the critical risk threshold because of contracts entered into before the enactment of the Bill.
Government amendments 7 to 11.
Amendment 6, in clause 18, page 40, line 12, at end insert—
“(8A) Where the CSIRT receives notification of an incident under regulation 11, 11A, 12A or 14E which it considers to materially involve autonomous or adaptive systems based on machine learning, the CSIRT must share relevant technical information with the relevant body within 72 hours.
(8B) For the purposes of this regulation, a “relevant body” means the AI Security Institute or any successor or replacement body designated by the Secretary of State.”.
This amendment would require incident data relating to AI systems in critical national infrastructure to be sent to the body designated by the Government as responsible for AI safety and security.
Government amendments 12 to 14.
Amendment 3, in clause 18, page 41, line 15, at end insert—
“Exemption from disclosure: right to a fair trial
(1) Nothing in sub-paragraphs (1)(d) to (1)(f) of regulation 6, or regulation 6A, permits a NIS enforcement authority to share information with another NIS enforcement authority or with a person within paragraph (2) of regulation 6 if the Secretary of State determines that—
(a) the receiving jurisdiction is one in which the right to a fair trial cannot be guaranteed, or
(b) the disclosure could result in actions being taken that would be incompatible with the right to a fair trial.
(2) For the purposes of making a determination under paragraph (1) above, the Secretary of State must have regard to the opinion of—
(a) subject matter experts, and
(b) competent civil society groups.
(3) The Secretary of State must, within 12 months of the passing of the Cyber Security and Resilience (Network and Information Systems) Act 2026, publish and lay before Parliament an annual report detailing the determinations made under paragraph (1) above in the previous 12 months.”
This amendment would prevent the sharing of information with overseas authorities for the purpose of prosecuting crimes not committed in the UK if the Secretary of State determines that the receiving country is one in which the right to a fair trial cannot be guaranteed.
Government amendments 15 to 17.
Amendment 4, in clause 29, page 54, line 9, at end insert
“, including the risks arising from the use of embedded communications components manufactured outside the UK;”.
This amendment would make explicit that regulations could concern the risks arising from the use of embedded components within the systems (such as cellular internet of things modules).
Amendment 2, in clause 40, page 63, line 7, leave out “5” and insert “3”.
This amendment would increase the frequency of the reports that must be published under Clause 40, from every five years to every three years.
Amendment 5, in clause 43, page 66, line 18, at end insert—
“(i) a requirement relating to embedded communications components manufactured outside the UK.”
This amendment would provide an additional requirement that may be imposed on a regulated person, in relation to an embedded communications component manufactured outside the UK.
Government amendments 18 to 27.
Victoria Collins
As the director of the National Cyber Security Centre has said,
“Every organisation delivering the UK’s critical services…relies on uninterrupted digital operations. Disruptions to those operations isn’t simply an IT issue; it’s a…national resilience issue”.
The Liberal Democrats wholeheartedly support that point, and it is why we welcome the measures introduced by this Bill, which strengthen existing cyber protections to enhance national security. However, as the Liberal Democrats have made clear throughout the Bill’s stages so far, there are many missed opportunities to truly future-proof our country’s cyber-security to protect our democracy, economy and national security. I will speak to the Liberal Democrat amendments to the Bill, which we think would achieve that.
First, on the scope of the Bill, last year we saw the costliest cyber-incident in UK history. The financial damage caused by the attack on Jaguar Land Rover is estimated to have cost between £1.6 billion and £2.1 billion—a cost shared between JLR directly and its supply chain. In the public sector, cyber-attacks are causing eye-watering costs too—just look at Redcar’s cyber-attack, which cost them a staggering £10.4 million. Despite that, the Bill takes no consideration of the significant economic cost of such cyber-attacks, excluding retail and manufacturing industries as well as local government from the scope of the Bill.
New clauses 4 and 5 address a crucial gap. New clause 4 would bring the manufacturing of critical transport equipment and the retail of food and essential goods, where they form part of a large-scale distribution chain, within the scope of essential categories under the Bill. That means that companies such as Jaguar Land Rover would finally receive the protections that their strategic importance demands and protect their supply chains too. New clause 5 extends that same recognition to local authorities, whose digital infrastructure underpins the delivery of services that millions of people depend on.
The Government’s own industrial strategy recognises that sustainable and secure growth requires strong levels of cyber-resilience across the economy, but their own cyber Bill does not live up to this. If a cyber-attack brought JLR’s production lines to a halt or crippled the digital infrastructure of a council, the damage to our economy and people’s daily lives would be enormous.
Those are not the only issues within the scope of the Bill. Safeguarding our democratic processes must be treated as a national security priority, and here, too, the Bill falls short. At a time when foreign interference in our elections is not a hypothetical but a documented and growing threat, the Government have chosen not to act. New clauses 8 and 9 would begin to change that. New clause 8 would designate the administration of elections and voter registers as essential services within the meaning of the network and information systems regulations—a straightforward recognition that the machinery of our democracy is as critical as any power grid or hospital network.
New clause 9 would designate political parties as essential services for the purposes of cyber-security, extending meaningful protection to the organisations through which the British people exercise their democratic voice. I understand that the Bill is not a silver bullet for cyber-security, but these amendments make the modest, targeted and entirely reasonable ask that vehicle manufacturing, food retail supply chains, local authorities, our elections and our political parties are brought within scope.
In turning to online-generated fraud and scams, we can see the impact of a lack of action to secure online and cyber-spaces. Fraud makes up 44% of all UK crime, and online technologies—especially artificial intelligence—are supercharging that. According to reporting in The Times a few weeks ago, research by Lloyds bank found that Meta’s social media sites are a starting point for 76% of purchase scams in the UK, with the value of losses to UK customers estimated at around £66 million in the last year alone. Not only does the Government’s fraud strategy completely overlook the role of social media giants and big tech in the proliferation of online scams, but the Bill fails to address explicitly the risks that fraud and scams pose to critical infrastructure and organisations. That is especially striking when we consider that the Government’s official statistics on cyber-security breaches show that phishing attacks—scams—remain the most prevalent type of breach or attack by far in the UK.
Amendment 1 would change that. It would amend clause 8 to add “risks arising from fraud” explicitly to the list of security threats facing relevant digital services so that those threats can be identified and managed. That is also why the Liberal Democrats are calling for social media giants to be financially liable for scams originating on their platforms and for an online crime agency to tackle these issues and standardise AI labelling.
We must not forget that these threats do not fall solely on large institutions and critical infrastructure. Small and medium-sized enterprises are on the frontline of cyber-crime; they are disproportionately targeted and too often without the resources or expertise to defend themselves. Many of the businesses caught up in the supply chains of our critical industries and exposed to the fraud and cyber-risks that I have described are SMEs, yet there are no provisions in the Bill to help potentially under-resourced SMEs cope with the increasing threat of cyber-attacks. New clause 2 would require the establishment of dedicated cyber-security support services for those businesses. For the Liberal Democrats, backing British small businesses means ensuring that they are not left to face those threats alone.
The Liberal Democrats have also tabled a series of further measures that would make the legislation fit for purpose over the long term. A law is only as good as its enforcement, which is why we are pressing for board-level accountability for cyber-resilience under new clause 10, regular proportionate testing of systems under new clause 11 and more frequent Government reporting every three years—rather than every five years—under amendment 2.
Last week, at London Tech Week, as I was surrounded by experts across the industry, one thing became clear. We think that technology is moving quickly now, but with the growth and development of AI this is the slowest we will ever see change happen. That is why we need the framework to evolve, which means reviewing the security risks posed by foreign-linked critical suppliers, which new clause 3 would do, modernising the outdated Computer Misuse Act 1990, which new clause 6 would do, and assessing whether regulators have the resources they actually need to do their job, which new clause 7 would do. Those are not radical tasks; they are basic conditions for a cyber-security regime that works today and will continue to work in the future.
If there is one matter that cuts to the heart of what the Bill should be about, and asks the fundamental question about Britain’s place in a contested digital world, it is digital sovereignty. All the protections we have discussed for our industries, our democracy and our small businesses will mean little if we do not first answer who controls the digital infrastructure on which all of them depend, and question whether, at every level of the stack, we have critical control over that.
That is echoed loudly by the industry itself. A study by Civo, a UK sovereign cloud provider, found that 83% of IT decision makers in this country worry about the impact of geopolitical developments on their data sovereignty. When we look at the numbers, it is not hard to see why. About 55% of central Government organisations report that over 60% of their estate is on the cloud, and the vast majority of that is with just two providers, both of which are American.
We have handed the keys to significant parts of our national digital infrastructure to foreign corporations, subject to foreign laws and exposed to foreign decisions entirely outside our control. That includes our public services. The Liberal Democrats are alarmed at the NHS’s growing reliance on complex, opaque digital systems set up by Palantir. With Palantir’s background in security and surveillance, that marks a divergence from the traditional relationship between the NHS and firms with specialised medical knowledge. The procurement process for the federated data platform, which was awarded to Palantir in 2023, is worryingly opaque.
Peter Fortune (Bromley and Biggin Hill) (Con)
I recognise the importance of sovereignty, but there are real challenges. How can we deal with the prevalence of, for example, Taiwanese chips in our tech market?
Victoria Collins
I thank the hon. Member for his question. That is why we need a strategy—we need to be clear about the Government’s priorities. On procurement, we have heard from the National Audit Office that cost is often a priority, but at what cost? When the Government are looking for suppliers, what do we value? There must be a strategy for that, and we need to have that conversation so that the direction is clear, whether on hardware or software.
Working internationally is vital, but it is also important to be clear about what is important for us, especially in the tech stack. That is the thing: it is about our security and resilience as well as our economy, strengthening those developing technologies as well as using technology. It is also about working together internationally and knowing that we have the resilience to look after and trade our technology stack.
Jim Shannon (Strangford) (DUP)
It is about our security, our cyber-security and our resilience. Within a three-mile radius of Belfast, we have some of the best cyber-security resilience in the whole of the United Kingdom. It is about those 2,750 employees and the £258 million of direct gross value added. Does the hon. Lady recognise that powerhouses like Belfast must be fully integrated into our national cyber strategy? Will she put on the record that that is what we should be aiming for?
Victoria Collins
I thank the hon. Member for his intervention. I absolutely agree. Across the United Kingdom, including in Northern Ireland, there are incredible British tech firms. Many of them have said to me that their services are being procured by other Governments in Europe and around the world, yet they find their own British Government not using them or getting the value out of that British technology here by developing skills and jobs.
The Liberal Democrats welcome the Government’s hardware strategy, announced last week, which at least acknowledges the importance of British procurement, but acknowledgment is not a strategy. New clause 13, which I am pleased to say has drawn support from across the House, would make it one. In an increasingly unstable world, the case for British digital resilience, British technology and British sovereign capability has never been stronger. I therefore urge hon. Members to vote for the new clause.
Cyber-security is no longer a technical matter confined to server rooms and IT departments. It is a question of national resilience, economic strength and democratic integrity. The Bill before us takes important steps, but important steps are not enough in today’s digital age. With these amendments, we have the opportunity to close the gaps, broaden the protections and build a framework that is genuinely fit for the digital age.
Madam Deputy Speaker (Judith Cummins)
I call the Chair of the Select Committee on Science, Innovation and Technology.
Dame Chi Onwurah (Newcastle upon Tyne Central and West) (Lab)
It is a pleasure to follow the hon. Member for Harpenden and Berkhamsted (Victoria Collins). I would like to start by making two relevant declarations of interest. I worked for the Office of Communications before entering Parliament and I am currently a fellow of the Institution of Engineering and Technology. Madam Deputy Speaker, you might have heard me mention on occasion that I was an engineer before coming into Parliament. As such, in 2010, I was desperate for issues around technology to come up in Parliament, as it was a subject I actually knew something about, but they rarely did. In the intervening 16 years, however, things have changed, and technology issues such as online safety, wi-fi on trains, sovereign technology and infowars are now raised regularly.
I welcome the increasing role of technology in all our constituents’ lives, but this must go hand in hand with rigorous cyber-security to protect against threats from state and non-state actors. As I highlighted in my speech on Second Reading, the UK’s only cross-cutting cyber-security legislation is currently that inherited from the European Union. The previous Conservative Government failed to update these regulations, leaving us working under an outdated framework. I therefore really welcome this Bill, which seeks to expand the scope of existing cyber-security regulations to new sectors, strengthen the role of regulators and grant the Government new powers to respond to the threats posed by cyber-security breaches.
We are only as secure as our weakest link, but I am afraid we still have a number of weak links left. Cyber-attacks are having a real financial impact on the UK and are happening at an increasing rate. According to the Institution of Engineering and Technology, cyber-attacks cost UK businesses an estimated £64 billion annually, with £37 billion in direct costs and £26 billion in indirect costs. Last year we also saw the well-documented cyber-attack that hit Marks & Spencer, leaving shoppers unable to buy online from the company for months. The company’s profits were almost wiped out, down from £390 million to £3 million for the first half of 2025. As a Sparks card holder myself, I was unable to use my card for six months and I fear I may have contributed to those figures.
This brings me to my first amendment, new clause 20, which seeks to designate retail businesses as an essential activity, bringing them within scope of part 3 of the Bill. Retail is the UK’s largest private sector employer. It holds large amounts of consumer data but often relies on dated IT systems. Yet, as I noted on Second Reading, the existing scope of the Bill would not have prevented or even had an impact on the attacks on Marks & Spencer or Jaguar Land Rover, despite the significant disruption they caused to our constituents and our economic activity. Indeed, in November, the Bank of England cited the cyber-attack on JLR as a factor in its decision to hold interest rates.
The Government’s plan to promote the new cyber governance code of practice to improve pre-operative preparedness in sectors such as retail is welcome, but voluntary measures alone will not deliver the consistent adoption of good cyber governance across economically significant sectors such as retail. According to the Government’s figures, only 9,680 Cyber Essentials Plus certificates were issued to small and medium-sized businesses between November 2023 and October 2024. There are an estimated 6 million small and medium-sized enterprises in the UK, so this is not going to address that challenge at the rate at which it needs to be addressed.
I welcome the Opposition amendments that would bring retail businesses within the Bill’s scope, but I am concerned that they might be too extensive in bringing small and medium-sized businesses into its remit and placing a disproportionate burden on them. The revenue threshold of £12 billion in my new clause 20 provides the necessary specificity to ensure that only large retail businesses, including Marks & Spencer and Jaguar Land Rover, would fall under the expanded Network and Information Systems Regulations 2018. This would lead to faster incident-reporting responses and customer notification, alongside stronger powers, including those to deal with non-compliance.
Turning to my new clause 18, we have already heard that the concentration of the UK’s public sector data within a small number of US-owned providers—Amazon Web Services and Microsoft Azure specifically—presents a structural risk to national resilience. Combined, AWS and Microsoft account for 70% to 80% of the public cloud market, according to the Competition and Markets Authority. Part of the issue is that that figure is an estimate. I have put down a series of written parliamentary questions over the last seven years to find out just how dependent the Government are on AWS and Microsoft. This data is not tracked across Government. Can the Minister say how he intends to assess a threat that the Government are not measuring?
As set out in my Committee’s report entitled “Rewiring the state: Delivering digital government”, our national resilience is put at risk by the strategic lock-in that these companies have in many of our public services and Administrations. Major Departments, including His Majesty’s Revenue and Customs and the NHS, are under multi-year agreements that further entrench these cloud infrastructures within the Whitehall ecosystem. Included in my Committee’s report was evidence we heard from the Open Cloud Coalition, who suggested that the Department for Science, Innovation and Technology should consider a period of over-correction, including the mandatory re-competition of high-risk or large-scale contracts, to break cycles of vendor lock-in.
The Government are rightly seeking to co-ordinate cloud contracting, but I believe that this should be done in a way that would ensure more, not less, competition. We would like to see the detail of how the all-of-Government cloud contract will prevent vendor lock-in, and I would like the Minister to outline his engagement with the CMA on the contract’s development. Not only does our reliance on these two cloud services raise practical issues—as seen with the AWS outage in October—but there are questions around data protection. Under the Clarifying Lawful Overseas Use of Data Act and the Patriot Act, the US Government can compel US companies, including AWS and Microsoft, to hand over data if held overseas—that is, in the UK.
I am aware that the Minister might reference our sovereign hosting capability, Crown Hosting, but it hosts only 4% of Government legacy services. Will he please outline how the Government intend to ensure protection so that the public sector makes better use of the services provided by Crown Hosting? Could he also set out how he will ensure that the Government’s digital transformation ambitions cannot be derailed at any time by decisions based on the narrow interests of a foreign, commercial or state actor? He might choose to argue that this is highly unlikely, but I would point him to the recent decision of the US Government to withdraw foreign nationals’ access to Anthropic’s Fable 5 model.
Finally, my new clause 19 calls on the Secretary of State to conduct a review into the risks posed by foreign state ownership or control of providers of cellular internet-of-things modules. I always like to mention that I was the first Member of Parliament to speak about the internet of things, in my debate back in 2011. Having worked in technology as an engineer, the threat posed by cyber-attacks on the internet of things was very real to me from the start of my parliamentary career. Indeed, in 2017 I wrote an article highlighting the threat of cyber-attacks on sex toys, in a vain attempt to raise the profile of the issue.
Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)
The hon. Lady was very prescient then, and it has got worse since. There was lots of talk under the previous Administration about Downing Street cars being searched for IOTs. We know about the huge imports from bad actors, such as China and other countries—that is really what we should be worried about. Many of them contain kill switches, which would devastate some of our industry, such as energy. That would be a disaster. She is right to have raised the issue and to continue to raise it.
Dame Chi Onwurah
The right hon. Member does well to remind us that the impact of hostile action using CIMs, such as by turning on a kill switch, would be devastating across multiple sectors, including potentially the consumer sector, as well as security, automotive, transport and finance. That is why it is so important to consider this.
I particularly draw the Minister’s attention to the list provided by the US Federal Communications Commission—the equivalent of Ofcom—of equipment and services covered by section 2 of the Secure and Trusted Communications Networks Act. The list dictates what technology is legally permitted to be authorised for import and sale in the US, and many companies on the list are owned or controlled by the Chinese state. I thank the Minister in the other place for meeting me and my hon. Friend the Member for Dunfermline and Dollar (Graeme Downie), whose amendment I also support, and hearing our concerns about the supply of IOT devices. It was unfortunate that the Minister did not see the need for action, particularly given that the US has taken action against Chinese-made goods and that, during a trip of the British-American Parliamentary Group to the US just last week, we heard that further action is likely to be taken against cellular IOT modules specifically. That could mean UK products being banned from import into the US if they contain such CIMs.
We have seen a rapid growth of those devices across transport, as we have mentioned, as well as energy and, importantly, water and health. I am concerned about the ability of our domestic British businesses to export into the US given those restrictions, as well as the impact on our security. I would therefore be grateful if the Minister could set out whether he is looking into that concern.
As was eloquently emphasised in the personal statements made by the recently resigned Secretary of State for Defence, my right hon. Friend the Member for Rawmarsh and Conisbrough (John Healey), and Armed Forces Minister, my hon. Friend the Member for Birmingham Selly Oak (Al Carns), the first duty of Government is the security of their citizens. That is true when it comes to our armed forces and our defence in the real world, and it is also true when it comes to our security in the virtual world. Those two overlap so much more than in the past.
I welcome the Bill, but I have real concerns about the need to bring retail businesses such as M&S within its scope, the concentration of the UK’s public sector data in a small number of US-owned providers, the implications for technology sovereignty that that raises, and the risks posed by foreign state ownership of providers of cellular internet-of-things modules. I hope that the Minister will address those concerns and deliver the cyber-security and resilience that our constituents deserve.
Sir Iain Duncan Smith
It is always a great honour to follow the hon. Member for Newcastle upon Tyne Central and West (Dame Chi Onwurah), who talks common sense most of the time she gets up, which may be one of the reasons why she is still on the Back Benches. If we listened more to those who know something about things, rather than talking as though we know things, and saying things that are invariably wrong, we in Parliament would obviously be better off.
The greatest threat we face is that bad actors out there are using this level of technology to get across to countries such as the UK. This is not a party political point, because both Governments have failed to face up to it to the degree that they should have—that is why this Bill is welcome, but it is not everything, as the hon. Lady says—but we think that we can treat the bad actors as though they were normal actors in a commercial sense. However, China is using slave labour to undercut markets and regularly puts IOTs into cars. It gets away with it because we think that we need China more than it needs us. That is the big problem. The hon. Lady is right to raise it, and I congratulate her for again making an excellent speech.
I will in due course beg to move my amendment on anti-refoulement, because although this is a good Bill, some bits are missing and others have been skated over. This is one area about which we will come, again and again, to regret that we had not done more. The issue is British citizens abroad ending up under the rule of Governments that do not believe in the concept of freedom before the law, in a fair trial as part of that process, or in habeas corpus, which is an English common law right that has gone around the world.
The amendment seeks to prohibit data sharing with jurisdictions that cannot guarantee a fair trial. It maintains the current legal approach, which generally restricts the sharing of sensitive information outside the EU. Currently, information sharing of a type enabled by proposed new regulation 6, which is in clause 18, is prohibited outside the EU. The proposed new regulation is therefore weaker than what is going on in the European Union. Sadly, it paves the way for such sharing, rather than restricting it.
The amendment therefore seeks to prohibit information sharing with places where the Secretary of State believes that a fair trial simply cannot be obtained. It would require the Secretary of State to consult civil society and human rights experts to identify jurisdictions—this would apply universally and not just to China, although China is a big player in this—where the right to a fair trial cannot be guaranteed, with all decisions subject to mandatory annual reports to Parliament. That is important: Parliament should be part of this and make decisions about whether it agrees with the Government.
Beijing is a good example. It has frequently used seemingly legitimate criminal complaints to target dissidents. Proposed new regulation 6, if unamended, therefore raises transnational repression risks rather than solving them. The amendment is necessary to close that loophole in the Bill, which currently fails to anticipate politically motivated requests from such totalitarian states. I often say that we should stop speaking about countries such as China, Russia, Iran and North Korea as authoritarian states. They are not authoritarian states; they are totalitarian states. Why do I say that? Because everything in those countries is owned and run by the state. Authoritarian states are often dictatorships, but they are not the same thing as totalitarian states. They are brutal and nasty, but totalitarianism is a complete system. This is about totalitarian states.
Proposed new regulation 6 is predicated upon helping other Governments obtain justice. The argument of my amendment 3 is that—quite apart from the transnational repression risks—justice as we understand it cannot be served in a country where essentially there is no rule of law, no right to a fair trial, and a judicial system that serves the party. As I often say, it is a matter of pride that perhaps the greatest gift this country has given to the world is the concept of freedom in the face of the law. That is the point I made earlier: habeas corpus came from English common law and dominates so much of the free world’s thinking. It was not until the 1970s that some countries in Europe actually practised habeas corpus, so it was not just the case that it was produced by Britain; it was also owned by many other countries. That is what is at risk here, and we should be the greatest defenders of that right to a fair trial anywhere in the world.
Let us take a few of these countries as examples for why amendment 3 is needed. Let us look at China. Requests were made by authoritarian states—totalitarian states in this case—regarding Interpol notices, as has been the recent pattern, and this happens a lot. The People’s Republic of China and other countries have a troubling recent history of very significant transnational repression, hounding dissidents in the UK and cloaking their political persecution in superficially legitimate criminal charges. The PRC is not alone in requesting information on political opponents in the UK, and it does it a lot. We can confidently speculate that China will make requests of the UK almost immediately should the Bill be passed.
Let me look at the single biggest case that confronts us in China at the moment: that of Jimmy Lai. He is a British citizen. I cannot tell you, Madam Deputy Speaker, how endlessly in debates, even under the previous Administration, we had to fight to get the Government to state that he is a British citizen, not a dual nationality citizen. He is a British citizen, is proud to be British, has been British all his life and has only ever owned a British passport—he has never been a Chinese citizen with a Chinese passport.
The special rapporteur on torture, Alice Jill Edwards, in her 2024 and 2025 reports, specifically flagged concerns that evidence obtained through torture is still widely admitted in Chinese courts. She also expressed concerns in late 2024 regarding the case of Jimmy Lai in Hong Kong, noting that evidence allegedly secured through torture in mainland China was and is being used in the trial. On 15 November 2024, the United Nations working group on arbitrary detention published its opinion that Jimmy Lai is “unlawfully and arbitrarily detained” and called for his immediate release. The proposed new regulation will not go far enough and therefore does not deal with this, and that is what my amendment 3 is all about.
On the risk of extradition to China from safe third countries, currently the UK does not have a bilateral extradition treaty with the People’s Republic of China, and it has suspended its bilateral extradition treaty with Hong Kong—something that many of us were calling out for at the time in 2020. In 2025, proposed changes to the Extradition Act 2003 would allow co-operation between UK and Hong Kong authorities on a
“case-by-case ad hoc basis”.
The trouble with that is that it begins to open the door. The risk of sharing NIS data is not confined to the physical removal of individuals; it also poses a profound threat to national security and the safety of the diaspora within the UK—how often have we heard about that?
These totalitarian states not only seek to extradite dissidents, they seek to silence them through transnational repression and to compromise the UK’s own digital resilience. Sharing NIS data with an adversarial jurisdiction is akin to providing a road map for a state-sponsored cyber-attack. For dissidents and human rights defenders living in the UK, NIS data can be used to demonise and de-anonymise their activity. This information is frequently used to identify and harass family members remaining in their home country, to conduct targeted phishing and surveillance against the individual’s private devices, and to coerce the individual into becoming an informant under the threat of criminal charges based on the shared technical data.
Let me deal with another case: that of Ryan Cornelius in the United Arab Emirates. Ryan Cornelius is a British citizen who has been arbitrarily detained in Dubai for 18 years, despite well-documented evidence of an unfair trial and inhuman treatment. Ryan’s detention has been found to be arbitrary by the UN working group on arbitrary detention. His case arose from a high-profile financial dispute involving loans connected to a major Dubai development project. Although he and his associates had reportedly complied with restructuring agreements with Dubai Islamic Bank, he was arrested without warning, transferred by plain-clothed officers to a police facility, where he was held incommunicado, denied access to a lawyer and subjected to aggressive interrogation. During this time, he was coerced into signing documents in Arabic—a language he does not understand—under the false premise that this would give him his release.
Matt Western (Warwick and Leamington) (Lab)
It is a pleasure to follow the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith). I concur with the points he made on Jimmy Lai and Jagtar Singh Johal and, more widely, about the internet of things. I think of Norway and Denmark, which suddenly realised that hundreds of buses they had imported from China had kill switches, meaning that their entire public transport networks could potentially have been disabled, just like that. That is the reality of these new technologies, and we need to face up to it and have our eyes wide open in the contracts and deals that we sign.
On Second Reading five months ago, I welcomed the Cyber Security and Resilience (Network and Information Systems) Bill, but even in the short time since then, the world has become an ever more dangerous place, and the cyber-threat has only intensified. I commend the Government on their hard work in the intervening period, and in my remarks today I want to focus on the cyber-threat landscape, my two amendments—new clause 21 and amendment 28—and the need for a national conversation on national security, which of course includes cyber-security.
Let me start with the cyber-threat landscape. The UK is the most cyber-attacked nation in Europe and the third most cyber-attacked nation globally, with three in four businesses having suffered a cyber-attack in the past year. My hon. Friend the Member for Newcastle upon Tyne Central and West (Dame Chi Onwurah) talked about the attacks on Jaguar Land Rover, Marks & Spencer, the Co-op and others. Having spoken with those businesses with the Joint Committee on the National Security Strategy and individually, I know of the scale of the impact that was felt within their operation and how affected they were by these attacks. It is unimaginable, even for the most seasoned business and industry leaders, to suddenly find themselves under such attack, and the repercussions for the economy have been very significant.
In April, the CEO of the National Cyber Security Centre, Richard Horne, laid out the scale of cyber-attacks: on average, the NCSC deals with around four nationally significant incidents a week—that is not the hundreds of incidents that are occurring every day, but the really serious, significant ones. The threat of cyber-attacks will only intensify. Continued state-backed cyber-attacks from Russia, China and Iran, either directly or via proxies, are being fuelled by technological advancements in AI and quantum computing, increasing the complexity and sheer volume of such attacks. The reality is that major cyber-attacks are no longer rare one-offs but an operational reality facing every business and organisation—public and private—across the UK, as they are globally. It is important that we secure our systems to make them more robust and deter such attacks, so that those who wish to do us harm will go after others. It is in this context that the Bill has been introduced, and it takes serious, robust steps to increase the resilience of the UK.
However, given the escalating threat picture, I continue to have concerns about the scope and breadth of the Bill. That is why I have tabled new clause 21 and amendment 28, which I hope the Minister will reconsider. New clause 21 would bring those in the food supply chain within the scope of the NIS regulations and regulate them as “operators of essential services”, while excluding smaller businesses, to avoid an unnecessary administrative burden. I understand that the Minister addressed this on Second Reading, explaining that essential services would only include those sectors
“the failure of whose network and information systems poses imminent threat to life to the British public.”—[Official Report, 6 January 2026; Vol. 778, c. 225.]
I would gently suggest that the collapse or disruption of the food supply chain would pose an imminent threat to life. I say that in an honest and not patronising way. Those of us who have had conversations behind the scenes about what happened during the pandemic, and Opposition Members who were far closer to that when in government, will realise that the health threat was one element, but the collapse of society—not just the economy, but society—with the potential for civil unrest and rioting, due to the lack of food and toilet rolls on shelves and so on, would have been the most urgent and pressing issue. It is worth noting that the European Union’s NIS2 directive does include food distribution in its regulation, so it is feasible and recognised internationally as important. The Bill does grant the Secretary of State powers to bring in new sectors. Could the Minister reassure me that the Department will give this due consideration today and in the future?
Secondly, amendment 28 would ensure that relevant managed service providers do not provide services to manage the technology systems for a number of customers that exceeds a critical risk threshold within the same sector or subsector. The rationale behind this is simple: it is about building resilience and ensuring that if one RMSP fails or is breached, a whole sector is not hamstrung by it. I can envision a situation whereby one particular RMSP dominates a large category or small subsector that may be a crucial part of a supply chain, thereby crippling the whole chain. Indeed, my hon. Friend the Member for Newcastle upon Tyne Central and West cited the UK Government’s dependency on AWS and Microsoft as an example. Will the Minister please consider that?
Aside from my two amendments, it is clear that the Bill, in itself, is not the only answer to our cyber-resilience; multiple approaches are needed. Given that the Bill does not include large swathes of the economy or local government, it is even more important that we explain to businesses and the public the very real threats that we face. That brings me to my final point, which is on the need for a national conversation on national security. We can have the best crafted and tightest legislation and regulation, but unless we have a real cultural shift and acknowledgment of the cyber-threat and its impacts, from board level to entry-level positions, all of this will be wasted. I once again encourage the Department and the whole machinery of government to go further and faster in explaining the threat posed and the steps we can all take to boost resilience, because resilience starts with the mobile phone in our pocket, and cyber-security is only as strong as its weakest link.
The Joint Committee on the National Security Strategy, which I chair, has begun its inquiry into building national resilience through a national conversation. It is clear from the evidence we have heard from Taiwan, the Netherlands and other European nations I have spoken to that we need to explain the threat to people, build a stronger cultural sense of resilience and explain that we all have a role to play; it is not simply the state’s responsibility. I will update the House on our findings in due course, and I hope the Minister and the Government will find that useful when considering their plans for national resilience.
To conclude, this Bill is a substantial and serious step forward in protecting the UK from cyber-attacks. It makes us more resilient and strengthens our collective security, but there are areas where I encourage the Government to be more ambitious—namely, by bringing the food supply chain into the essential services classification, as Europe is doing; setting critical risk thresholds for RMSPs; and expanding the scope of the Bill to encompass more of the economy.
Alex Sobel (Leeds Central and Headingley) (Lab/Co-op)
It is a pleasure to follow such esteemed colleagues. My only declaration before I start my speech is that I hold a degree in information systems from the University of Leeds.
I have been sat here for the last two hours looking at the memorial plaque for Jo Cox, 10 years after the horrific day that we lost Jo. I was a West Yorkshire candidate alongside Jo in the run-up to the 2015 election. It is to my huge detriment that I never got to serve with her here. Today is such a difficult day for so many colleagues. I know that Jo would have dearly liked to see many of the things that Labour is doing in government. It is incumbent on us to try to push forward all the things that Jo strived for, to make this place better, to make the country better and to make the world better.
Let me now turn to cyber-security. Data centres are warehouse-like facilities that house the information technology equipment upon which almost all digital activity relies. The UK Government say that they
“underpin almost all economic activity and innovation, including the development of AI and other technology, public service delivery”
and modern-day communications. Europe’s largest data centre market is Greater London, where most of the UK data centres are concentrated. There are four types of data centre, one being AI data centres, which are facilities specialised for the high-performance computing needs of AI development and AI models. Having data centres based in the UK allows our Government to regulate them, such as by requiring them to meet cyber-security standards and reduce their environmental impact, which is obviously very important.
Data centres are an essential part of our critical national infrastructure. They have a huge environmental impact so must be managed carefully, but the benefits of having them on our home turf is that we can regulate them. In our current state of hybrid war with Russia, it is vital to protect those data centres from any nefarious actors or cyber-warfare, and to strengthen their protections against cyber-attacks spawned by AI. Otherwise, the impact on public safety, the economy and society could be catastrophic.
Graeme Downie (Dunfermline and Dollar) (Lab)
I refer Members to my registered interest as parliamentary chair of the Campaign for Secure Technology, which I thank for its work in preparing my two amendments as well as my speech.
I echo the comments of my hon. Friends the Members for Leeds Central and Headingley (Alex Sobel) and for Newcastle upon Tyne Central and West (Dame Chi Onwurah) about the scale of the threat that we face from cyber-attack. We must ensure that we are having that national conversation about the nature of the threats we face, and who those threats come from. In many ways, this country is already in conflict with Russia, and in more than what we could call competition with China—something that the public are not fully aware of. We must do more to ensure that they are fully aware of that threat, and that they hold our feet, and those of the Government, to the fire, and ensure that we are taking the kinds of measures in this Bill, and beyond, that we need to protect our economy, our military and our democracy more widely.
I will limit my remarks to amendments 4 and 5, which I tabled. It is always difficult to speak at this point in a debate, because people with far more experience and knowledge than me have said a lot of the things that I was planning to say, and have done so with far more eloquence and knowledge than I have. Amendments 4 and 5 seek to deal with part of our digital infrastructure that is almost entirely invisible to the public and rarely discussed in Parliament—other than this afternoon—yet is essential to our national security: cellular internet-of-things modules. As my hon. Friend the Member for Warwick and Leamington (Matt Western) described, cellular IOT modules are small electronic components, about the size of a credit card, and they allow a device to connect to the internet over a mobile network. They sit inside everything from smart meters, CCTV cameras and traffic lights to industrial sensors, medical devices and parts of our energy grid. They are the connective tissue of our modern digital economy, and we all rely on them every day. Despite their importance, however, very little is known publicly about what they do and the potential harm that they could cause.
Today, more than 70% of all cellular IOT modules used globally are manufactured in China, and that dominance creates strategic vulnerabilities that the Bill must address. Amendments 4 and 5 would ensure that the Bill covers the risks created by embedded communications components manufactured outside the UK. Amendment 4 would ensure that the Secretary of State can treat the provenance of those components as a cyber-security risk, and amendment 5 would allow Ministers to require operators of critical systems to identify and mitigate those risks. In short, the amendments would give the Government clear authority to act where foreign-made modules create known vulnerabilities.
Why is that necessary? Because the modules present three major security threats. The first is dependency. When one country controls the overwhelming supply of a critical technology, that is by its nature a structural risk. If supply is disrupted, whether for geopolitical leverage or commercial pressure, our energy systems, transport networks and emergency services could be left without essential replacement parts. We have already seen that threat with Huawei and our 5G network—a mistake we must not repeat.
The second reason is disruption—as colleagues have said, that is increasingly referred to as the “kill switch”. Internet-of-things cellular modules contain firmware that can be updated remotely. If a manufacturer is subject to state influence—and in China we know that they are—it could insert a kill switch or back door that allows it to disable devices at scale and at will. It could push out malicious updates, insert malware or remotely disable devices. That could mean vehicles being turned off, cranes and industrial machinery being halted mid-operation, or financial terminals suddenly going offline. We could even see disruption to areas such as NHS refrigeration, affecting drugs and blood supply.
The concern with that type of module is that it might not happen overnight or be something we immediately see. It could be hidden for a number of weeks or months in different technologies and across different parts of our economy, and it would be incredibly difficult—nigh on impossible—to prove exactly what had happened and who had done it, and to tie it to any one state actor with certainty. It is certainly not something that could be done quickly, allowing for a full response. As my hon. Friend the Member for Warwick and Leamington said earlier, there are a number of examples of that from around the world. Perhaps the best known was when Russia invaded Ukraine in 2022 and tried to steal more than two dozen John Deere tractors and ship them to Chechnya. The US company intervened to switch them off. It remotely locked the thieves out of the equipment, rendering the tractors useless. That is the kind of action we could see China take in the event of a future crisis.
Closer to home, my hon. Friend the Member for Warwick and Leamington mentioned that Norway tested two of its Chinese-designed electric buses, one manufactured in the Netherlands and one built in China, to discover exactly the same kill switch technology.
Jim Allister (North Antrim) (TUV)
Does the hon. Member agree that, given that Transport for London now has 500 Chinese buses ordered and on the streets of London, there is a glaring opportunity for huge embarrassment to this nation if those kill switches were ever used on the buses in our capital city?
Graeme Downie
That proves why we need more awareness of the threat that we face. It is not necessarily a case of banning certain components or technologies, but we must be more aware and ensure that the Government have the powers they need to respond where possible.
Dame Chi Onwurah
My hon. Friend is right to say in his eloquent speech that raising awareness and having a debate about this issue is important, but the problems may not necessarily be the result of hostile actors. If the providers of the modules were to stop providing software updates, the modules would be more likely to fail and then become the subject of hostile attacks. So not only could the technology be killed by a hostile actor, but an increased dependency on software updates puts us at risk.
Graeme Downie
As ever, my hon. Friend is correct. How many of us have had some bit of technology break because the firmware is no longer allowed to be updated, meaning that something no longer works, it is no longer supported and it breaks down immediately?
To add to that, by its nature, something that is not regularly updated becomes more vulnerable to attack by hackers. They may not be state sponsored, but they may take advantage of a weaker part of a technology. That was pointed out to me on a recent visit to Taiwan. Its semiconductor industry is incredibly strong, but it builds the more high-tech elements of semiconductors. I was told that it would not bother to commit to manufacturing other types of technology because they were too cheap and simple to make and could be mass produced. On that note, I refer to my entry in the Register of Members’ Financial Interests about the trip to Taiwan. I did not intend to raise it during my speech, but there was an opportunity to do so.
The third element of risk is data extraction, as was mentioned by the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith). Under the Chinese national intelligence law, companies and organisations are legally required to assist state intelligence agencies and to hand over data upon request, creating a systemic risk in the UK that any data accessible through a cellular internet-of-things module could ultimately be accessible to the Chinese state.
Modern vehicles, especially electric and autonomous vehicles, are effectively computers on wheels, continuously collecting data on drivers, surroundings and infrastructure. The US Select Committee on China recently warned that Chinese EVs are “rolling data collection devices” and argued that restricting Chinese-made components is a national security imperative. The US Department of Commerce has now moved to limit the deployment of software and communications equipment sourced from adversary Governments in connected vehicles. Those who are worried about China’s reaction to such measures should be aware that it has already taken precisely these steps against the west. Tesla cars have been banned not just from entering Chinese defence, bases but from various Government agencies and authorities.
In the meeting mentioned by my hon. Friend the Member for Newcastle upon Tyne Central and West (Dame Chi Onwurah), I was concerned that there was a suggestion by one of the officials that there was no need to concern ourselves about the threat of Chinese internet-of-things modules because the threat was merely “theoretical”. As I and others have shown today, these examples are not just theoretical. Frankly, most threats are theoretical until they are not theoretical. This is happening now across critical sectors and national infrastructure. Other countries, such as the US, Australia and those in the EU, are all moving to toughen up their legislation specifically on cellular internet-of-things modules, and I believe that the UK must take action as well.
My amendments would ensure that the Bill explicitly covers these risks and gives Ministers the clarity and authority to act when necessary. If this Bill is to truly strengthen the UK’s cyber-resilience, it must not leave one of the most serious threats to our modern and increasingly digital world outside its scope. I ask the Government to work with me to address the threat of cellular IOT modules.
Melanie Ward (Cowdenbeath and Kirkcaldy) (Lab)
Madam Deputy Speaker, I hope you will not mind if I take a moment to reflect on the fact that today is the 10th anniversary of the murder of our dear friend Jo Cox. I was lucky to serve alongside Jo on the board of the Labour Women’s Network and we had done similar kinds of work previously. I often sit here in the Chamber and look at Jo’s shield and wonder what she would have made of the state of our politics, our country and our world today. I think about how much better we would be if she was still here to contribute. Jo’s most famous words matter so much today—that we
“have far more in common than that which divides us.”—[Official Report, 03 June 2015; Vol. 596, c. 674-65.]
As my hon. Friend the Member for Midlothian (Kirsty McNeill) said today, holding on to Jo’s words and keeping her spirit going matter always, but they matter even more when it is difficult to do that. I hope that Jo’s family and friends, and those closest to her, know how much she is missed and that we strive to carry her light forward with us.
Helen Maguire (Epsom and Ewell) (LD)
In my view, this Bill does not explicitly reference misinformation or disinformation threats. I have just met with the Council for Countering Online Disinformation, and in that meeting I learned that X’s algorithm amplified misinformation and disinformation online about the riots that took place in Epsom. Does the hon. Member agree that it is really important that we add strong safeguards against misinformation and disinformation into the Bill?
Melanie Ward
I certainly agree. Misinformation and disinformation are a huge challenge to our democracy and our country. We know that many enemy nations, such as Russia and Iran, are seeking to exploit loopholes, and I believe the Government have to take further action on that, for sure.
We should not wait to find out whether AI has the potential to damage our critical national infrastructure; we know that in some cases it does, and we should be prepared for it. “Catastrophic risk” includes harm to critical infrastructure, national security or a severe, large-scale harm to human life. Governments should have the power to prevent those risks from coming to pass. It is our No. 1 duty to keep our citizens safe. In a speech in April, the Secretary of State argued in favour of greater AI sovereignty in the UK, and kill switches would provide exactly that—sovereign control over the most dangerous risks posed by artificial intelligence.
New clause 12 includes proportionality and accountability, and the costs of implementing kill switches on data centres would be minimal, particularly in comparison with the financial losses associated with major cyber-attacks; we have heard more about that from many of my hon. Friends in this debate. It would ensure that there is parliamentary reporting within seven days of any direction from the Secretary of State and a debate in this House at the earliest opportunity. Any operator served with direction would have an immediate right to receive a High Court review.
We are elected to this House first and foremost to keep our nation safe. AI developers are moving at a pace far, far faster than Governments, and they are racing towards superintelligence. It is crucial that if—or, more likely, when—that is achieved, we have the right safeguards in place to avoid catastrophic outcomes. That is a crucial part of our national resilience and an issue that I and others who are present today continue to speak about, because it badly needs more attention.
New clause 12 does not seek to stymie the development of AI systems that could bring radical benefits to our society. Instead, it provides the Government with a suitable mechanism to stay ahead and in control of real threats to our critical national infrastructure. That is why I support the new clause and hope that the Government will do the same. If not, I ask the Minister to set out how the Government plan to ensure that we have these powers, which are so clearly needed.
Chris Vince (Harlow) (Lab/Co-op)
I thank all my hon. Friends and all hon. Members who have contributed to what has been a really good and well-meaning debate. People will be relieved to know that I intend to keep my contribution fairly brief. I say to the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith) that I do not pretend to be an expert when it comes to cyber-security and resilience, although other Members across the House would say that that has never stopped me talking before.
It was a pleasure to be on the Bill Committee for this legislation; in part, I think that was because of the very constructive nature of conversations in Committee. As the shadow Minister in particular will know, I sat very passively throughout Committee and said very little, which is common for me. This is a really important piece of legislation. As Members across the House have rightly said, it is the first duty of any Government to protect their citizens. There are obviously huge benefits as we move forward into a more technologically advanced world, but there are also real challenges, and as a country we need to be ready for them.
It was also a pleasure in Committee to have the opportunity to mention my father-in-law, Professor Robin Bloomfield—not least because I need all the brownie points that I can get—who is a professor of cyber-security at City St George’s, University of London. Let me also reference the fact that I have a data centre in my constituency, the Kao data centre; it is named after Charlie Kao, who, along with George Hockham, created the fibre-optic cable in Harlow. It is fair to say that I have some skin in the game in terms of the importance of this legislation.
When I looked through the list of amendments, the first thing I thought was, “The Liberal Democrats have been busying themselves.” I say genuinely to them that I welcome conversations about the need to protect local government and electoral services. Although I do not think that necessarily has to be covered in this legislation, I hope the Minister has listened to the comments made by the Liberal Democrats. We can absolutely come back to that conversation in this House, because it is hugely important that our democratic services in particular are not eroded by bad state actors, as has been discussed previously.
Jim McMahon (Oldham West, Chadderton and Royton) (Lab/Co-op)
On local government, there are clearly hundreds of local authorities, many of which are busy upgrading their systems. However, one thing that is not spoken about enough is the human capacity to actually do the work. Many local authorities, like Government themselves, find a real difficulty in recruiting the talent that they need. Does my hon. Friend agree that central Government could provide a greater role and act almost as a centre of excellence for cyber-security for local government?
Chris Vince
As a former councillor in a district council bordering London, I know the particular challenges we had in recruiting really decent council officers. I should put it on record that we have had some fantastic officers in Harlow district council, but it was always more difficult to recruit them, because they were drawn particularly to London. I recognise the challenges that he highlights, and I obviously want more support to be given to those professionals to understand cyber-security risks. My father-in-law is very much retired, so I am not giving him a job, but I am sure he would be very keen to see that as well.
My hon. Friend’s intervention brings me nicely on to my next point. My hon. Friend the Member for Warwick and Leamington (Matt Western) spoke very well and with a great deal of expertise on this topic. He referenced something that I referenced in Committee, which was that even if we think this legislation is perfect, it will not be enough. We need a culture shift when it comes to cyber-security, so I welcome my hon. Friend’s comments and ask the Minister to reflect on them when he concludes the debate.
I did say that I would not give a very long speech, but I have been on my feet longer than I thought I would be, which is typical of me. I will finish by saying that over 11,000 NHS appointments and procedures were lost last year due to cyber-attacks. For too long, successive Governments have failed to properly address the growing threats from cyber criminals and hostile states. I am pleased that this Government are addressing those threats by giving regulators new powers to designate which suppliers are critical in the supply chain, and by investing £210 million to tackle threats and strengthen public services. For that reason, I strongly support the Bill.
Luke Myer (Middlesbrough South and East Cleveland) (Lab)
My part of the world has already had a hard lesson in what a serious cyber-attack can do, and I thank the Liberal Democrat spokesperson, the hon. Member for Harpenden and Berkhamsted (Victoria Collins), for mentioning it. In 2020, Redcar and Cleveland council was hit by a cyber-attack that has been attributed to the Russian Conti syndicate, and around 135,000 residents were left without online public services. Systems were disrupted, and the cost was put at more than £10 million.
That is a story that has been repeated across our public and private sectors, and we have heard other examples today—my hon. Friend the Member for Leeds Central and Headingley (Alex Sobel) spoke about the NHS, and my hon. Friend the Member for Warwick and Leamington (Matt Western) spoke about manufacturers such as JLR. I echo their calls in the amendments they have tabled today, particularly about the need for last-resort powers in relation to data centres, but also for a national conversation about these issues. I have had discussions with constituents who are sceptical that the Russian state might attack a little council like ours, and it is important to get across the point that it is precisely because ours was low-hanging fruit that it was such a target for Russia.
That is exactly why this Bill is needed. Since the NIS regulations were introduced in 2018, the threat has changed; we are more interconnected and more reliant on cloud services, managed IT providers and data centres than ever before, often across long and complex supply chains. As such, it is very welcome that this Bill gives Ofcom a clearer role and brings significant data centre services into the regulatory framework, as well as relevant managed service providers and critical suppliers. The new reporting regime is a practical improvement as well—a 24-hour initial notification and a fuller report within 72 hours will help regulators and the National Cyber Security Centre to spot patterns, warn others and build a better national picture, which is especially important when we consider hostile states.
Cyber-security is plainly now a frontline part of our national defence—we have seen how Russian military intelligence activity is targeting Government and critical infrastructure, and we need to be equipped to respond. I am sympathetic to new clause 3, which relates to the role of foreign state bodies, but it ought to be broadened beyond critical and essential services. I will give an example that concerns the security of British citizens’ data from foreign Governments. Right now, the largest leveraged buy-out in history is under way—the takeover of global videogames maker Electronic Arts by Saudi Arabia and Jared Kushner’s Affinity Partners. They are buying access to the sensitive personal and behavioural data of 700 million players worldwide, as well as the ability to expand foreign influence in Britain. I urge the Government—both DSIT and the Department for Culture, Media and Sport—and the CMA to look at this deal with their eyes wide open. Ministers should be prepared to stand up for UK data, UK jobs and UK security.
The Chair of the Science, Innovation and Technology Committee, my hon. Friend the Member for Newcastle upon Tyne Central and West (Dame Chi Onwurah), mentioned interconnectedness between data security and national security. I endorse her amendments dealing with internet-of-things modules and the potential threat of hostile states switching off various pieces of infrastructure around our country. I also urge Ministers to keep pushing further on the threat of hostile state disinformation on social media, which has also been referenced in this debate. That is a fundamental security issue. Russia and others do not only try to knock systems offline; they also try to rot public trust, spread falsehoods and undermine democracy, so the technical threat and the information threat are part of the same hostile playbook. I do wonder whether regulators have sufficient resources to act, and I will listen carefully to the Minister’s remarks on new clause 7.
Ultimately, this Bill does not solve every problem, but it is a serious and necessary step forward. It strengthens resilience, widens responsibility, improves reporting, and gives Government clearer powers where national security is at risk. As such, I support the Bill.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
Before I begin, I would also like to make some remarks in commemoration of the 10th anniversary of the murder of Jo Cox. I never met Jo Cox. I never knew Jo Cox, and I am very sad that I did not, because having seen the impact she has had on our politics, on this place and on the people who knew her, she was clearly an incredible person. I do not think anyone can disagree with what she stood for, and in particular, that we have more in common in our politics. Our politics is worse off without her.
Yet again, we return to this Government’s vacant vacillation regarding our national security. I urge the Minister again to take this opportunity to strengthen UK cyber-security from the threat posed by foreign state actors. Protecting the UK and its citizens is the primary responsibility of Government, but still, in the face of clear evidence of increasing threats, this Government fail to act. The risk of physical threats and the need to invest in defence are clear to all, yet the Government prioritise increasing welfare spending over the safety and security of armed forces personnel and our country. The situation is so serious that the Defence Secretary had to resign, as he could not defend the inaction of this Government or the risks they are taking.
While the dangers presented to our cyber-security may be less visible, they are no less real. Hostile state actors are working every single hour of every single day to undermine our democracy and our security. These are risks that every Member across this House will be aware of. It is chilling to know that when Iran shut down its internet access, social media accounts purporting to be pro-independence Scottish people stopped tweeting. Expert analysis has estimated that thousands of similar accounts could originate in Iran and that as much as 26% of such accounts could be fake. Social media is now a weapon. We know that hostile state actors have sought to attack and undermine Parliament. Just last week we were told that spyware had been discovered in Government buildings linked to recent high-profile decisions regarding China’s controversial mega-embassy project in London.
Jim McMahon
I have often said about the device that was found in the Ministry of Housing, Communities and Local Government that unless someone is a member of staff, they cannot get to that side of the building without going through the Home Office. That obviously raises serious questions about the complex on Marsham Street more broadly. Does the shadow Minister accept that there is a pattern of foreign malign forces impacting our institutions, whether that is our Parliament or even the sovereignty of the United Kingdom itself? Unless there is resolve by Government and all parties in this place, we will not face that threat with the scale of response needed.
Dr Spencer
I thank the hon. Gentleman for the knowledge and experience he brings to the background of that particular case. I entirely agree that it is incumbent on all parties across the House to strengthen our national security and to be clear-eyed about the threat of hostile state actors. I will continue to develop that point in my wind-up speech.
The evidence is clear that we face an increasing threat from foreign state actors. We need to take action to recognise those risks and to prevent such attacks. Cyber-security should be at the forefront of our defences, and for that reason, His Majesty’s loyal Opposition have focused again on amending the Bill, particularly with new clauses 14 and 15. We table them in the hope that the Government will not squander another opportunity to act in this Bill.
New clause 14 would require the Government to directly identify the threats we face, ending the prevarication we have seen in recent months by obliging the Secretary of State to establish and maintain by regulation a list of foreign powers presenting a significant cyber-security risk to the UK. The amendment would strengthen the link between intelligence agencies and policy enforcement, ensuring that decisions by the Secretary of State to deploy special national security direction powers are based on GCHQ’s verified risk assessments regarding hostile states and state-affiliated groups. It is not about reacting after an attack occurs, but creating a proactive framework to evaluate and mitigate threats, built directly into UK supply chains. That would ensure that the UK is better prepared to deal with cyber-threats and attacks from hostile state actors. With the risks continuing to grow, these decisions cannot remain at the political whim of a Government who are reluctant to act.
Let us talk about the dragon in the room. In 2024, the National Cyber Security Centre confirmed that China state-affiliated actors were responsible for cyber-attacks on the UK’s Electoral Commission and Parliament in 2021 and 2022, yet this Government continue to refuse to recognise China as a threat to the UK. New clause 14 would compel the Government to recognise formally what is readily apparent to those on these Benches, to our security services and to the many Members across both Houses who have expressed urgent concern about the security risks that China and other foreign state actors pose to the United Kingdom. The new clause would force the Government to acknowledge that China is a threat.
In view of this established and growing threat, our new clause 15 would compel the Secretary of State to review state-sponsored cyber-threats to the UK’s infrastructure, including the cyber-security risk to surrounding critical networks in the vicinity of the super-embassy site in the City of London. As I said in Committee, there is simply no point in granting the Secretary of State powers to issue directions on the basis of national security if the Government are not willing to be clear-eyed about the most critical national and cyber-security threats to this nation. The new clause also strikes an important balance between ensuring parliamentary scrutiny and recognising and protecting the sensitive nature of some of the material that may be unearthed, by making provision for such information to be sent to the Intelligence and Security Committee of Parliament.
I am pleased that, having resisted calls to address this risk during previous stages of the Bill’s progress, the Government have now taken some action to address risks from foreign state actors. The publication last week of their National Security (State Threats) Bill comes in response to a sharp spike in state-backed intelligence operations, sabotage and proxy violence. Their own explanatory notes to that Bill state:
“Threats to the UK from foreign states are persistent and take many forms, including espionage, foreign interference in the UK’s political system, sabotage, disinformation, cyber operations, and even assassinations. Collectively these are referred to by the Government as state threats.”
However, the Bill itself does not once mention cyber-security, and contains no provision requiring assessment of the risks posed. It does not apply to states themselves, and therefore can only be complemented and strengthened by new clauses 14 and 15, which no responsible Government or Member of the House could vote against.
Amendment 3, which would insert a provision headed “Exemption from disclosure: right to a fair trial”, was tabled by my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith). As a Member of Parliament whose constituency includes Runnymede, I am proud both to call him a friend and to work with him on, in particular, his fight for the rule of law and fair trials.
The amendment would prevent the sharing of information with overseas authorities for the purpose of prosecuting crimes not committed in the UK, if the Secretary of State determined that the receiving country was one in which the right to a fair trial could not be guaranteed. It would address genuine human rights concerns, and would close a loophole in the Bill that currently fails to anticipate politically motivated requests from authoritarian states. It would help to block hostile state actors such as Russia, China and Iran from probing our systems to detect firmware back doors or vulnerabilities within, for instance, the UK’s utility networks, healthcare systems and data centres. It would also create a statutory duty for the Secretary of State to submit an annual report to Parliament justifying decisions on which foreign jurisdictions are trusted or barred from intelligence sharing. That alone would be invaluable, and would end the many fruitless hours of questions and debate in the Chamber initiated by Conservative Members seeking a clear answer from the Government on whether they see countries such as China as a threat—per my earlier remarks. I am therefore pleased, on behalf of His Majesty’s Opposition, to support my right hon. Friend’s amendment.
Let me also pay tribute to the Chair of the Science, Innovation and Technology Committee, the hon. Member for Newcastle upon Tyne Central and West (Dame Chi Onwurah). I thank her for her comments, which were echoed by others, about the risk from the internet of things and cellular modules. That is an important area, and we need to get it right.
I will conclude by addressing the amendments tabled by our Liberal Democrat colleagues regarding digital sovereignty and the impact that this approach could have on the UK. New clause 13 is the clearest demonstration to date that the Liberal Democrats do not understand the tech sector or global supply chains. Of course it is right to support British business, but it is not feasible or possible to achieve full sovereignty in a global market or supply chain. Rather, we should prioritise capacities and capabilities, and ensure that the UK has an indispensable role in global supply chains.
Victoria Collins
I do not think that the hon. Member has understood our amendment, which is about having a strategy. It does not say that everything should be sovereign, but we need to look at our tech stack and have a strategy for what is sovereign and what requires the procurement of elements. I ask him to look at our amendment again.
Dr Spencer
I refer the hon. Member to her new clause 13, particularly subsection 3(c), which makes it very clear that companies would need to deviate from “foreign technologies”, which would be quite a burden.
We need to back Britain in key sectors, from quantum and photonics to chip design and innovation. In so many areas, we lead the world. We should not try to restrict the influence and access of global markets. We must engage not in protectionism, but in leverage, to back Britain and position ourselves so that we are indispensable in the modern global tech sector and supply chains.
Jim Allister
Does the hon. Member agree that if we are to excel, we must excel on a UK-wide basis? Does he agree that it would be a very retrograde step to have part of this United Kingdom subject to another jurisdiction’s AI regulations, rather than those of the UK? Does he agree that it is imperative that the AI regulations that govern our digital sector are those of this Parliament and not those of the European Parliament?
Dr Spencer
I do not want any part of the UK to be subject to the awful AI Act that has been passed by the European Union. Northern Ireland, and particularly Belfast, is a technological powerhouse of which we should be very proud. We need to ensure that it continues to go from strength to strength as part of our fantastic Union.
We on the Conservative Benches will not back new clause 13, because we understand how markets and global supply chains work. We believe in Britain.
The Parliamentary Under-Secretary of State for Science, Innovation and Technology (Kanishka Narayan)
I start by echoing the thoughts of many Members from across the House, particularly my hon. Friends the Members for Leeds Central and Headingley (Alex Sobel) and for Cowdenbeath and Kirkcaldy (Melanie Ward). I did not know Jo Cox, but I admired her deeply. As we talk about our country’s resilience, her central message—that there is no deeper route to resilience than through the unity of our country and community—is top of our minds for all of us in this House.
It is a pleasure to bring this important Bill back to the House this afternoon. The Bill will increase our cyber-defences and resilience, making the UK an even safer place to live and do business. I thank Members on both sides of the Chamber for their valuable contributions to this debate and for the expertise that they have brought throughout the passage of the Bill. I particularly thank them for their recognition of my core belief: that the central question for our national security and resilience is the question of our technological and AI capabilities.
We tested the Bill’s measures carefully before introduction, but we have since listened to feedback. There are a small number of minor, technical drafting improvements, which I will briefly go through. Government amendments 16 and 17 ensure that regulators can ask for the information they need to fulfil their obligations under the NIS regulations. This does not give regulators any new powers; it simply confirms that the current reasons for requesting information under the NIS regulations will still apply under the updated regulations.
Government amendments 7 and 8 make changes to align with two information-gathering Government amendments made in Committee—amendments 16 and 17. Government amendment 11 makes consequential changes following an amendment made in Committee. That amendment enables information sharing between NIS regulators and other public authorities for cyber-matters outside the scope of the NIS regulations.
Government amendments 14 and 15 clarify the safeguards for information sharing gateways, and amendments 9, 10, 12 and 13 make the necessary changes to ensure that the rest of the clause is consistent with the change made by amendment 14. Government amendments 18 to 26, to clause 57, allow regulators and the Secretary of State to issue notices related to the powers of direction to nominated representatives of regulated entities. I have also tabled Government amendment 27, which corrects minor drafting errors to ensure the Bill works as intended.
Members raised a series of questions, and I will address them thematically. First, the question of scope was raised by new clauses 4, 20, 21, 5, 8 and 9. I thank my hon. Friend the Member for Newcastle upon Tyne Central and West (Dame Chi Onwurah), the Chair of the Science, Innovation and Technology Committee, who brings consistent expertise and experience to these questions; the Chair of the Joint Committee on National Security Strategy, my hon. Friend the Member for Warwick and Leamington (Matt Western); and the hon. Members for Harpenden and Berkhamsted (Victoria Collins) and for Brecon, Radnor and Cwm Tawe (David Chadwick), who tabled amendments on the services and scope of the Bill.
All organisations, from high street shops to manufacturing giants, should take steps to increase their cyber-security and resilience. The Government and the National Cyber Security Centre are making sure that the right tools are available for every part of the economy. I am sympathetic to their intent, and in particular with my hon. Friend the Member for Middlesbrough South and East Cleveland (Luke Myer) when he talks about the impact of cyber-security incidents on local communities.
The Government have committed to reviewing whether new activities need to be brought into the scope of the NIS regulations, but it is essential that any such decision is based on a systematic and specific assessment of carefully considering whether the regulation in these particular parts of statute are the most appropriate response. The NIS regime has been put in place to protect the most essential parts of our economy, often those whose disruption would cause an imminent threat to life. It is focused on a specific set of tests where sectors have little or no alternative service provision in the event of disruption and relates the latest systematic evidence of the threats that each sector faces.
In that context, all Government Departments with sectoral responsibility work with their sectors on broader cyber-resilience. The Department for Environment, Food and Rural Affairs does so with food, and the Department for Business and Trade does so with retail, automotive and so on. The NCSC also has strong relationships across sectors, actively working with them to share best practice and incident insights, and to strengthen overall resilience, such as by engaging with the British Retail Consortium following incidents affecting the sector last year.
The food sector is unique among other critical sectors because of its high levels of diversity. In the analysis underpinning the judgments made in the Bill, there are approximately 20,000 SME food manufacturers in the UK alone, and many more farms, distribution centres, retailers and other types of businesses that form the UK’s food supply chain. Given the lack of a single point of failure, we think there are more proportionate levers to pull, rather than bringing food in scope of the NIS regime. We have made similar judgments about other sectors on the basis of that systematic analysis, as I have shared in Committee and at other stages of the Bill’s consideration.
Matt Western
I accept the point about the plethora of businesses in the food supply sector, but my amendment simply seeks commonality with what the European Union has pushed for. Why can it not be the right thing for the UK Government to do as well?
Kanishka Narayan
I am happy to the write to the Chair of the Select Committee about comparisons with the EU, but the broad thrust is that we have undertaken a specific analysis of whether the burdens of the Bill should apply in a systematic, proportionate and coherent way to sectors. The analysis suggests that food supply is not in scope for the reasons I mentioned—primarily diversity of supply—but I would be delighted to engage with him on the question of why Europe took a different decision. We have based our decision on our analysis here.
Kanishka Narayan
I am going to make some progress but will try to come back to the Chair of the Select Committee shortly.
The Government’s cyber action plan is the overarching strategy to raise public sector standards across Government, including local government. The Ministry of Housing, Communities and Local Government has taken action to strengthen local authorities’ cyber-resilience, backed by £29 million of cyber grant funding, technical support and the adoption of the cyber assessment framework for local government. In that spirit, I take particularly seriously the point made by my hon. Friend the Member for Oldham West, Chadderton and Royton (Jim McMahon) on supporting capacity even further with centralised capacity support from the Government Digital Service and other parts of cyber-capability in central Government.
The joint election security and preparedness unit, also raised by Members, works to protect UK elections and referendums, co-ordinating across Government on response to threats, including cyber-risks. JESP works closely with the National Cyber Security Centre, producing guidance for organisations involved in delivering elections and electoral infrastructure, particularly local authorities. JESP and NCSC regularly engage with political-party representatives as well.
The question of a register of foreign powers has been raised in relation to new clauses 14 and 15, tabled by the shadow Minister, the hon. Member for Runnymede and Weybridge (Dr Spencer). New clause 14 would require the creation of a register of foreign states that pose a risk to the UK, based on GCHQ advice, for the purpose of exercising powers under part 4 of the Bill. I assure the shadow Minister, as I did in Committee, that the use of those powers will always be underpinned by robust intelligence. That includes, where relevant, information about state actors involved in cyber-threats. As a result, it is unclear what additional support the register would provide to the Secretary of State.
New clause 15 would require the Government to report annually on risks posed by foreign powers. Drafting a report of vulnerabilities would simply duplicate existing assessments and risk distracting the Government from more effective measures to protect the UK from hostile foreign actors. The shadow Minister also proposes that information that cannot be included in the report for national security reasons is sent to the Intelligence and Security Committee. I have made it clear to him, both in Committee and more broadly, that the Government value the independent and robust oversight that the Intelligence and Security Committee provides on behalf of Parliament. However, we do not consider that the report described in the new clause sits within the ISC’s current oversight remit, as outlined in the Justice and Security Act 2013 and the Committee’s memorandum of understanding with the Prime Minister. The Government are actively reviewing the Committee’s existing memorandum of understanding and will update the House in due course.
New clause 3, tabled by the hon. Member for Harpenden and Berkhamsted, would require the Government to assess how many entities regulated by the NIS regime are owned, in part or in full, by foreign states, and the risks that they pose. Publishing a review identifying national security risks caused by foreign state ownership would provide valuable insight for our adversaries. Furthermore, conducting an assessment of the ownership structure of every in-scope entity within six months would be disproportionately resource intensive, and would distract the Government from more effective measures to protect our services.
Dame Chi Onwurah
Let me take the Minister back to the question of bringing the retail sector into the provisions of the Bill. He seems to be saying that cyber-security and resilience require Government intervention only when there is an immediate threat to life. Will he clarify whether that is what he is saying? My understanding is that we need to keep our economy and citizens secure in all circumstances. On the question of proportionality, my new clause 20 seeks to bring in only very large businesses, so that the requirements of cyber-security on them are proportionate. We know that such businesses are not taking the measures to keep cyber-secure, as we have seen recently with Marks & Spencer, Jaguar Land Rover and others.
Kanishka Narayan
It is rare for me to have a point of divergence with the Chair of the Select Committee, given her experience and expertise. However, on that question I am absolutely not saying that Government support is limited only to the certain number of sectors covered by the Bill. There are a range of other ways in which the Government act to support sectors outside of the scope of the Bill. That is the right thing to do.
The scope of this Bill—the only Bill horizontally applicable to large parts of the economy—is systematically and specifically set to sectors that are significant as essential services, sectors where there is the risk of significant disruption and threat to life, and sectors where alternative supply is limited. For those reasons, we have excluded retail. Consideration of the scale of the business is not currently in that rubric, because there are also businesses that are small in scale but very material in life-threatening impact. I hope that is a satisfactory answer.
I thank my hon. Friends the Members for Dunfermline and Dollar (Graeme Downie) and for Newcastle upon Tyne Central and West for their amendments relating to the risks posed by communications modules made or controlled from outside the UK. Although I am sympathetic to their concerns, the Bill’s approach is intentionally technology and incident-agnostic. Instead of reacting to individual components in isolation, we focus on structural checkpoints and systematic dependencies in this context.
There are a range of other levers—investment screening through the National Security and Investment Act 2021; telecoms and cyber data security requirements to protect data and networks; supply chain measures, such as those in the Procurement Act 2023; diversification requirements to reduce dependency and build resilience—all of which are important to respond to the deeply significant concerns raised.
Kanishka Narayan
I will make some further progress.
I thank my hon. Friend the Member for Leeds Central and Headingley for his amendment relating to AI emergencies. I recognise his concerns, as well as those of my hon. Friend the Member for Cowdenbeath and Kirkcaldy. Technology is evolving rapidly, and Government must be equipped to respond. That is why the Bill grants the Secretary of State the power to direct regulated entities if the compromise of their network and information system, or the threat of it, gives rise to a national security risk. This could, for instance, require an entity to cease using and isolate an AI model.
These powers are a backstop to an effective cyber-security regime, enabling Government to act swiftly in the face of unexpected national security threats. They are also designed to be proportionate, recognising the need for stability among regulated entities and the importance of proper accountability. While I share my hon. Friends’ concerns, I encourage them to work with the Government on a systematic range of ways in which we can mitigate the risks they have rightly highlighted.
Several hon. Members rose—
Kanishka Narayan
I will give way to my hon. Friend the Member for Leeds Central and Headingley in the first instance and then to my hon. Friend the Member for Dunfermline and Dollar.
Alex Sobel
There is obviously a level of complexity here in relation to the data centre, AI development and the network in the UK and more broadly. Will the Minister therefore commit to a meeting with me and my hon. Friend the Member for Cowdenbeath and Kirkcaldy (Melanie Ward) to discuss this matter further?
Graeme Downie
I would be more than happy to work with the Government on something that will provide specific protections against cellular internet-of-things modules. What assessment has he made of the specific threat of internet-of-things modules, and what protections are there against that in the legislation?
Kanishka Narayan
Given the specificity of his question, I will suggest that I come back to my hon. Friend. The broad thrust is that through our investment control legislation and procurement legislation, there are a series of responsibilities on Departments to look at it. [Interruption.] Given your encouragement, Madam Deputy Speaker, I shall move on.
Finally, I will respond to the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith), who raised a very important point. The most important thing to say is that I share his diagnosis, although for reasons mostly of technical drafting, I disagree with his prescription—I hope he will take that in the spirit in which it is intended. His amendment risks creating undue uncertainty in law for many other areas where we do not have an explicit requirement. While I share his diagnosis and his objective, I hope that we can work together to consider how best to give it effect, including through the Foreign, Commonwealth and Development Office’s overseas security and justice mechanisms for information sharing.
I thank all hon. Members for their consideration.
Jim Allister
I want to draw the Minister back to a point I raised with him at an earlier stage of the Bill, when he gave me what I would call a holding reply. When this legislation goes through, will the whole United Kingdom be subject to it, or will my part of the United Kingdom—Northern Ireland—be subject to the EU’s AI laws as they affect the digital sector? Businesses in that industry in my constituency want to know whether they will be governed by this Bill or by the EU’s AI Act. In other words, will the EU’s AI Act and Cyber Resilience Act be added to annex 2 to the Windsor framework, which would give them superiority and direct application in Northern Ireland? Can we have an answer—are they going to be added or not?
Kanishka Narayan
The hon. and learned Gentleman will be aware from a response I recently gave him that both the complexity of the EU’s AI Act and its interaction with the Windsor framework are under consideration at the moment. The EU has made a proposal and we are working with it on that. I will be happy to engage with him on that particular question in due course.
Sir Iain Duncan Smith
I am not quite certain that I understand the Minister’s reasons for why he cannot accept my amendment, tweak it or work with it in the other place. The reality is that with this Bill, we are opening the door in a way that we would not have otherwise done to the use of information that may predicate a failure for some British citizen sitting in a country where the rule of law does not protect them in the courts. The Government are taking a risk of making it worse, not better. While the Minister agrees to some degree with the principle of what I am saying, surely this is the time to put it right in the Bill.
Kanishka Narayan
As I say, I agree with much of the right hon. Gentleman’s diagnosis. Let me state in more detail the reasons for objecting on the mechanism. First, the provisions for information sharing are deeply discretionary for UK regulators. Secondly, the subjects in which they can pursue that information sharing are restricted to significant matters of national security and domestic crime prevention in the UK. Thirdly, the way that the amendment is drafted risks creating undue uncertainty in law. If this is the only regime where there is a specific and explicit reference to fair trial in the legislation, it calls into question how other information-sharing regimes are interpreted, such as under section 114 of the Online Safety Act 2023. In other words, drafted as it is, the amendment could invite legal challenge where a regulator exercises its discretion not to disclose this in other regimes, as there is no explicit exclusion. For those reasons, while I totally agree with the right hon. Gentleman’s diagnosis and his objective, I am afraid that the amendment in question risks undermining the objective.
Kanishka Narayan
I will not, because I am testing the patience of Madam Deputy Speaker—[Interruption.] With your permission, Madam Deputy Speaker, I will give way.
Dame Chi Onwurah
I thank the Minister for generously giving way again. I have no desire to test the House by pushing my amendments to a vote, and I will be happy if I can receive his assurance. I take his points on not having technology-specific regulation where possible, but can I have an assurance that the Minister will work with me, my Committee and other hon. Members to look at the need to safeguard where there are technology-specific risks?
Kanishka Narayan
As ever, I would be delighted to work with the Chair of the Select Committee on a range of technology questions, including this one.
I am delighted with the support that this House has shown for the intention and principles of the Bill, and I am grateful for Members’ consistent, principled scrutiny.
Alex Sobel
On the amendment from the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith), I think we have made some progress with the Minister, but it is clear that trying to isolate the issues around fair trial from other matters is complex. Repeating my earlier call, will the Minister meet me, the right hon. Member for Chingford and Woodford Green and others who signed his amendment to explore the complexities of this after the debate?
Kanishka Narayan
I can confirm that the Government will be very happy to engage on this question further with my hon. Friend and the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith). I commend the Bill to the House.
Victoria Collins
Before I withdraw new clause 2, I want to draw Members’ attention to my entry in the Register of Members’ Financial Interests in reference to my earlier speech. I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
New Clause 13
Digital Sovereignty Strategy on risks posed by foreign interference and reliance on foreign technologies
“(1) The Secretary of State must, within 12 months of the passing of this Act, publish a strategy (“a Digital Sovereignty Strategy”) which sets out the Government's approach to maintaining the security and resilience of relevant network and information systems by—
(a) assessing, managing and mitigating risks—
(i) associated with foreign interference,
(ii) arising from reliance on foreign-supplied technologies, and
(b) preventing over-reliance on foreign providers by building domestic capacity.
(2) For the purposes of this section, a “relevant network and information system” is a network and information system belonging to—
(a) an operator of an essential service,
(b) a relevant digital service provider,
(c) a relevant managed service provider, or
(d) a critical supplier, within the meaning of the NIS Regulations.
(3) A Digital Sovereignty Strategy published under this section must—
(a) include risks associated with—
(i) hardware,
(ii) software,
(iii) supply chains, and
(iv) procurement processes;
(b) include a specific focus on security and resilience in government digital procurement processes, detailing how the Government intends to reduce strategic dependencies on foreign-owned service providers to mitigate the risk of systemic disruption;
(c) include a commitment to prioritise the use of technologies developed in the UK by UK organisations in relevant network and information systems to reduce reliance on foreign technologies, and
(d) where risks are identified under subsection (1)(a)(i), state how the Government intends to address these risks by supporting the use of domestic technologies or systems for the purpose of ensuring the security of those systems.”—(Victoria Collins.)
This new clause would require the Government to publish a Digital Sovereignty Strategy setting out how it intends to address risks to relevant network and information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies.
Brought up, and read the First time.
Question put, That the clause be read a Second time.
Kanishka Narayan
I beg to move, That the Bill be now read the Third time.
It has been a privilege to take this vital piece of legislation through the House. I thank everyone who has played a role in getting the Bill to this stage, including the noble Baroness Lloyd of Effra, who has been instrumental in driving the policy in this Bill and leading its passage in the other place. I also thank my right hon. Friend the Secretary of State for Science, Innovation and Technology; the officials who have worked tirelessly since the Bill’s inception; the Bill team, led by Shona Lester; the policy teams, led by Nick Dodd and Liam Harkin; the legal team, led by Alicia Swannell; and my private secretary, Ben Holloway. I also thank parliamentary counsel, the Clerks and the Chairs of the Public Bill Committee, and every Member of the House who served on the Committee, as well as Members who have provided important input today and during all previous stages.
This country is subject to daily and unrelenting cyber-attacks. This is no longer the stuff of science fiction, but a daily reality that threatens public services, businesses and even our ways of life. As Dr Richard Horne, the CEO of the National Cyber Security Centre, has said:
“The real-world impacts of cyber attacks have never been more evident than in recent months”.
The Bill delivers on the Government’s commitment to drive secure growth and make the UK more resilient to the threats we face. It recognises how things have moved on since 2018, with data centres playing an increasingly important role in our digital lives and supply chains continuing to diversify. It also recognises that things will continue to change, with a deliberate, technology-agnostic approach and proportionate powers to enable the Government to close regulatory gaps and respond to imminent national security threats.
Since the introduction of the Bill, I have tabled a small number of amendments to refine its drafting and ensure that it achieves its intended purposes. They include designating Ofcom as the sole regulator for data centres, to reduce administrative burdens and strengthen accountability in this key sector. They also include enabling the network and information systems regulators to share vital information with other regulators and public bodies overseeing sectors and vice versa, enabling more co-ordinated and strategic oversight without unnecessary business burdens. They also updated the definition of cloud computing to respond to important feedback from the sector and made several minor and technical corrections to ensure that the Bill can be practically implemented.
The version of the Bill before us is an ambitious, practical and proportionate piece of legislation. It is the result of engagement with industry, important regulator feedback, international dialogue and tireless work from officials. I wish Baroness Lloyd the best in moving the Bill forward in the other place, and I commend it to the House.
Madam Deputy Speaker (Caroline Nokes)
I call the shadow Secretary of State.
Julia Lopez (Hornchurch and Upminster) (Con)
I thank Members across the House for their contributions to this Bill over many months and for their relentless scrutiny. I have never known a Minister to be in such a rush, with three hours of protected time left. I am grateful to officials both in the Department for Science, Innovation and Technology and in Parliament for their hard work in getting this legislation to its final stage. I particularly recognise the hard work of my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) and his team in providing such top-notch scrutiny of the Bill during its passage through the House.
The Opposition have remained at all times supportive of the principles behind the Bill. It was the previous Government who recognised the need to increase cyber-resilience standards for critical digital infrastructure and services, including managed service providers and data centres. It is welcome that those entities—which are so vital to the functioning of the economy, public services and our daily lives—are now covered. However, I said on Second Reading that opportunities to legislate in this area are few and far between, and we need to ask two questions to assess whether this law is fit for purpose: will it work, and is it enough?
There was already an urgent need to strengthen our cyber-defences. However, AI is equipping hostile states, criminal gangs and opportunists alike with tools capable of eroding our national defences at speed and at scale, in ways that will affect businesses, the public sector and our infrastructure. It is right that Parliament legislates to raise the collective security bar, but the nature of the cyber-security risks that necessitated this Bill have developed rapidly as we have been taking it through this House. That demonstrates the difficulties we all face as legislators in dealing with the constantly shifting sands of the digital age. We may need to be ready to return to this subject sooner than we had hoped.
It is right that critical digital infrastructure such as data centres will fall within the scope of regulation, but we need to recognise that no security measures or standards are 100% effective. Government and businesses need to ensure that essential data and workloads are stored and processed in a way that keeps them secure and operational even when they are under attack. Resilience is key—the Islamic Revolutionary Guard Corps’ apparent targeting of Amazon Web Services sites in the United Arab Emirates and Bahrain earlier this year has shown that digital infrastructure is becoming a prime target in times of conflict. It would be irresponsible to assume that these facilities will not also be targets for cyber-warfare, which is why we have to look closely at concentration of risk, our overall resilience, and any leverage we can build in maintaining access to the best technology going forward. From work on the security of our telecoms infrastructure to scrutiny of the platforms on which critical Government services run, we must now be thinking extremely carefully about our procurement of digital technology.
A further significant development since this Bill was introduced is the rapid advance of AI systems capable of identifying cyber-vulnerabilities, particularly in poorly protected legacy IT across Government and public services, including the NHS. It highlights the urgent need to address the Government’s extensive legacy estate, which is especially exposed to exploitation. Nothing in the Bill addresses that need, yet the Government are creating a broader digital architecture for hackers to attack through their plan for Government-issued digital IDs.
If public trust is to be restored, especially after the Government’s abortive attempt to introduce mandatory ID last year—still, I fear, a risk by the back door—such systems must always remain both optional and secure. It is therefore concerning that the Public Accounts Committee felt compelled to write to the permanent secretary at the Department for Science, Innovation and Technology in April to criticise the lack of urgency in reviewing legacy IT equipment, given both the sensitivity of the data involved and the scale of the cyber-risk.
Earlier, my hon. Friend the Member for Runnymede and Weybridge set out one of the most significant threats that this Bill fails to address: the intensifying cyber-security risk posed by the Chinese Communist party and its affiliates. It is regrettable that the Government have, for a second time, voted down amendments that would have compelled the Secretary of State to create a register of hostile state actors threatening the cyber-security of essential networks and information systems. Those concerns are not restricted to Conservative Members, which is why the amendment tabled by my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith) attracted cross-party support.
The risks posed by cellular IOT modules have been set out expertly in the Chamber today. IOT modules supplied by Chinese manufacturers are now embedded in nearly all internet-connectable products and devices, from smart TVs to electric cars. They can be used to intercept data and track locations, and can even be controlled remotely. The scale of the cyber and physical security threat from IOT modules is the tip of the iceberg, with components that can be used for espionage or cyber-attacks or disabled remotely woven into countless aspects of our critical national infrastructure. This is an issue that is not going away.
In summary, although this Bill is necessary and goes some way towards enhancing our cyber-resilience in critical areas, it will not be enough in isolation. It heaps all the burden on the private sector, yet it would have been insufficient to prevent the Jaguar Land Rover incident. It does not address public sector vulnerabilities, and it falls far short of meeting the moment that the now former Defence Secretary, the right hon. Member for Rawmarsh and Conisbrough (John Healey), lamented that this Government were missing in their approach to our collective defence and security. It speaks to this Government’s continued inability to grapple with and address the red lights that are now flashing on the national dashboard.
The “corrosive complacency” that Lord Robertson called out in the Government’s approach to investment in defence can also be seen here, in the Government’s ongoing refusal to address the urgent threat to our national cyber-security caused by our reliance on technology and components from nations that have demonstrably malign intent. We are living with the uncomfortable reality that the end of history was a dangerous illusion; one that has led to us gradually outsourcing our critical industries to our geopolitical rivals and competitors, only to have their wares sold back to us in the form of latent time bombs.
That is why this legislation, which we support, can only be a discrete tool in addressing a much wider challenge. Cyber-security is no longer a niche compliance exercise; it is about protecting the fundamental economic and defence interests of our nation. That is why I suspect we will be returning to cyber issues in this House before too long, and with greater urgency.
Madam Deputy Speaker (Caroline Nokes)
I call the Liberal Democrat spokesperson.
Victoria Collins
I reiterate the importance of a digital sovereign strategy for our cyber-security. It is about our resilience, our security and our economic strength as a country and collaborative sovereignty. We very much welcome the extended scope of the Bill and we support it moving forward.
Question put and agreed to.
Bill accordingly read the Third time and passed.
Calum Miller (Bicester and Woodstock) (LD)
On a point of order, Madam Deputy Speaker. I seek your guidance. There are reports that a Russian warship has today fired warning shots near a UK-registered yacht in the English channel, south of the Isle of Wight. If verified, this action would be of grave concern to the House and would represent a significant escalation in the hostilities shown by Russian actors towards UK interests. Can you guide me on how the House might seek to be urgently updated by a Defence Minister on this development and guided as to the Government’s proposed response?
Madam Deputy Speaker (Caroline Nokes)
I thank the hon. Gentleman for his point of order. I have had no notice that the Government intend to bring a statement, but I am sure that those on the Government Front Bench have heard him, and should that change, we will doubtless hear before the Adjournment.
Business without Debate
16:56 - The House divided: - Ayes: 262 / Noes: 86 - Question accordingly agreed to.
Matt Western (Warwick and Leamington) (Lab)
On a point of order, Madam Deputy Speaker. I wish to raise with you my concern about comments attributed to the right hon. Member for North West Essex (Mrs Badenoch), who I understand has described my right hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson) as acting like a Gestapo officer—I think that is the term she used. This is extremely alarming, particularly on this day of all days. In recognition of Jo Cox’s assassination, I just ask that all of us around this place temper our comments and calm down the rhetoric. I simply ask your advice, Madam Deputy Speaker, on how to take that matter forward.
Madam Deputy Speaker (Caroline Nokes)
I thank the hon. Gentleman for his point of order. He will know that comments made outside the Chamber are not a matter for the Chair, but he has put his point on the record.
Petitions
(1 day, 4 hours ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate
Ms Julie Minns (Carlisle) (Lab)
I am pleased to present a petition on behalf of residents of the village of Wetheral calling for traffic-calming measures, including a 20 mph zone, to improve the safety of pedestrians and other road users.
The issue of traffic calming was raised with me by local residents at a coffee morning I held in Wetheral a few months ago. The introduction of a 20 mph zone and other measures would build on the excellent work of Wetheral parish council, which has recently funded the installation of a speed camera in the village. However, Wetheral residents remain concerned by the speed of traffic through the village, and the lack of pavements on stretches of road. A total of 298 residents signed the petition that local people, members of the parish council and I took door to door around the village.
The petitioners
“therefore request that the House of Commons urges the Government to work with the relevant local authorities to introduce traffic calming measures”,
including the establishment of a 20 mph zone in Wetheral.
Following is the full text of the petition:
[The petition of residents of Wetheral and the wider Carlisle constituency,
Declares that traffic calming measures, including the establishment of a 20mph zone, should be introduced to the village of Wetheral.
The petitioners therefore request that the House of Commons urges the Government to work with the relevant local authorities to introduce traffic calming measures in Wetheral, specifically the implementation of a 20mph speed limit through the village to improve road safety.
And the petitioners remain, etc.]
[P003207]
Frank McNally (Coatbridge and Bellshill) (Lab)
I rise to present this petition on a national strategy for motor neurone disease. I do so on behalf of my constituent Mark Sommerville, who was diagnosed with MND in 2023 and who, along with his foundation, has been doing tremendous work to identify new treatments and a cure.
Following is the full text of the petition:
[The petition of residents of the constituency of Coatbridge and Bellshill,
Declares that motor neurone disease is a devastating, fast acting, terminal illness that currently has no cure; and further declares that the UK Government must act to create a national strategy for MND that:
is led by clinical and research experts, in partnership with patients and their families, and patient organisations;
introduces a national taskforce to drives forward delivery of key objectives;
supports MND research with enhanced access to participation in clinical trials;
accelerates novel drug discovery, drug repurposing, and access to innovative treatments;
improves diagnostic waiting times and specialist multidisciplinary care;
ensures equitable support, equipment, and palliative services across the UK;
co-ordinates health, social care, and research through a single national plan.
The petitioners therefore request that the House of Commons urge the Government to work in partnership with the devolved administrations to deliver a national strategy for motor neurone disease with emphasis on finding effective treatments and a cure, supporting research, enhancing access to clinical trials, and improving co-ordination of social care.
And the petitioners remain, etc.]
[P003208]
Victoria Collins (Harpenden and Berkhamsted) (LD)
The people of Tring have spoken. This petition, signed by over 500 residents, rejects the top-down, developer-led approach to planning from this Government, which threatens to impose significant large-scale development on their community with little regard for its character, infrastructure or precious environment. That has been made even worse by the latest power grab from Whitehall, which will now take over large planning applications.
Residents are not opposed to housing, but they are righty alarmed by the burden being placed on their town and deeply frustrated by the lack of a meaningful voice in shaping proposals that will define Tring for generations to come.
Following is the full text of the petition:
[The petition of residents of the United Kingdom,
Declares that Tring faces significant large-scale development proposals driven by top-down national planning policy, which is being imposed on local communities with insufficient regard for the views of residents or the detrimental impact on Tring’s character, infrastructure, and environment.
The petitioners therefore request that the House of Commons urge the Government to schedule a debate in the House of Commons on the Government’s review of the National Planning Policy Framework and how communities like Tring can be better protected from inappropriate over-development, and how local residents can be given a genuine and effective voice in the planning decisions and infrastructure provision that shape their towns and affect their daily lives.
And the petitioners remain, etc.]
[P003209]
Isle of Wight Dementia Patients: Discharge to Mainland Care Homes
(1 day, 4 hours ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Richard Quigley (Isle of Wight West) (Lab)
I am grateful to have secured my first Adjournment debate as an MP on an issue that has resonated so deeply with many residents across the Isle of Wight, whether they are directly touched by dementia or not. I put on record my thanks to those across the island who have contacted me and are passionately fighting for their family member or friend during their time of need. It really shows the best of our island, and it makes me even more proud to represent Isle of Wight West in this place.
I also thank the Minister for her engagement to date with me and my constituency neighbour, the hon. Member for Isle of Wight East (Joe Robertson), on the wider issue of patient discharges off the island. I will continue to do all that I can to work across the island and with Government to help find a solution.
Amanda Martin (Portsmouth North) (Lab)
I thank my hon. Friend and neighbour for securing this debate, and I strongly support him on this issue. People living with dementia and their families deserve care close to home, and should not have to cross oceans or seas and get trains to get the support that they need. I want to recognise the dedicated workers across Portsmouth North who support those people’s families. In my constituency, cuts to dementia nursing have led to some of my constituents—and my team—visiting the Isle of Wight, where we saw the Parklands Dementia Resource Centre, which is an excellent example of what can be done. Will my hon. Friend expand on Parklands’ work, and join me in urging the Minister to consider more dementia hubs in under-served communities?
Richard Quigley
I thank my hon. Friend for that timely intervention. Before I get into the deeply troubling accounts that have been brought to me, I pay tribute to Maggie Bennett and her team who run the Parklands Alzheimer’s café. While the café cannot offer overnight accommodation, it offers vital respite for carers. Loved ones can spend a great day at the café, doing activities, chatting over tea and cake and even getting their hair cut. However, for island dementia sufferers, that is where the happy story ends.
The issue of mainland discharges has struck a chord across the island because it goes to the heart of many of the other inequalities my constituents have been expected simply to accept as part island life. We are the only English island where the sole means of transport on and off is entirely privately operated. Coupled with that, we have only a small specialist dementia in-patient ward, and no dedicated long-term NHS dementia provision. There is a very real fear that when someone is at their most vulnerable, where they live will determine how they are treated and whether they are afforded the dignity they deserve: the dignity of being close to family, of continuity in care, and of remaining in the place they call home.
For those unfamiliar with the situation, the recent closure of three care homes on the Isle of Wight, including one in Freshwater in my constituency, has led to 44 residents being displaced, with 10 already placed in care homes on the mainland. The niece of one resident living with dementia contacted my office to say that she is terrified that her uncle will die in his proposed placement in Horsham, 70 miles away,
“alone, confused and feeling that no one cares.”
Worse still, his family have been told that if they do not accept the placement, they will be liable to pay £500 a day for the hospital bed he will need to occupy.
Other than a few brief periods away, the Isle of Wight is the only home that Phyllis, Adam and Rob Snow’s 87-year-old island-born mother, has ever known. Phyllis now requires round-the-clock care due to a brutal combination of dementia and Parkinson’s, and her family are absolutely terrified by reports of patients like her being relocated to the mainland. With Phyllis already having been stuck on a hospital ward for months, her family are in a lose-lose situation: they either watch her become more vulnerable to infection the longer she spends in hospital, or push for a care home release only for her to be relocated miles away from the only home she has ever known.
It is important to understand how dementia care is currently funded on the Isle of Wight. Much of our provision relies on a limited number of block-booked beds commissioned by the local authority, layered on to an adult social care budget that is already under severe strain.
Peter Fortune (Bromley and Biggin Hill) (Con)
The hon. Gentleman is giving a typically excellent and passionate speech. No person living with dementia should be removed from their family or support network. Does he agree that as the NHS is restructured, there needs to be a proper focus on outcomes for dementia sufferers right across the country?
Richard Quigley
I could not agree more; a national dementia strategy is of the utmost importance. As I will go on to say, we currently have a situation where people are being moved away from home or where the care they need just is not available.
Nationally, 87% of care services are now commissioned by councils or the NHS at rates below the true cost of care, and locally contracts are being let at around £24 an hour—only 84% of the Homecare Association’s minimum recommended rate. Within that model, smaller island providers are often subcontracted by larger mainland-based organisations at even lower rates. Despite demand continuing to rise, the island is one of the only authorities inadvertently forcing local care providers to make staff redundant or even consider closure, simply because the funding does not stack up and because price increases are not being passed on to those smaller providers by first-tier commissioning organisations. I strongly urge the Minister to press Isle of Wight council to ensure that any funding uplift reaches the frontline providers that are actually delivering care.
Once again, with no dedicated long-term NHS dementia ward on the island, as soon as those block contracts are full, as they increasingly are, there is simply nowhere else for people to go. At that point, decisions are no longer driven by what is best for the individual, but by whatever capacity happens to be available.
The closure of three care homes this year has not occurred in a vacuum. In 2022, the island lost six care homes. With one third of our population aged 65 and over, alongside staff turnover rates that are significantly higher than the national average, this is a system already under immense strain. While dementia care on the Isle of Wight is delivered across a mix of NHS, council and private provision, the reality is that the capacity and specialist care has not been enough for some time.
This is not just an island problem; it is a warning of what lies ahead for the country as our population ages. In making that point, I wish to strongly advocate for any measures the Government consider adopting to confront this national challenge being piloted on the Isle of Wight, where the need is greatest and where meaningful change can be delivered most urgently and, most importantly, measured in almost real time. What makes the Isle of Wight a particularly stark case is the added cruelty of our geography: the reality that families must cross the Solent, which some estimates have placed as the most expensive stretch of water in Europe, in order to visit a loved one who is sick and in need of care that simply cannot be provided closer to home.
Eighty-two-year-old Graham Martin, who is living with dementia, is yet another example of the impact of this reality. In mid-April, he was moved to Southampton against the wishes of his family because of his complex needs, separating him from his wife of 63 years, Carol, who is unable to travel to visit him due to her own health and the cost of ferry travel. Being moved away from home, across a stretch of water, is distressing enough; being effectively cut off from loved ones because they cannot afford or physically manage the journey, at the very moment that people need their family most, borders on forced isolation.
As the niece of another patient facing a mainland placement said to me, “Imagine a vulnerable elderly resident in Westminster being sent to a care home on the Isle of Wight. It simply would not happen.” It would not happen because in other parts of the country, the system would not tolerate separating vulnerable people from their families in this way, yet for the Isle of Wight, that basic standard is not applied.
MPs and Ministers all the way up to the Prime Minister have heard me talk relentlessly about how the island is a brilliant place to live, work and learn, and despite my intervention today I still believe that to be the case. But that comes despite the inequality and deprivation we face, which is hidden by neighbouring prosperity. Whether it is schools unable to take a trip across the Solent due to budgetary constraints, young workers having to look for jobs elsewhere due to lack of opportunity, or—as I have spoken about today—an elderly person ripped away from their home because of lack of capacity, the Isle of Wight has been functioning with one arm tied behind its back. The time has come to do something about it.
When capacity on the island runs out—and without the necessary action, it inevitably will—people are not just delayed but displaced. What should be an absolute last resort for the most vulnerable people is fast becoming a routine response, with elderly people being sent miles from their home simply because the system cannot cope. That is neither sustainable nor dignified, and it cannot be allowed to continue. I ask the Minister to take action for the benefit of my Isle of Wight residents.
The Parliamentary Under-Secretary of State for Health and Social Care (Preet Kaur Gill)
I am grateful to my hon. Friend the Member for Isle of Wight West (Richard Quigley) for raising this very important issue, and I recognise the deeply concerning experiences that he has highlighted of families on the Isle of Wight, including the story of Maggie Bennett and the café that she runs.
For people living with dementia or complex disabilities, being moved away from their homes and loved ones can be profoundly distressing. Familiar surroundings, routines and relationships are often central to their wellbeing, and it is entirely understandable that families feel anxious when those links are disrupted. The Government are clear that people should be discharged from hospital safely, promptly and with appropriate care and support in place. This is essential not only for patient outcomes but to ensure that hospitals can continue to treat those in greatest need.
Local authorities have a statutory duty under the Care Act 2014 to shape their local care markets, ensuring that there is a sufficient range of high-quality, person-centred services available to meet local needs. Decisions about care placements are made at a local level based on clinical need, the suitability of available services and the individual’s circumstances. Where a person requires specialist or higher-intensity support, it is essential that the placement meets those needs in full.
However, I do recognise that local capacity pressures, particularly in geographically isolated areas such as the Isle of Wight, can mean that suitable placements are not always immediately available. My hon. Friend spoke about the impact of care home closures in his constituency and shared Phyllis’s story. While temporary placements further away are necessary to ensure that a person is discharged safely and without delay, those situations clearly have a huge impact on families.
On the Isle of Wight, local partners are working to improve access to more seamless pathways across health and social care so that people can move more easily between services and receive the support that they need. This includes strengthening co-ordination and expanding care in the community so that wherever possible people can be supported at home or close to home. As my hon. Friend said, because of the island’s size and physical isolation, that also requires close working with mainland partners to ensure that residents can access the full range of care that they need, including specialist provision where it is not available locally.
We will continue to explore and build on opportunities to deliver services for the benefit of the Isle of Wight community so that care can be delivered at the right place at the right time. We expect local systems to plan for demand and work with providers to strengthen capacity, including for people with dementia and complex conditions.
As we heard from my hon. Friend, it is vital that when a difficult decision is made to close a care home, the process is handled as sensitively as possible. Local authorities should have procedures in place to minimise disruption, with time allowed to support a safe transfer that supports the wellbeing of individuals, families and carers. Providers should ensure that proper arrangements are in place to support the transition of residents to their new position. Our expectation is that every effort should be made to provide care as close to home as possible and to take account of family connections and personal preferences wherever practicable. It is also essential that individuals and their families are involved in decisions about discharge and ongoing care. The guidance is clear that planning should begin early and that patients and carers should be supported to make fully informed decisions where appropriate.
We know that people who are discharged in a timely way with the right care and support in place experience better recovery and health outcomes. That is why we expect local systems to work together to ensure discharge processes are as effective as possible, particularly for people with dementia and other complex needs. The Government are therefore working with the NHS and local authorities to strengthen the local health and care system so that it can better meet those challenges.
Through the better care fund, more than £9 billion is being used to support integrated working between the NHS and local authorities, enabling more joined-up services and improving the planning of care outside of hospital. We will also reform the better care fund to support more effective joint planning and delivery between health and social care. That will be focused on improving how services are co-ordinated and supporting care that helps people regain their independence, reduces unnecessary hospital stays and enables people to receive care closer to home.
We also recognise the importance of improving care and support for people living with dementia. According to NHS data, NHS Hampshire and Isle of Wight integrated care board recorded that as of March more than 18,000 people had a diagnosed form of dementia. The Government want a society where individuals with dementia and frailty receive high-quality, compassionate care from diagnosis through to the end of life. That is why we will deliver the first ever modern service framework for frailty and dementia to deliver rapid and significant improvements in the quality of care and productivity. That will be informed by phase one of Baroness Casey’s independent commission into adult social care, which is under way and expected later this year.
We are committed to feeding into the NHS and local government planning cycles in September and aim to publish the full framework by the end the year, as recommended by Baroness Casey. We intend to engage with a range of partners over the coming months and will ensure that the voices of people with lived experience are at the centre of our work to develop the modern service framework.
I thank my hon. Friend for bringing his constituents’ voice to the House. I reiterate that we recognise the very real concerns raised by families on the Isle of Wight, particularly when people with dementia or complex needs have been moved away from their homes and communities. While there will be circumstances where temporary placements further from home are necessary, care should be provided as close to home as possible in a way that respects the individual’s needs, preferences and connections to their family and community.
Madam Deputy Speaker (Ms Nusrat Ghani)
I did not have time to congratulate the Minister, a fellow Brummie, on her promotion. It is good to see those from Birmingham here in the Chamber.
Question put and agreed to.
Draft Digital Waste Tracking (England) Regulations 2026
(1 day, 4 hours ago)
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The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs (Mary Creagh)
I beg to move,
That the Committee has considered the draft Digital Waste Tracking (England) Regulations 2026.
It is a pleasure to serve under your chairmanship, Mr Vickers. I begin by wishing my hon. Friend the Member for Newcastle upon Tyne North a happy significant birthday, and I look forward to celebrating with her later and at various points throughout the week ahead.
The draft regulations were laid before the House on 23 April this year. More than 200 million tonnes of waste are produced in the UK each year, and there is currently no comprehensive way of tracking it. Legislation relating to the transport, management and description of waste has been introduced in a piecemeal fashion over the last 30 years. Large amounts of waste movement data recorded through the current system are either not collected or are required to be submitted only each quarter and, of course, they are collected on a paper-based system. As a result, at a national level, it is difficult to determine where waste is from and what happens to it. At a local level, it is difficult for waste producers to check that their waste has been handled appropriately.
The system’s lack of transparency gives waste criminals opportunities to undercut legitimate waste businesses and to cause harm to our environment and communities. This crime costs the UK economy an estimated £1 billion each year, due to activities such as fly-tipping, deliberate misclassification of waste to avoid paying landfill taxes, illegal waste exports and the operation of illegal waste sites. For investigations, regulators usually need to request individual waste records by serving legal notices, which is time-consuming and prone to document falsification.
Replacing the outdated paper-based system will give the Environment Agency much-needed compliance oversight and help to close the loopholes that rogue operators exploit. The regulations will support those who do the right thing, not those who undercut them and think that “muck” is an accurate waste description or that providing a partial postcode for the source of waste is acceptable. By requiring near real-time information about waste movements to be recorded on a centralised system, the regulations will enable officers to identify unusual patterns, pinpoint high-risk operators, intervene earlier and shape targeted initiatives.
We are shifting from reactive investigation to proactive prevention. The regulations are the crucial first step in transforming the waste industry so that regulators—the Environment Agency—have timely data on waste movements from production right through to disposal.
The previous Government consulted on these reforms way back in 2022. They responded to the consultation the following year, but critically, they did not introduce these changes. This Government are acting. The first set of regulations will mandate that waste receivers operating under an environmental permit make a digital record of waste that comes into their facilities and submit that information to the digital waste tracking system within two working days of the waste being received. A second statutory instrument will be laid before the House next year to extend requirements to capture the full end-to-end waste journey information.
Before I turn to the detail of the legislation, I acknowledge the work of the Secondary Legislation Scrutiny Committee. Its report highlighted a point of interest on how digital waste tracking will interact with the new packaging extended producer responsibility scheme, or pEPR. Of course, once it is fully implemented next year, the data submitted to the digital waste tracking system will help to reduce fraud in the pEPR system as well.
I turn to the detail of the legislation, which provides a new statutory framework to tackle the problem of waste tracking. It designates the Secretary of State for Environment, Food and Rural Affairs to establish, maintain and operate the digital system. It requires that permitted waste receivers make digital records of specified information, as set out in schedule 1, before submitting it on to the system. There is a requirement for operators to pay an annual fee of £26, which will be used to recoup the costs of establishing, operating and maintaining the system.
Although there will also be transition costs to businesses of just over £1.5 million over four years between 2026 and 2029, and costs to obtain software estimated at under £39 million over 15 years, those costs are significantly outweighed by the future benefits of businesses no longer having to submit quarterly waste returns and, of course, the reduction in waste crime, which gives legitimate operators more waste to legitimately dispose of. Together, those savings are estimated at nearly £600 million over the 15-year appraisal period. As the illegal businesses—the criminals—leave the industry, there will be reduced unfair competition, more waste for the compliant operators and increased revenue.
The draft regulations introduce a new offence of failing to comply with the legislation and make provision for criminal penalties and civil sanctions, with unlimited fines available to punish offenders. Those who try to commit fraud by entering false information on to the system can also be prosecuted under section 44 of the Environmental Protection Act 1990 and receive up to two years in prison.
The introduction of digital waste tracking is a cornerstone of the Government’s waste crime action plan, the toughest ever crackdown on illegal waste activity. Through the action plan, we are strengthening regulations; pursuing the criminals responsible with more boots on the ground, more drones in the air, advanced technologies and stronger punishments; and accelerating the clean-up effort.
We are doubling the Environment Agency’s enforcement budget with an additional £45 million over the next three financial years, on top of the £5.6 million increase we had already announced for this financial year—£50 million in total over three years. That will bring waste crime enforcement funding to more than £30 million a year, compared with a miserly £10 million a year in 2023-24.
We believe in regulation for the environment, whether that is in the water sector, as we heard today with the Secretary of State’s statement to the House, or in the waste system. We are also introducing the waste carriers, brokers and dealers reform, tightening the waste exemption system and giving courts the powers to put up to nine points on the licences of fly-tippers.
My message to the waste criminals is clear: we are coming for you, we will track you down and there is no longer anywhere to hide.
Dr Neil Hudson (Epping Forest) (Con)
It is a great pleasure to serve under your chairmanship today, Mr Vickers. I thank the Minister for introducing the draft regulations to the Committee.
It is good to see the Government building on the progress made by the previous Conservative Government, who laid the foundation for digital waste tracking to be introduced by passing the landmark Environment Act 2021. Additional measures introduced by the Conservatives that sought to tackle waste crime include increasing the upper limit for fixed penalties to ensure proportionate and effective enforcement action. The previous Government also provided 30 local authorities with grants to enhance resources to tackle fly-tipping. The grants supported a range of projects such as CCTV, anti-climb fencing and better waste infrastructure.
Maria Eagle (Liverpool Garston) (Lab)
Does the hon. Gentleman have any insight into why the previous Government did not follow through and actually implement the regulations they consulted on?
Dr Hudson
I am very proud of the previous Conservative Government passing the landmark Environment Act. We consulted and brought forward measures to tackle waste crime, and I am very pleased that the Labour Government have taken the baton forward and are enacting some of the measures that we started.
Sadly, my constituents have also been faced with the blight of fly-tipping in our communities, with many serious cases caused by shameless criminals who should face the full extent of the law. It not only harms communities and the environment, but threatens the precious wildlife and biodiversity that the forest of Epping Forest is so privileged to enjoy. I must pay tribute to the litter-picking groups across Epping Forest, including the Waltham Abbey community group and Theydon Bois parish council, who regularly roll up their sleeves to fight the scourge of waste carelessly dumped. I have had the pleasure of joining that fantastic community in action on many occasions.
When I have joined community groups on litter picks, it has been particularly concerning to see an abundance of discarded large nitrous oxide canisters. They are used illegally for drug misuse and then discarded on the side of roads to be cleared up by those who do the right thing. Any activity to clear up waste, such as the measure we are discussing, needs to address this issue as a priority for urban, rural and semi-rural communities alike. Can the Minister outline what steps the Government are taking to tackle the illegal use of nitrous oxide and the damaging discarding of those dangerous canisters in our environment?
I welcome the cross-party support for tackling waste crime. Not only does it cost the English economy about £1 billion a year, but it has become interlinked with criminal gangs who profit from breaking the law. We should all be deeply concerned that an estimated 20% of all waste is illegally managed. Importantly, the regulations have the full co-operation of the devolved Administrations, which is vital to ensure that we have an effective regime that works for waste operators.
As the Minister will be aware, the Secondary Legislation Scrutiny Committee noted that the Government need to clarify exactly how the digital waste tracking regime will interact with the new extended producer responsibility —she made some comments on that point. Under the packaging scheme, producers will have to pay the costs of dealing with household packaging waste and provide information about its disposal. I hope she can provide further clear and practical information on that, particularly as many businesses have expressed strong concerns about the timing of the implementation of the EPR regime, which will add costs to businesses when the Chancellor is already taxing them hugely and making their lives very difficult.
The Minister might be aware that His Majesty’s most loyal Opposition hosted a food and farming emergency summit last year to which key stakeholders, including food producers, were invited. A key demand from that summit was a call for the Government to conduct a rapid review of EPR for the food, drink and hospitality sectors. The shadow Secretary of State for Environment, Food and Rural Affairs, my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins), wrote to the Government to ask them to act on that. It was disappointing that the Government did not consider the merit of such a request from the businesses directly affected by the policy.
Ministers are always keen to emphasise their desire to transition to a circular economy in which we keep resources in use for as long as possible, extract maximum value from them, minimise waste and promote resource efficiency. That goal is shared by all. However, aside from introducing individual measures here and there, the Government have yet to publish their clear circular economy strategy. As I understand it, the circular economy taskforce was established for the very purpose of creating a strategy. Will the Minister clarify when she anticipates further details will be published?
Tom Collins (Worcester) (Lab)
In my constituency, we have already paid dearly the price of waste crime and seen its impacts on our city and the surrounding area, so I really welcome this measure. I think most people would expect that we use digital tools these days to track, trace and gather data on the movements of value streams like this one. As we move forward into a more circular economy and see higher energy waste streams being handled, that becomes all the more important. As an officer in the all-party parliamentary group on critical infrastructure and heritage crime, it is good to see measures coming into place to tackle those areas of crime as well.
I note that the regulation introduces a fee and I am interested in the future value for money of that fee. In particular, I note that the Secretary of State has responsibility for the operation of the digital waste tracking system, but it is not clear how that will be administered in practice or to whom the fee will be paid.
Can the Minister explain the Secretary of State’s intention on the day-to-day administration of the waste tracking system? Will that be done by the Environment Agency, some other public body, or will it be contracted out to a private entity?
Will the Minister also comment on the development of the software? I note from the accompanying papers that it is currently in a private beta test stage, but the optimism bias being used is 400%. Does that indicate a problem or some very high uncertainty on the final areas of development of that software?
Apart from those small details, I strongly welcome the regulations and all the Department’s work.
Rachel Gilmour (Tiverton and Minehead) (LD)
I rise to speak on behalf of the Liberal Democrats, who broadly support the establishment of a digital system to track the movement of controlled waste. We have long campaigned—as people would expect us to—for stronger waste regulation and enforcement to protect our environment and tackle waste crime after years of inaction by the Conservative Government. As waste is a devolved matter, with separate legislation and systems being developed in Wales, Scotland and Northern Ireland, the Government must work closely with the devolved Administrations to ensure that these digital systems are interoperable and provide effective coverage across the whole UK.
Although we support the draft regulations, we urge the Government to go further in tackling the waste crime national emergency by taking up our calls to increase fixed-penalty notices for fly-tipping to £2,500, transferring responsibility for investigating major waste crime to the National Crime Agency, and introducing rewards of more than £5,000 for information leading to a successful prosecution of criminal gangs.
Mary Creagh
It is a pleasure to respond to that short but pithy and valuable debate. I am grateful to the Opposition spokesman, the hon. Member for Epping Forest, for his comments. He is beginning to remind me a bit of St Augustine, who was famous for his prayer of, “Grant me chastity, Oh Lord, but not yet”, because, as he said, he laid the foundations for some of this work while in government. That includes the EPR system, which he voted for in 2024 along with all his Conservative colleagues. He now stands loudly lamenting EPR, but I just remind him that it is something that his party developed in government and voted for less than two years ago.
I share the hon. Gentleman’s frustration about NOx canisters. I am still mystified as to why they are on sale in the UK. I know they are useful for whipping cream, but we see when we go on Amazon, as I did a couple of years ago, that people who bought NOx canisters also bought little canisters to sell it for £1, £2, or whatever it is they do to create further litter. It is absolutely clear that there is not a sudden, massive interest in whipping cream across the festivals and parklands of this great nation.
In fact, nitrous oxide is a highly regulated substance and a fluorinated gas that we need for some medical emergencies. I remember the glory days of British dentistry, where any time someone went for a filling they got the happy gas so that they did not really mind what was happening to their teeth. Those of us who are old enough will remember that—[Interruption.] I can see nods of recognition. There were various bans of nitrous oxide, but it is still used for women in childbirth. If we have a quota for fluorinated gas, under various UN conventions, we should keep that quota but reduce it and save it for absolutely medically necessary issues, and not allow a huge black market to proliferate in this thing that is allegedly used for whipping cream.
Last Friday, I was out picking up litter and a variety of other things, including a wendy house, that had been fly-tipped in Willenhall in Coventry, and I picked up three nitrous oxide canisters. The day before that I had been to an incinerator, an energy-from-waste plant, where they had shown me how these canisters can burn at incredibly high temperatures. They told me that the canisters should never be put into any sort of incineration, because that presents a danger to workers both on the journey towards incineration and at the incinerator—even though they can come out of the incinerator safely because they are tested to such a high engineering capacity. I thought, “Right, I will not just leave these canisters for the council to pick up; I will take them to a metals recycling facility.” I took them to European Metals Recycling, which is close to my office in Coventry, where I was told, “We don’t take these.” I am not clear where these canisters are meant to be safely disposed of, and if I am the waste Minister and I do not know, I am not clear what everyone else is supposed to be doing. I will start my little battle on NOS—watch this space.
Let me talk to some of the other points that were raised. First, charities and local authorities will have to pay the fees. With this waste system, we have essentially mirrored what His Majesty’s Revenue and Customs has done through Making Tax Digital. We have done something that is legible and readable through the back end and that can be used by proprietary software providers, rather than building our own proprietary software and making it clunky and rubbish, which is what Government software schemes are famous for doing. We thought, “How can we turn this on its head and do something that can be used and is fungible and readable across other databases?” We watched what had happened with HMRC and fundamentally designed that in.
The system is in beta testing because I believe in making haste slowly. I do not believe in big-bang changes. I believe in working with a coalition of the willing to test, refine and improve. The fee is set at £26. That includes charities, local authorities—anyone operating permitted waste facilities where commercial waste activities are carried out. The fee recovers the cost of establishing, operating and maintaining the services. It includes costs for things like the digital system build, the ongoing hosting cost and the operation of the helpdesk for users, which is run through the Environment Agency.
The total costs were estimated over a 10-year period and averaged over the total number of operators expected to be using the service once it has been fully delivered, ensuring that those in the first phase will not pay more, so people are not penalised for being one of the good guys. That approach has been agreed by Treasury. We intend to review the service charge once the system is fully operational and we have more accurate data about the number of users on the system. Of course, one of the issues is that lots of people are not on the system, and we do not know where they are, so we will amend the service charge through legislation as needed. The service fee is paid annually to the Department for Environment, Food and Rural Affairs by users as part of their account registration.
One of the main aims of introducing digital waste tracking is to reduce waste crime. Regulators need to distinguish between someone who is digitally excluded and someone who is deliberately not complying with the regulations. There are provisions in the statutory instrument for the digitally excluded—although in this day and age, if someone is running a company without any sort of computer, we do have to wonder. By not having a criminal sanction for failing to apply for a digitally excluded number or recording that number on written records, it may give the impression that this is less important than digital users applying. It may lead to digitally excluded operators choosing not to comply and there would be gaps in waste movement records, which would undermine the whole system, so we have included that.
On packaging extended producer responsibility, one of the questions that has been around for at least the last decade—it is not a new one; the hon. Member for Epping Forest will have heard it, as I have—is about the need to reduce fraud in the producer responsibility note and the producer export responsibility note system. We have already introduced a number of measures to address that fraud. All reprocessors and exporters who handle any packaging waste will now have to register, collect and report data on packaging waste received, processed, rejected and exported.
The pERP regulation will place requirements on accredited reprocessors and exporters, including monthly reporting of packaging waste reprocessed or exported and monthly data on packaging recovery notes/packaging export recycling note prices by material. Exporters will need to provide proof of receipt at the final overseas destination site to issue a PERN and retain records of the recycling of the packaging waste. Critically, there will also be a new fit and proper person test for operators as part of the accreditation process. In addition, DEFRA has recently consulted on further proposals to enhance the PRN system, target fraud and ensure that packaging waste is managed in an environmentally sustainable way. The results of that consultation will be published shortly.
Digital waste tracking is being introduced in phases, but we intend to mandate the recoding of information about exports of green list waste, also known as article 18 waste, in the system from 2027. So it will come here in April next year and we will look to introduce it from October 2027. The increased visibility of export data will also help to combat fraud in the system.
On litter, local authorities already have powers to take enforcement action. We have been encouraging them to make good use of those powers, because under the previous Government they did not have the cash to pursue prosecutions and actions against offenders. We have published new statutory litter enforcement guidance: “Litter enforcement powers—when and how to use them”. Local authorities now have a legal duty to have regard to that guidance, which will lead to a more consistent approach to tackling litterers across the country.
We have also published a refreshed code of practice on litter and refuse, which sets out the standards expected of local authorities and other duty bodies with regard to keeping land clear of litter and refuse. I pay tribute to the many Wombles and clean-up squads across the country that are doing such great work, but we want to get to a stage where there is no littering and people understand and respect the areas around them.
I will add a final thought on fly-tipping: councils already have powers to seize and search the vehicles of suspected fly-tippers. Again, to support them making better use of that power, we have published best practice guidance and case studies on the website of the National Fly-Tipping Prevention Group. We have also secured powers in the Crime and Policing Act 2026 to provide statutory fly-tipping enforcement guidance on using their powers and powers for the courts to award between three and nine penalty points on the driving licences of those found guilty of fly-tipping. Often, we find that fly-tippers are doing a little job for their mates on the weekend. They might be drivers in the week, and this is a little weekend side-hustle. The penalty points would make it harder for offenders to continue dumping illegally if they are disqualified from driving and send a clear warning: fly-tipping is not to be tolerated.
Jim McMahon (Oldham West, Chadderton and Royton) (Lab/Co-op)
I congratulate the Government on the efforts being made on fly-tipping. We can quite often skirt over just how important these issues are, but in areas where fly-tipping is common, it absolutely ruins the local community. I put on record our appreciation for the work that is being done.
Mary Creagh
I thank my hon. Friend for his kind words. I also pay tribute to his council in Oldham, which wrote to me about a very thought-provoking motion that the council passed. The leader of the council—I am sorry; his name escapes me—said that environmental justice goes hand in hand with social justice. These environmental crimes are predominantly perpetrated against poorer communities. There is a kind of social injustice there that we must not lose sight of. There are certain parts of Coventry that are spotless and have no litter or fly-tipping, and other areas, like Foleshill, the ward where my office is, where fly-tipping is absolutely endemic.
I will conclude by talking about our manifesto commitment to forcing fly-tippers and vandals to clean up their mess. We will soon consult on giving local councils the powers to issue fly-tippers with conditional cautions, one of a range of pre-court community-based sanctions that could see offenders completing up to 20 hours of unpaid work cleaning up streets and parks and paying back the cost of cleaning up the waste that they have dumped on public land. If an offender admits to the crime, agrees to the caution and complies with those conditions, they will not face prosecution. Anyone who spends a couple of hours cleaning up litter and sweating in the hot sun, as I did on Friday in Willenhall, will be very keen not to repeat the experience.
Nationwide waste tracking does not exist, so the costs are uncertain at the moment because we do not have a baseline to go from. However, we have used HMRC’s Making Tax Digital as an assumption as it is a similar digital delivery policy. We have put in a 400% optimism bias to account for underestimation because we do not know what we do not know—the unknown unknowns. There are more firms in scope for Making Tax Digital compared with digital waste tracking—obviously, because not everyone is doing waste. Therefore, economies of scale will differ.
With that, I thank the Committee for its attention, good humour and positive comments this afternoon. I commend the fact that the legislation is widely supported by stakeholders for whom it could not come soon enough and who have been begging for it since the previous Government’s waste and litter strategy was published back in 2019. The hon. Member for Epping Forest asked about the circular economy growth plan. That is going through the normal Government channels and processes. I am sure he will be very excited when it is eventually produced, because that is our whole economy plan: to be a resilient, clean and highly efficient materials nation. The legislation has been highly anticipated by our stakeholders. I am delighted that it is supported by Members on both sides of the House and am thrilled to have been able to present it here today.
Question put and agreed to.
Resolved,
That the Committee has considered the draft Digital Waste Tracking (England) Regulations 2026.
Draft Immigration (Leave to Enter and Remain) (Amendment) Order 2026
(1 day, 4 hours ago)
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The Parliamentary Under-Secretary of State for the Home Department (Mike Tapp)
I beg to move,
That the Committee has considered the draft Immigration (Leave to Enter and Remain) (Amendment) Order 2026.
It is a pleasure to serve with you in the Chair, Mr Betts. Lowering the e-gate age to eight is a logical next step in realising our vision for the future border and is an extension of existing Government policy. We anticipate that the change will allow an additional 1.5 million children to become e-gate eligible, making it easier for families to move through the UK border, especially during the busy summer months, and enabling our highly skilled Border Force officers to focus their efforts on those who may pose a threat to the UK.
Peter Fortune (Bromley and Biggin Hill) (Con)
My intervention is about the age for access being lowered to eight years old. Perhaps the Minister could reassure us on what assessment has been done of safeguarding. That would make me very happy.
Mike Tapp
I thank the hon. Member for his pertinent question. Our best mitigation to counter any safeguarding concerns is our Border Force officers. Officers will continue to be deployed to provide a visible presence to counter risks and interact with passengers should any safeguarding concerns arise. Border Force will continue to play an important role in monitoring the use of e-gates, intervening where necessary and protecting the public at the UK border.
We already encourage parents travelling with children to use e-gates first, ensuring that their child remains in the protection of Border Force should either face any issues when using e-gates. I reassure the Committee that this change will apply only to those children accompanied by a responsible adult. Any child under the age of 18 who is unaccompanied must proceed to the desks and be processed by a Border Force officer.
The Committee may have concerns about the increasing dependence on automated technology deployed at the UK border. I cannot comment on the specifics, for obvious reasons, but I can confirm that we rigorously test all border equipment and the Home Office has robust technical and business continuity arrangements in the event of any system failures.
The draft order makes the most modest of changes to existing legislation, but allows us to take a significant step forward in the development of our future border—one that remains secure and fluid, and targets resource where it is most needed. Subject to approval from Parliament, we intend to implement this lower e-gates age for accompanied children at airports and juxtaposed controls with e-gates on 8 July. I commend the order to the Committee.
Alicia Kearns (Rutland and Stamford) (Con)
It is a pleasure to serve under your chairmanship, Mr Betts. I am grateful to the Minister for his remarks. The Conservative party supports this order and the sensible operational change that it makes. e-Gates were rolled out across our major airports under successive Conservative-led Governments, with 264 e-gates operating by 2019. They now process the majority of arrivals at our busiest ports of entry, freeing up border officers to focus on genuine threats and concerns at our borders. We lowered the minimum e-gate age from 12 to 10 in 2023, following a successful trial, so we support the Government continuing in that direction.
This is a practical change. As anyone who has stood in a Border Force queue at Stansted, for example, on a Sunday night in August with tired children knows, we want to get our children home as quickly and safely as possible. Where changes can be made safely and can ease the burden, we will support them. However, the effectiveness of e-gates relies on public confidence in the system, so can the Minister expand on whether the Home Office will monitor the impact of lowering the age threshold, particularly on processing times and accuracy rates, and the experience of families travelling with younger children?
Will the Minister confirm whether the Independent Anti-slavery Commissioner has been formally consulted on the change, given her work highlighting the challenges that Border Force faces in identifying trafficked children, particularly at ports of entry? Will the Government commit to a review after the first year of operation to look specifically at the ability of Border Force to identify trafficked or vulnerable children at the gates, particularly those subject to modern slavery, and commit to broader safeguarding regarding children at those gates?
We recognise the measure is a positive change. Our border must remain welcoming to legitimate travellers and robust against those who try to abuse it, particularly anyone with a malevolent interest in children.
Mike Tapp
I thank the hon. Member for her questions. On the first one, tech at the border is under continuous review, I meet with officials on a regular basis to look at friction rates, data and stats. We can adjust accordingly if needed in future. Those are under continuous review. On the anti-slavery question and whether there was consultation, I do not have an answer at the moment, but we will write to her in due course with an answer.
The order will enable a positive next step in our ambition to transform the UK border and drive up the use of automation for legitimate travellers to the UK. I emphasise again that the change is minor and builds on existing policy, with robust safeguards in place to support children and their families to cross the UK border in a safe and efficient way. I commend the order to the Committee.
Question put and agreed to.
Draft Pensions (Abolition of Lifetime Allowance Charge etc) Regulations 2026
(1 day, 4 hours ago)
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The Parliamentary Secretary to the Treasury (Torsten Bell)
I beg to move,
That the Committee has considered the draft Pensions (Abolition of Lifetime Allowance Charge etc) Regulations 2026.
I will briefly take the Committee through the background and purpose of these draft regulations, which relate to the abolition of the pensions lifetime allowance. At the 2023 spring Budget, the previous Government announced that they would abolish the lifetime allowance. The Finance (No. 2) Act 2023 removed the lifetime allowance charge. The Finance Act 2024 removed the other elements of the lifetime allowance from the pension tax regime from 6 April 2024. That was a significant task; the entire pensions tax regime was structured around the existence of a lifetime allowance, and many other aspects of the regime, such as allowable pension and lump sum benefits, were calculated with reference to the lifetime allowance. Additional regulations have thus been needed to provide further administrative and technical detail.
Since the Finance Act 2024 and the regulations that followed, His Majesty’s Revenue and Customs has continued to work with industry representatives to ensure that the legislation operates correctly. In doing so, HMRC has identified further areas that do not operate as intended. This statutory instrument simply modifies a number of areas of primary legislation and some areas of subordinate legislation purely to ensure that the abolition of the lifetime allowance is delivered as originally intended.
Those changes ensure that the lump sum allowances work fairly and consistently, including treating overseas pensions in the same way as UK schemes and giving individuals flexibility to decide the order of multiple payments on the same day. They also clarify the calculation of protections and enhancements so that the outcomes more closely reflect those achieved under the lifetime allowance. Finally, they introduce targeted technical fixes and improved reporting rules to support accurate administration for the post-lifetime allowance regime. The draft regulations are not a change in policy but make the further technical and consequential amendments necessary to ensure that pensions tax legislation can operate as intended following the abolition of the lifetime allowance.
Most of these changes will take effect from 6 April 2024 —in other words, they will apply retrospectively—when the lifetime allowance was abolished, although a small number of amendments will come into effect only from the date that the regulations come into force. The regulations have been made by the Treasury by exercising the powers conferred by paragraph 134 of schedule 9 of the Finance Act 2024. I therefore commend the instrument to the Committee.
Mark Garnier (Wyre Forest) (Con)
I was going to bang on with a very long and intelligent speech, but in the interests of brevity and keeping everybody happy, I will not. I am delighted that the Minister is introducing legislation relating to the glorious regime of the strong and stable Conservative Government of 2020 and the 2023 Budget. This policy was slightly bonkers. We need to do everything we can to encourage people to save and not put a cap on their savings. I am tempted to go on about salary sacrifice, but I will spare the Minister the embarrassment of reminding him about that. We will certainly not oppose these regulations.
Health Bill (First sitting)
(1 day, 4 hours ago)
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The Chair
Before we begin, I remind Members please to switch all electronic devices off or to silent. I also have to tell you that tea and coffee are not allowed during the sittings. Date Time Witness Tuesday 16 June Until no later than 9.55 am NHS England Tuesday 16 June Until no later than 10.25 am The King’s Fund; National Voices Tuesday 16 June Until no later than 10.55 am The Academy of Medical Royal Colleges; The Institute of General Practice Management Tuesday 16 June Until no later than 11.10 am Health Services Safety Investigations Body Tuesday 16 June Until no later than 11.25 am The Rt Hon Sir Jeremy Hunt MP Tuesday 16 June Until no later than 2.30 pm The NHS Alliance; The Royal Berkshire NHS Foundation Trust Tuesday 16 June Until no later than 3.10 pm The Patients Association; Together for Short Lives; Healthwatch England Tuesday 16 June Until no later than 3.50 pm Local Government Association; Association of Directors of Adult Social Services; South East London ICS Tuesday 16 June Until no later than 4.30 pm Carers UK; Age UK; Tommy’s Tuesday 16 June Until no later than 5.10 pm Dr Michael Cocker, East Lancashire Hospitals NHS Trust; Dr Towhid Imam, Croydon Health Services NHS Trust; Dr Nicola Byrne, National Data Guardian for Health and Social Care Tuesday 16 June Until no later than 5.25 pm Managers in Partnership Tuesday 16 June Until no later than 5.40 pm Sir Andrew Dilnot Tuesday 16 June Until no later than 6.00 pm Department of Health and Social Care
We will consider first the programme motion, as on the amendment paper, and then the motion to report written evidence for publication and the motion to allow us to sit in private to discuss questions before the oral evidence sessions begin. In view of the timetable, I hope that we can take those matters formally, without any debate. I call the Minister to move the programme motion standing in her name, which was discussed yesterday at the Programming Sub-Committee for the Bill.
Ordered,
That—
(1) the Committee shall (in addition to its first meeting at 9.25 am on Tuesday 16 June) meet—
(a) at 2.00 pm on Tuesday 16 June;
(b) at 11.30 am and 2.00 pm on Thursday 18 June;
(c) at 9.25 am and 2.00 pm on Tuesday 23 June;
(d) at 11.30 am and 2.00 pm on Thursday 25 June;
(e) at 9.25 am and 2.00 pm on Tuesday 30 June;
(f) at 11.30 am and 2.00 pm on Thursday 2 July;
(g) at 9.25 am and 2.00 pm on Tuesday 7 July;
(h) at 11.30 am and 2.00 pm on Thursday 9 July;
(i) at 11.30 am and 2.00 pm on Thursday 16 July;
(2) the Committee shall hear oral evidence in accordance with the following Table:
(3) proceedings on consideration of the Bill in Committee shall be taken in the following order: Clauses 1 to 14; Schedule 1; Clauses 15 and 16; Schedule 2; Clauses 17 to 29; Schedule 3; Clauses 30 and 31; Schedule 4; Clauses 32 to 35; Schedule 5; Clauses 36 to 38; Schedule 6; Clauses 39 to 50; Schedule 7; Clauses 51 to 59; Schedule 8; Clauses 60 to 64; Schedule 9; Clause 65; Schedule 10; Clauses 66 and 67; Schedule 11; new Clauses; new Schedules; Clauses 68 to 72; remaining proceedings on the Bill;
(4) the proceedings shall (so far as not previously concluded) be brought to a conclusion at 5.00 pm on Thursday 16 July.—(Karin Smyth.)
Resolved,
That, subject to the discretion of the Chair, any written evidence received by the Committee shall be reported to the House for publication.—(Karin Smyth.)
The Chair
Copies of the written evidence that the Committee receives will be made available in the Committee Room.
Resolved,
That, at this and any subsequent meeting at which oral evidence is to be heard, the Committee shall sit in private until the witnesses are admitted.—(Karin Smyth.)
The Chair
We are now sitting in public again and proceedings are being broadcast. Before we start to hear from witnesses, do any Members wish to make a declaration of interest in connection with the Bill?
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I am a member of the Royal College of Paediatrics and Child Health, a member of the British Medical Association and an NHS consultant paediatrician.
Sojan Joseph (Ashford) (Lab)
I used to work in a mental health trust for many years, and I am still its employee—I am on an extended career break from the trust.
Helen Morgan (North Shropshire) (LD)
I am a vice-president of the Local Government Association.
The Minister for Secondary Care (Karin Smyth)
I am a member of the Managers in Partnership trade union, which is giving evidence this afternoon.
Liz Twist (Blaydon and Consett) (Lab)
I am co-chair of the Unison group of MPs, which is linked to Managers in Partnership.
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I am a retired ENT surgeon and a fellow of the Royal College of Surgeons.
The Chair
Thank you very much. It will be helpful if you reiterate those declarations at the start of any speech or question, if they are relevant.
Examination of Witness
Dr Penny Dash gave evidence.
The Chair
We will now hear oral evidence from NHS England. I am afraid that we have to stick to the timings very rigidly because we have a lot to get in this morning, and we have until 9.55 am for this session. Dr Dash, could you be very kind and briefly introduce yourself for the record and make any very short opening remarks you wish to make?
Dr Dash: Good morning. My name is Penny Dash, and I am the chair of NHS England. I thought I was here to answer questions, so—
The Chair
You are, absolutely. Normally, as a courtesy, I allow a very brief comment if you want to say anything.
Dr Dash: No, thank you.
Dr Johnson
Q
Dr Dash: I do not believe it is affecting our ability to deliver. Much of the work to date has been led by a joint team of people from across NHS England and the Department of Health and Social Care, who are working together, have put together a process and have been going through all the things you would expect of any integration process. That has been a fairly confined team.
As they are starting to look at what needs to happen in each of the different functional areas—the different directorates—that we have set out, they are working with the directors general or the executive directors leading each of those to understand what different functions we need to enact within each of those directorates, and what their teams could look like. They are putting time into that, which is good—that is what we want them to do, not least because they are also looking at ways of working, not just at numbers of people—but I would not say that it is a distraction. In fact, in some ways, I would say it is really helpful, because it is helping to define the core priorities and the key things that we need to focus on, and how we can continue on the journey of seeking to improve health and healthcare services. That is across those executive directors and directors general.
The team who are putting a lot of time into this, not surprisingly, are the people working in the HR functions. That team are spending a lot of time going through the mechanics, and they have been managing things like the voluntary redundancy programme. I would hope, and I believe, that there is no negative impact on our focusing on what we need to focus on.
Dr Johnson
Q
Dr Dash: On the first question, as you say, my first review looked at the CQC, and that there are a number of considerable challenges there. I would have hoped that, by now, many of those challenges had been addressed. Some of them have been, but some of them have struggled. It has already gone from the previous chief exec to a new chief exec, and it is now out looking for another chief exec, and the chair has changed too. That has definitely impeded progress. As I said, it has made considerable progress in some key areas, in particular the use of technology, but it still has a way to go, and we all need to acknowledge that. I note that the ministerial team in the Department of Health and Social care has suggested that the integration of HSSIB into the CQC should happen only when the CQC is in a more stable position, which sounds sensible and pragmatic to me.
On the second review that I did, I was asked to look at the regulatory and quasi-regulatory landscape. I was referred to a report that had been done by Professor Carl Macrae and others that talked about 126 organisations. When I looked, I found more than 150, and I listed all of those in my report. I spoke to many people—well over 200 people who joined various roundtables and so on—and the very consistent theme was that this is so busy and confusing, and keeps leading to all sorts of different recommendations from different organisations, but also to people having continually to respond to all these different bodies asking for people to fill out a form, asking questions and doing reviews. As a result, our clinical staff—not just our nurses, but all our clinical staff—are having to spend considerable time filling out those forms and going through tick-box exercises. You will hear people talk about that a lot.
The concern is that this very busy landscape is distracting from what it is there to do, which is to improve quality of care. I was asked by the Department of Health and Social Care to look at that landscape. I was asked to focus on six organisations, which are listed in my report, of which HSSIB was one. Across the six—of course, six is a small number out of that 150—I was asked to look at where there were opportunities for rationalisation and simplification. The observation was that colleagues in HSSIB have some great skills and capabilities in carrying out investigations into healthcare, highly complementary to the work of the CQC, which is equally there to understand how well different organisations are performing, to give the public confidence, to give ratings and to identify problems, and therefore putting those two organisations together would create significant synergies and opportunities for them both to work well.
Dr Johnson
Q
Dr Dash: I do not see a conflict. I think they are complementary and this is all about improving the regulatory landscape in the healthcare system.
Karin Smyth
Q
Dr Dash: One of the things that I observed when I was doing the review, and that I have observed even more so now that I am in post, is that we do not have effective mechanisms of really learning from patients and patient experience. If I compare how the NHS works with how other large organisations in our country work, we are not systematically collecting patient information, we are not looking at that in detail, we are not segmenting it into different groups of people, and we are not systematically bringing it into board meetings, which is where it should be in order to drive improvement. We are hoping, or expecting, that the new director of patient experience will take a real leadership role in this and will improve the way in which the centre works but, more importantly, will be working with organisations right across the NHS to build those skills and capabilities, and to put patient experience feedback and improvement in patient experience right at the centre of every discussion on improvement.
Helen Morgan
Q
Dr Dash: The CQC is an independent regulatory body as well. The hope and expectation is that we have a high-calibre, independent regulatory body that is the prime regulatory body for looking at how well health and care services are delivered and, as well as observing how well they are currently performing, is able to carry out specific, focused investigations when it spots systematic problems across the healthcare system, or indeed when particular problems are identified.
In terms of safe space, clearly, confidentiality is important. Confidentiality is important right across the board; staff need to feel able to report within NHS organisations and to the CQC where they have concerns. I have to say that I was concerned in that Health Committee session to hear an example given by Jeremy Hunt, who said that if a midwife is concerned about quality of care in their maternity unit, they need to be able to go somewhere and report that, and to know that HSSIB would not tell anyone else about it. I looked at Duncan, our chief nursing officer, who was there with me, and we were shocked to hear that. How can that possibly be right? We need to have a mechanism whereby if there are concerns about quality of care, they are properly investigated, and mechanisms to deal with those problems and improve services. Yes, we need confidentiality, but I was not convinced by what I heard then—that we needed a completely separate organisation that was duplicating the work of others.
Helen Morgan
Q
Dr Dash: I will talk first about providers and then about the commissioners, the payers, the ICBs. We absolutely should expect all providers—GP practices, community trusts, hospital trusts—to see patient experience as a crucial part of their role and not to outsource it to someone else; it has to be a crucial part of what they do. They need to get way better at collecting patient experience, they need to understand it from different groups, wards and medical teams, and they need to be playing that back. Ideally, that should be part of everyone’s appraisals: “Here’s the sort of feedback that we’ve had. Here’s what we’ve heard. Here’s how we’re acting on that.” We need to put that in the places where healthcare is delivered, and that is in those provider organisations.
The ICBs have a different role, which is to commission healthcare services in order to improve health and ensure high-quality care, and it is their responsibility to speak to communities. They all have considerable teams of people who are doing that—speaking to different members of society and conducting usually frequent events to get input and hear what people are looking for from their health and care services. When they are looking to design particular services, whether mental health services or children’s services, they go much deeper into that and speak to specific groups, often involving the providers as well.
Those mechanisms are already embedded within ICBs, but we need to continue to ensure that they do those as well as they can. When I was speaking to people, I found some fantastic examples of different healthwatch organisations across the country, but that is not at all consistent and they are often too far removed from what is actually happening in terms of day-to-day services to have a significant impact on improving patient experience.
Sureena Brackenridge (Wolverhampton North East) (Lab)
Q
Dr Dash: I think that we do need to recognise that. I hear that as well and experience it myself; lots of people are often reluctant to come forward, and they think, “If this is my GP, how is this information going to be treated?” That is why we need to really raise the calibre of our directors of patient experience. There are ways in which you can manage that and treat that data confidentially—in fact, you have to treat all data confidentially. There are ways in which you can support people and give them the confidence that their information will be taken seriously and treated confidentially. You can do that often through focus groups, one-to-one conversations and anonymous surveys. We are hoping to be able to do a lot more of that through the app, to link it directly to people’s care, and to give people prompts as soon as they have had an interaction: “Please feed back.” I think there are ways in which we can overcome that. Bringing this much closer to people’s care, linking it in much more to day-to-day practice and making sure that feedback goes straight back to our frontline clinicians in an anonymised way to encourage and support them to improve brings a significant benefit, and we can find a way around the concerns about confidentiality.
Gregory Stafford (Farnham and Bordon) (Con)
Q
More specifically, if, as you said to the Health and Social Care Committee, the safe space element would be retained and HSSIB would operate as an independent organisation, how can you square the fact that it would remain independent and yet be part of the CQC? If it does remain independent, what is the need to bring it into the CQC?
Dr Dash: The point of bringing it into the CQC, as I said before, is that we are trying to simplify this landscape. There are so many different organisations continually commenting and doing reviews—often replicating the same reviews that other people have done. The concern is that it is distracting rather than enabling. The hope that I had when I made the recommendation, and still have now, is that by bringing HSSIB into the CQC, you can align the work of the two.
For example, if the CQC is going round the country and spotting a particular problem with the way in which anaesthesia is being given or with managing patients post-surgery, the CQC could then say to HSSIB—that team of people with specific expertise—“Can you go in and take a look at this? Can you do a detailed focus review of this particular area of care that we are spotting through our visits and which seems to be a particular challenge?” It is that bit about enabling the CQC to identify a problem and then asking HSSIB to review it in detail, and HSSIB bringing its expertise in investigations into the CQC to enable the CQC to go deeper and then come back to the NHS with particular areas, but also to supplement the work of the NHS.
I would like to point out that since HSSIB was established, the NHS has established its own much more rigorous, much more robust investigatory teams and processes. Of course, I am not saying that they are perfect—we can all see that—but I encourage all colleagues here today to look at the work they are doing, the specific areas they are reviewing, the outputs of those reviews and the ways in which those are leading to improving care. That feels to me to be a much more systematic way of addressing the concerns of patients, families and staff in the place where those concerns happen, having mechanisms to escalate those through the NHS so you can bring them to regions—some investigations get done at the NHS England level—and having the CQC as an independent body that can separately review and spot if there are problems but also ensure that those investigations within the NHS are happening well.
Gregory Stafford
Q
Dr Dash: Well, we then have to deal with that as a problem. That is the same as saying, “What happens if the problem is this organisation or that one?” We have 150 organisations—150. What if the GMC is a problem? What if the Nursing and Midwifery Council is a problem?
Liz Twist
Q
Dr Dash: There are a few different things. First, we have talked about appointing a director of patient experience. They will report directly to the chief exec of the NHS. That is crucial; it is about emphasising the importance. We are about to do the interviews for that person, so I hope they can be in post very quickly.
Secondly, we are hopefully about to publish the quality strategy. Within that strategy, which has come out of the 10-year plan, we are very clear about the three dimensions of quality. Those are: safety, so ensuring that basic standards are in place; effectiveness, so making sure that patients receive the right care in the right place at the right time and it is delivered to a high standard; and, crucially, patient experience. In the quality strategy, we emphasise that all three of those are crucial. You need to have all three and all three need to be done really well.
We then go on to talk about different mechanisms for improving those dimensions. Crucially, we have a set of 183 metrics, which we will review within the NHS England quality committee while it still exists, and then within the National Quality Board. We also expect every region to review those metrics, as well as others, and every ICB and provider to review the ones that are relevant to them. So the next bit is to have all those different metrics.
Thirdly, we need wider transparency. There are way more than 183 different metrics and we need to have far more on patient experience. They need to be routinely collected in the same way that we do surgical audits or audits of GP work. Those all got in the public domain; that was a big element of the 10-year plan.
Finally, as I said before, we need boards to take full responsibility and accountability for all aspects of quality, which includes patient experience. As I go round and meet individual hospital boards, I ask them about that. I spend quite a lot of time with chairs and new non-executive directors coming into NHS providers, and I continually emphasise, “This is a crucial area for you to focus on as a board.” What are you asking your exec colleagues? Who have you put in place as your director of patient experience within the organisation? How are you routinely collecting information from a whole spectrum of users from the whole of society? How are you doing that in a confidential way for the reasons we spoke about earlier, and then ensuring that people are acting on it? I do not think we are doing anything like enough of that, and we need to get much better and do far more of it.
Joe Robertson (Isle of Wight East) (Con)
Q
Dr Dash: Yes, I am aware. The analogy is continually made—and it has been made several times—and to be honest, 20 years ago, I would have shared the view that healthcare was similar to airlines. Indeed, I did quite a lot of talks about that at the time. However, the more I have looked into it, the more I think there are limits to that analogy.
We are running out of time and this is a much longer conversation, but if I look at the specific examples that people bring up from the airline industry, it is about spotting some very specific things. An example was used at the Health and Social Care Committee about spotting a bolt that is not working properly. The equivalent of that within the NHS is actually something like the MHRA, which is separate. If we spot a drug, an anaesthetic machine or a cardiac device that is not working properly, that is for the MHRA, which is separate from the CQC.
The CQC is there to be the independent regulator of the quality of care more generally, which is more the space that HSSIB has been in. HSSIB has been looking at things like the use of digital triage in general practice and corridor care, and it has done some work on surgical safety and so on. All of that is part of a bigger landscape of quality of care, which the CQC is responsible for. The more that I looked at this issue and the more I spoke to people, I became less sure that it is analogous to the airline industry. It is much broader and more complex, and certainly the airline industry does not have 150 different regulators and quasi-regulators.
The Chair
Dr Dash, thank you very much indeed. The Committee is indebted to you. I am afraid that brings us to the end of this panel and we will now move on.
Examination of Witnesses
Sarah Woolnough and Jacob Lant gave evidence.
The Chair
We will now hear evidence from the King’s Fund and National Voices. Again, I fear that we will have to stick to the timings, as we have very limited time. We have until 10.25 am for this session. Could you please identify yourselves for the record?
Sarah Woolnough: I am Sarah Woolnough, chief executive at the King’s Fund.
Jacob Lant: I am Jacob Lant, chief exec of National Voices.
Dr Johnson
Q
“would be minimal in the context of the entire NHS budget”.
Many MPs across the House have struggled to get numbers and costings in questions both oral and written, particularly in relation to staff redundancies. We have not received information on the full arrangements of where NHS England’s functions are going to go yet. How can we be sure that its abolition will save any money at all?
Sarah Woolnough: I think, on the basis of the question, we do not know. Our worry has been about the opportunity cost. The Government, when in opposition, said that they would not launch wholescale reorganisation, because they understood the potential opportunity cost on time and other resources. As this has played out, taking longer than anticipated, we have had multiple examples of teams left in limbo about where they will end up in the target operating model. Our ongoing concern has been, “Is the benefit worth the cost?”
Dr Johnson
Q
Sarah Woolnough: It is inevitable that, in any large-scale change in an organisation, there will be opportunity cost. These arguments were very well rehearsed by the previous Secretary of State. He undertook personally that he would not follow this course of action, exactly because these things take longer and cost more, and because the benefit realisation case is not always clear.
It is also quite hard to tell—we have grappled with this as a think-tank—whether there is good evidence of what you are delivering at the end, and whether the benefits will be realised as you stated they would be up front. It is harder to get the granular evidence and costings to prove the case, but our ongoing concern has been whether you need to wholescale reorganise to drive the sorts of benefits that the Government have said they want to deliver.
We absolutely understand and agree with those who say, “Let’s reduce duplication. Let’s streamline. Let’s make sure that we’re getting value for money and spending taxpayers’ money wisely.” Do you need to launch a large reorganisation—a mass rearranging of the deck chairs of this nature? Our view has been, “You shouldn’t and you don’t.”
Dr Johnson
Q
Jacob, what effect will the abolition of Healthwatch have on people’s confidence in the independence and reliability of views of patient experiences?
Jacob Lant: First, it is important to note that we know that there are people who are reluctant to come forward and share their poor experiences of care with the NHS directly. They fear retribution if they complain or speak up. Research by Healthwatch has shown that about one in five people experience poor care, so a significant proportion of people are unwilling to come forward and speak to statutory agencies. That will be concentrated in communities who are particularly marginalised—those who already lack trust in institutions. There is a clear case already that there will be a group for whom the lack of independence will be a real concern.
The second point is about the unsolicited feedback that is gathered by the Healthwatch network. Dr Dash and others have talked about how the system does lots of engagement itself, and how it could therefore surely take over those functions. But the system engages on its terms: it is about service reconfiguration that it wants to do, or about trying to gather experiences on a particular topic in which it is interested. Healthwatch allows an opportunity for continual listening and engagement with communities, where they can speak up about anything that is affecting them, from dentistry to patient transport and administration of care. Those issues are not necessarily on the system’s agenda. As I see it, under the changes that will disappear.
Dr Johnson
Q
Jacob Lant: There are a few points on that. The narrative around the Bill is that Healthwatch is being abolished and its functions lifted and shifted across to local authorities and ICBs. That is not the case. We lose a number of important functions.
For example, the signposting support that Healthwatch provides will disappear so patients and care users will not have that to help them to understand how to navigate local services. I mentioned the unsolicited feedback that is gathered; that function will disappear. The outreach into communities, particularly marginalised communities, will disappear. The voice for patients and communities on health and wellbeing boards disappears, so there is no feed into those local decision-making bodies. There are several places where there is not a direct lift and shift across. That is a concern, and the Committee should probe it further.
On the resourcing point, at least local authorities will get part of the existing funding for Healthwatch to support their functions in that space. Under the Department’s impact assessment, ICBs will not get any funding from the current pot. That represents a 50% cut in the resourcing for listening to patients and communities, which is a concern.
Karin Smyth
Q
Sarah Woolnough: As an organisation, we have taken the view that we would not necessarily relitigate the decision. I think you can argue it both ways. I understand the desire to reduce duplication and to have clearer lines of accountability. Our concern has been the opportunity cost and everything that you are not doing at the time that you are spending so much energy and resource driving the abolition through.
Jacob Lant: I would echo everything Sarah says. From the work that we do, we see that decision making is taking longer, programmes are taking longer and it is taking longer to secure an impact on things. That is very frustrating, and underpinned by the massive change that is ongoing. Let us take as an example a programme exploring the experience of waiting for hospital care—of being stuck on waiting lists. Jim Mackey spoke about that at the NHS ConfedExpo last week. It is a major focus for the NHS and new guidance is expected by the end of the month. We have been waiting for that since 2021. The most recent effort towards it has been about 18 months. I can only think that drags on because we have so much other change going on in the system. I wish we focused more on doing things directly for patient care.
Karin Smyth
Q
Sarah Woolnough: It is a major opportunity. If they feel they have trust in the system, patients are generally supportive of a single patient record or joined-up records—they often assume one already exists. Of course, we have a patchwork across the country, and certain places are further ahead than others. The idea of having more national co-ordination and more infrastructure to drive progress in that area could be, and hopefully will be, transformative. I know from my previous work just how frustrating it is for so many people to experience fragmented care and to have to tell their story endlessly.
We must be a little careful, because telling your medical history is often part of a good consultation, but the idea of care being more streamlined and patients and staff having better access to information is a huge opportunity. It must be balanced with sufficient safeguards to maintain trust. Previous attempts to drive progress in this area have so often fallen down. Ensuring the right balance of progress, and building trust and sufficient safeguards, will hopefully lead to the most progress.
Jacob Lant: I have been working in patient and public engagement and involvement for about 15 years, and the most consistent theme in that time has been the frustration about constantly having to retell your story, and the fact that notes and information are not available for the care that people need in different settings.
There is a golden opportunity with the Bill to get the single patient record right and meet a long-standing patient need for that join-up of information. We are very supportive of the single patient record, and the debate needs to move on from whether we need one to what the safeguards are and how we build public trust. I have two things to say on that. First, you cannot legislate for everything on this, but it is important to have a commitment to an ongoing public conversation around the risks and benefits of data sharing. The Department has done some really good work in this space, on its public deliberative on use of data—that should continue—but we understand that cannot all be put into the Bill.
However, we know that the safeguards and red lines that we already have could be put into the Bill. For example, using patient data or non-consented data for insurance and marketing purposes is a red line that has been clearly talked about in policy for many year—we will not use data for that purpose. Why can’t we put that in the Bill to help build public trust? It would really help to be clear on red lines and what will not be included.
Karin Smyth
Q
Jacob Lant: There are three things there. First, we need transparency about what is being heard by the system. Wherever we put patient voice functions, it is really important that what they hear from communities is clear and made available publicly, in terms of themes and demographics, so that we understand who is being heard and who is not. That is really important for the transparency of what is being heard and how it is being interpreted by the system. What has it understood from the feedback it has received, and does that resonate with what people are actually trying to say?
The second thing is accountability. Can people see those voices leading to change—not just commitments to change, but following through? It is about evaluating where policy changes implemented as a result of patient feedback have improved patient experience, and drawing that golden thread through for people so they can understand how their feedback is making a difference. That is missing from the system at the moment.
The last point is around equity. My big concern is that we might design a system that hears from more people, but whether it hears from the right people and there is equity of voice is a real concern. The resourcing and support need to be put in, particularly at a local level, so that they can engage communities who are marginalised and make sure we are hearing from the people who are basically getting the worst experiences and outcomes at the moment.
If we can deliver on those three things—transparency, accountability and equity—we can build a system that is more effective than what we have at the moment. Personally, I think Healthwatch has done a fantastic job with the resources it has had available. It works out that less than 0.01% of the health and care spend is on Healthwatch, and that generates about 1.4 million interactions every year, either by gathering people’s experiences or by supporting them to navigate the health and care system. That is a really good return on investment, and it will be hard to find something more efficient. The challenge is in the system being more culturally open to listening and changing as a result of what people say, regardless of the way the evidence comes through.
Helen Morgan
Q
Sarah Woolnough: There are probably two concerns in a couple of different areas: appointments and the power of direction, which is very broad. We think it would be helpful to probe the detail and understand the intention a little more to see whether the legislation could do with amendment.
There is more general point. If the narrative is that this is a straight transfer, of course, you cannot legislate for culture and how those powers will be used. Our concern is that, while the narrative is about a straight transfer, empowering local systems and earned autonomy, the legislation pulls a lot of power back to the Secretary of State, and you cannot legislate for how a future Secretary of State may enact those powers.
Helen Morgan
Q
Jacob Lant: I will pick up the second part of the question first. The majority of the worst experiences of care—the worst incidents, where people feel most lost—tend to be in the gaps between services. Hospital discharge is a really good example of where the transfer between the NHS and social care services does not always work in the best interests of patients. That sort of insight will be lost entirely under the current structure, unless we build in a requirement for ICBs and local authorities to share the intelligence that they are hearing and to work collaboratively to understand patient and care user experience. That then raises the question, “Why are we splitting them?” If they have to work closely together to comment on the worst experiences of care, I do not understand the rationale for splitting them.
In terms of preparedness, I said earlier that ICBs will not have any additional resource for doing this. They have their own engagement teams at the moment, but even those that have been doing this very well have been leaning on their healthwatch for many years to help them engage with seldom-heard communities and build additional capacity. I worry about the capacity of ICBs to deliver once that is cut, particularly given the headcount and budget reductions in ICBs generally.
Local authorities are probably more experienced in doing direct community engagement and more confident about their ability to pick up the responsibilities. Indeed, I suspect that many of them will continue to commission some sort of external support to help them do this, but their budgets will be restricted. They will get only half the money for healthwatch, so that will be a concern.
Peter Prinsley
Q
Sarah Woolnough: We have had developments over many years in the direction of a single patient record. We have shared care records; we have attempts in different parts of the country to move in that direction. On the one hand, we have been held back by legitimate concerns about trust, privacy and the right safeguards, but some practical barriers have also held us back. For example—and this is really important to make the single patient record a success—what does it take to ensure that we achieve interoperability, that the data is cleansed and that penalties are followed through if providers are not sharing data? We need to back up any legislative and policy intent with the resource and measures needed to make it happen. That is perhaps a bit of the history of why it has not happened. Sorry, what was the second part of your question?
Peter Prinsley
Q
Sarah Woolnough: My reading of the legislation is that perhaps this issue is not quite resolved; the legislation does not seek to shift necessarily from having the GP as the data controller. Of course, there will be concerns as the record is brought together nationally. Ultimately, the data should belong to people and patients, but they rightly want to feel that it is protected and safeguarded appropriately through the system.
There are a couple of other points to make as we design this. This is a work in progress, so it is not neat in the sense that you cannot say, “This is exactly what a single patient record is, and this is exactly what it will be for evermore.” I think the policy intent is to build and develop it over time. To give one example, patients and the public being able to understand who has access to their records, and for what purposes, might be really helpful in the process of building trust and belief that their data is being well looked after.
Peter Prinsley
Especially if it were the case that the patient were the data controller.
Sarah Woolnough: Yes.
Jacob Lant: Whoever ends up being the data controller, the most important thing is that patients have a right to express how their data is used. That is where it is really important to keep things like the national data opt-out up to date, and to ensure that it is clear and accessible for patients to express how their data is used for secondary purposes.
That becomes much harder in a direct care scenario. If you restrict the sharing of data for direct care, you could inadvertently create a second-class system for people who are not in that. It is a really clear distinction. For secondary uses, we need a very clear opt-out, where people can understand how their data is used and express a preference.
Gregory Stafford
Q
Sarah Woolnough: The Government have an incredibly ambitious agenda, which is partly articulated in the 10-year plan. Our ongoing concern has been that some of the biggest-ticket items that the Government rightly want to achieve to fundamentally shift power to patients—delivering a shift towards prevention, moving care closer to home and allowing more digital enablement—do not require this kind of legislation or a reorganisation.
I go back to my first answer: what is honestly the opportunity cost of doing some of this at the expense of more focus and attention on, for example, delivering care closer to home? There is a lot of energy and activity in that area, but the Government want to make really good progress over the next few years. To take that example, if you are really serious, you need to understand what the barriers are to delivering more care in the community, closer to people and patients, and wrapping services around patients. It requires you to flow money differently and to have a different incentive scheme, but that is nowhere near this piece of legislation.
Our worry has been about what is not in the Bill, and what is the rightly and fantastically ambitious agenda to improve health for people and patients, versus the opportunity cost of a largely technical piece of legislation that reorganises some central functions.
Gregory Stafford
Q
Jacob Lant: Yes. I kind of think, as the debate goes on, that—with the changes to Healthwatch in particular—you could achieve so much without legislation. You could beef up the internal functions for listening to a patient and engaging with them without legislation—there is no requirement for that. You could invest more resource in that, and you could do the same with Healthwatch. You could think about the resourcing of the structures and the support they receive, so you could make that whole system better without legislating to get rid of it. As Sarah said, the NHS changes are a distraction at a time when we should be moving on with focusing on patient care.
Sojan Joseph
Q
Jacob Lant: The issue is that the system—the NHS provider, the commissioner or whoever is picking up the individual complaint—will treat that as an individual incident to look into. Healthwatch may support the individual to raise that complaint or that individual piece of feedback, but the collective learning across that is more important, and it is pulling out the themes that are consistent across multiple bits of feedback, both positive and negative, that makes the difference. We see that evidence and insight from Healthwatch making a difference in local and national policy. It might not feel like that to the individual patient, but things like the creation of a single patient record exist in part because of a lot of campaigning by local healthwatch on the issue of people having to repeatedly tell clinicians about their experiences.
It also could be issues to do with not being able to find a dentist, for example; the system will treat that as an individual incident of helping someone who is trying to find a dentist or not, but Healthwatch could use that insight to petition and push for national change around the commissioning of a service like dentistry. A topic like administration of care, which Healthwatch, National Voices and the King’s Fund have all worked on together, is invisible from the way that the system perceives performance at the moment, but because we listen thematically to patient experience, we can push for a much greater focus on things like the basics of communication and keeping patients up to date on what is happening with their care, which really matter. Healthwatch is thematically looking at patient feedback differently from the way that system does, and that is something I fear may be lost.
Liz Twist
Q
Sarah Woolnough: We have talked quite a lot about the culture in the NHS and whether these changes enable the sort of shift that lots of people talk about wanting. Let us be really serious about devolving power and earned autonomy, and about the balance between politicians rightly being held accountable for high-level metrics but with enough operational freedom to allow local systems—services close to people and patients—to get on and do the best for them?
We have a slight concern that, even though the Carltona principle should mean that the Secretary of State will enact powers in a way that does not slow things down, because of the broad sweep of powers given back to the Secretary of State, and the quite extensive powers of direction, politicians come under extreme pressure to intervene in certain cases or when there has been a scandal or patient safety issue, and that could lead to things clogging up.
Fundamentally, our worry has been—again, this goes beyond the legislation—how do you genuinely create a system where the culture is not as paternalistic as it has traditionally been, where you are empowering both staff and patients and citizens to have more say in their care, and where system leaders are not constantly looking up for permission, worried they may be held to account for quite a narrow set of metrics? Although managing money and constitutional standards is very important, if we are to deliver the 10-year plan aims and improved patient care, it is more than that. Our worry has been that the abolition of NHS England by the legislation will narrow things. We do not know, because it is broader than legislation, but how do we fundamentally shift the culture? I know that that is the Government’s intention, but it is about more than legislation. Where is the work to make that happen?
The Chair
Order. We have run out of time again. That brings us to the end of this session. Thank you both very much for joining us; the Committee is indebted to you.
Examination of Witnesses
Dr Jeanette Dickson and Kay Keane gave evidence.
The Chair
We shall now hear evidence from the Academy of Medical Royal Colleges and the Institute of General Practice Management. Once again, I am afraid we have to stick to the timings. This session will end at 10.55 am. Will the witnesses briefly introduce themselves for the record?
Kay Keane: I am Kay Keane, a full-time practice manager at Urban Village medical practice in Manchester, and the chair of the Institute of General Practice Management.
Dr Dickson: I am Jeanette Dickson, the current chair of the Academy of Medical Royal Colleges, a past president of the Royal College of Radiologists and a practising consultant clinical oncologist.
Dr Johnson
Q
Dr Dickson: I would go back to some of the comments that have been made before. It is the opportunity cost at the moment. We know that the workforce plan is being worked on in the background, but when you are unsure what the operating and delivery model will formally look like, there is a difficulty in seeing what the workforce for that will be. We are also talking about massive changes in the way we think about care delivery—movement into the community and a different way of working—so we need a different workforce.
Therefore, we need to put in some work to look at how curricula drive a different type of workforce, how we train people to work in a different way and how we empower them to see the opportunities to work in that way, when they do not have actual role models. We need a culture shift anyway, whatever is happening, but the abolition of NHS England is in many ways increasing the time. Things need to move, and they are moving, but they are not necessarily moving as fast as they should.
Dr Johnson
Q
Dr Dickson: We are delivering services as normal, but that head space and the innovation to see what the future should be and to work towards that future actively are limited by not knowing what that future looks like.
Kay Keane: We do not know what the left shift that we keep hearing about looks like; we do not know what that is for practices. In general practice, we are very practical—we get on with what is in front of us—so the big organisational changes do not have a huge effect on the day-to-day seeing of patients and organising that, but understanding what is around us does.
Dr Johnson
Q
Dr Dickson: The legislation is very much an enabler for a single patient record. The devil in the detail there is not entirely true. In my experience, if you ask most patients if they would like a single patient record, they feel that it is already there. They do not understand that we do not have the ability to share their data in a way that works for them. Therefore, the idea of a single patient record is very much a lodestone for medical practitioners and most patients. When you talk them through the detail of how you achieve that and who owns the data, it is a much trickier issue for many, including the professionals, but also the public.
Kay Keane: I agree. The detail is not there at all. At the moment, we look after the data that is in the GP summary care record. That creates lots of questions for our patients. They will see information in there that they are not sure about or that they want help with. They will perhaps be able to read some of their hospital letters within that record. However, lots of patients have a variety of health inequalities that might mean they cannot access that data. In general practice, our non-clinical staff often help them to navigate their way around all that information. We also have patients who will read something in their record on which they want clarity—maybe something that happened a long time ago that they cannot remember and want explaining to them.
All those things take time. Where will the responsibility for that go? It takes an awful lot of resources in general practice to educate and support patients and to help them navigate their appointments and the letters coming through. Where will that responsibility sit? At the moment, it is of course with the GPs, but practically it is practice managers, up and down the country, who take on the day-to-day responsibility.
Dr Johnson
Q
Dr Dickson: You need to believe that you have found out enough about a patient to deliver their healthcare. I would turn it around and say it is very difficult to deliver appropriate care to somebody on whom you do not have full information.
Dr Johnson
The question is, how do you find it within the way it is structured?
Karin Smyth
Q
Dr Dickson: Part of it has been touched on by the previous panel, regarding patient experience. Patients come in, they give the same story again and again to different healthcare professionals in different settings, and that frustrates them. Patients are human. I forget what I did last week; patients forget what they did last week, let alone what they did 10 or 20 years ago, although that is still relevant, increasingly. If you go on holiday to Whitby, fall over and break something, have tests done and come back to your house in central London, you cannot see information about that; you cannot share that information.
The opportunity to see everything on a patient across primary care, secondary care and social care is a huge benefit to them in terms of their view of seamless care, but also in terms of safety. I have a chronic health condition; part of my care is delivered by general practice and part by a hospital. At the start of the pandemic I was exceptionally clinically vulnerable; it took the NHS six weeks to tell me that. That is not safe.
Helen Morgan
Q
Dr Dickson: I am not a general practitioner. The key thing for data control and data sharing is the trust that patients have in us to share and to hold their data in a way that is beneficial for them as individuals, and potentially sometimes beneficial for the population, but not to share it for what you might call retail use.
One issue with data control is that most general practices are small businesses with a small number of staff working flat out. That legal obligation of a data controller looms large for them, whereas it does not loom as large for large NHS organisations—although, technically, the impact is as hard. I do not mind who controls the data; what we need to do is to find a way to enable that data to be shared safely and with a belief that it is done for patient benefit. I do not think it matters whether GPs maintain data control, with something else happening to support them, or whether it is taken away from them; it is about how we enable that to happen. But I do think that general practice struggles more with resilience.
Kay Keane: I think that is true, in that we are generalists, not experts in a lot of areas. Certainly, we can be very good data controllers of our own data—the stuff that we produce, and that we write and code about our patients. We have to code things to be able to respond to our contract, so we have to be good at that. Things fall down when information comes from other providers, which we have no control of. That would be an area of real concern—that such information would be part of our property and our jurisdiction.
I guess it is about the detail of how that record will be structured. If it is a brand-new thing and we all feed into it, that is very different from all the data coming to the current healthcare record that we hold. I think the detail is not there yet to enable us to describe who should be the data controller, but certainly I do not think that any practice manager would want to control data generated by someone other than themselves.
Helen Morgan
Q
Kay Keane: The patients need to understand exactly who has access to that record and exactly who is feeding into it. There is a huge amount of trust between a patient and a GP, and a patient and a healthcare professional in a general practice, and we do not want that trust to be diminished so that the patient stops telling us the things that are worrying them—the whole story. We want them to continue their trust, but if they think that information is spreading further and further across the system, we might lose some of it.
Sojan Joseph
Q
Kay Keane: In the example you gave, the hospital should be giving seven days-worth of medication to the patient. That is clearly its responsibility. Within those seven days, the GP practice should get a discharge letter that says what has happened; if appropriate, we then take over the prescribing.
If the information comes and is good quality—if the data is good and timely—the things you mentioned do not happen; they happen when neither of those things are the case. In my experience, information that comes out of A&E is often difficult to understand. A&E might make a diagnosis that it works with, but by the time that gets to the ward it can be different, so the A&E information we act on could be very different from what the patient is discharged with. Timely and good-quality information is therefore really important, and that GP record then becomes the centre of the patient’s care.
Dr Dickson: You are talking about transfer of care between services and about a weekend being an important flashpoint, but I think that that transfer of care does not happen appropriately even during the week. It is getting better, with electronic systems, but it is still not necessarily working for the full benefit of patients, especially if they access multiple services. The value of the single patient record is to make that safe, but the question is, will it do that? Can it do that? Is it safe to do that? Will the patient’s data be protected? That is what we are we are worried about. I think that is what patients worry about. They perceive that we do that already, and when they come up against the healthcare service, they realise that it does not happen; they do not realise that it is not a personal thing to them, but a systemic problem. It is about getting patients to understand the systemic nature of the lack of data sharing at the moment.
Joe Robertson
Q
Kay Keane: I think it is impossible, really, for me to understand that. It is a large part of our job already. As Dr Dickson said, we act as a small business. We do all the things that any other small business does, so being able to manage that record on top of that would take a huge amount of investment into general practice.
I would argue that maybe the investment into general practice should not be on data, but should be in the wider workforce. We are really good at looking after our data now. We care about it, we hold it close to the care of the patient and we share it only when appropriate, but in our view to then be the data controller of other information is too much and is unmanageable for a general practice to do.
Equally, our data is very personal to us, and we want to keep hold of that. We do not want our patients worrying about the stories that they tell us, so a model where we feed into something else and have responsibility for the bit that it is fed into sits more comfortably with the Institute of General Practice Management.
Dr Dickson: I do not have much to add to that. The devil is in the detail of where it sits and how we reassure patients that we are trusted with their data—that we are sharing what they have given us appropriately for their health, but not for spurious reasons. I think people’s understanding is that we share an awful lot more than we do, so there is a gap. People perceive that we are going to overshare, whereas actually this will allow us to come up to the level that we should be at.
Sureena Brackenridge
Q
Dr Dickson: I think the impact could be really positive. At the moment, we train nationally to high standards, so that the product of medical education can be deployed anywhere in the UK, and we are also all trained to develop, innovate, change the service and move forward. What we miss at the moment is parity of esteem for education as a productivity function of the NHS. There is the productivity function of elective care, waiting times, cancer treatment and all those things, but education must sit at that level of esteem for productivity for all professions in order for the service to continue—not to innovate, change and develop, but just to continue. Moving things to the Secretary of State gives us a chance to ensure that that pure parity is seen. The danger is that if you move the function in, it gets lost in the service productivity sphere. There is a huge opportunity to firmly embed the education and strategic development of different roles as a true productivity function of the NHS, which it needs to be.
The Chair
We have come in under time for a change. Thank you both very much indeed for joining us. Your contribution is invaluable.
Examination of Witness
Dr Rosie Benneyworth gave evidence.
The Chair
We will now hear oral evidence from the Health Services Safety Investigations Body. Again, we must stick to the timings, but we are doing rather well at the moment—let us hope we can stick to that. Would you be kind enough to identify yourself for the benefit of the record?
Dr Benneyworth: Good morning, everyone. My name is Rosie Benneyworth and I am the interim chief executive of the Health Services Safety Investigations Body.
Dr Johnson
Q
Dr Benneyworth: We are a safety investigator. We have been modelled on other industries that have very successful safety records, and we have learned from those other industries. We investigate patient safety concerns of national significance, and we make recommendations into national bodies about what needs to be improved. We make very few recommendations—only small numbers—into those national bodies, but they are about what needs to change from a systemic point of view to make patient care better. That is underpinned by learning from other industries—the safety science, the human factors and the real knowledge about how you improve safety—and we are trying to embed that in the NHS.
Regulation is very different. That looks at individual providers. I used to the work for the CQC and regulate primary care. It looks at how individual providers are functioning. It makes recommendations to individual providers about what needs to change, and it judges an individual’s performance against a set of regulations. The two functions are completely different.
The other important thing for us is that we do not attribute any blame or liability in our investigations. That is vital, because we learn from what we see. We learn from those investigations, and we are trying to embed a continuous learning environment and culture within the system.
Dr Johnson
Q
Dr Benneyworth: I think it will be very difficult. At the moment, we have the ability, being an independent organisation, to investigate any part of the system where there is a concern. That includes the national system. In several of our investigations we have looked at how the national system, the regulatory system and NHS England are working, and how other parts of the system are working. We are unique in that, because a lot of those bodies do not get the scrutiny from any other part of the system, and they do not get that oversight and ability to look and understand how the national system works together.
If we were a directorate in the CQC, as outlined in the legislation, it would be very difficult for us to comment on how the CQC was looking at different areas and how it was managing certain aspects of safety. I think there is also concern about our ability to make effective recommendations to the CQC if we are a directorate within it.
Dr Johnson
Q
Dr Benneyworth: That would be unusual. We have undertaken one very detailed set of investigations into mental health in-patients, which was directed by a previous Secretary of State. We would very much want to hear the patient safety concerns of the Secretary of State to understand what we investigate. We work extensively with stakeholders across the system. We want to be a constructive part of the system. We want to investigate the areas that people are concerned about. We work extensively with all stakeholders to hear their patient safety concerns and make sure that our investigations are informed by that knowledge and by what we are hearing from patients and families, as well as staff working in the system.
However, we need to make sure that we have the independence to investigate what we are hearing about. It is very important that we are not stopped investigating something, and it would be concerning if someone told us not to investigate something. We need to maintain that independence.
Dr Johnson
Q
Dr Benneyworth: There is no doubt that it helps to improve safety. That is something we have learned from 100 years of the air accidents investigation branch, which has had an immense impact on aviation safety, the rail accident investigation branch, and many others. Safe space, or protected disclosures, means that people can talk freely to us about things that have gone wrong without fear of sanctions, being told off by their line manager or losing their jobs.
We hear all the time about people who have ended up losing their jobs or getting into trouble because they have raised concerns. We see in our investigations that we are still working in a culture of fear. In an ideal world, that would not be the case and people would feel able to speak up openly about what has gone wrong, but we are working in a culture where people are not in that place.
This enables staff working in the service and patients to talk to us freely about what they see on a daily basis that they think needs to change. Patients sometimes worry that they will be treated differently and not get the same care after they raise things. This enables patients to talk to us in the knowledge that they will not be named. The patients we work with who have been harmed from healthcare tell us, “We don’t want this happening to other families. We’ve been through this awful, terrible time, and we want to change the system.” This enables them to talk to us.
We do not name individuals in our reports and do not name organisations. We are now in a stage where we are growing that trust. We are coming up to being three years old as an organisation, and we are growing that trust with the system. When we launch an investigation, organisations right across the country say, “Please come and see what’s happening here. Please come and talk to us.” I worry that that might be impacted by the changes ahead.
Karin Smyth
Q
Dr Benneyworth: The two key things have been touched on already. The first is the independence to choose what we investigate and make recommendations to any part of the system. The second area is around protected disclosure. The legislation needs to be much clearer around the protection of protected disclosure materials, to give the system confidence in our ability to hold and not share confidential information.
At the moment, the legislation talks about connected individuals having access to the protected materials. The clauses outlining connected individuals mean that anyone working in the CQC could potentially have access to protected materials. That is a very large number of people, and it will create risk. There needs to be a legal duty on the CQC to protect the safe space. There is also something about maintaining an identity that gives people confidence that when they are talking to us, their information will not automatically go into the CQC regulatory functions.
Some of that may be about perception rather than the reality of what is happening, but as we know, perception is very important. People will perceive that we are part of the regulatory system even if we have the same email address, for example.
Karin Smyth
Q
You talked about the culture of fear, which I think we have recognised over time. We are all constituency MPs, so we recognise that. Can you say something about the opportunities for learning that could arise from working with the CQC, which is in that regulatory space?
Dr Benneyworth: We already work very closely with the CQC. In fact, we meet with them on a very regular basis. They share their learning and concerns with us already. Some of our investigations have come from the learning that they have seen on inspection, so we have a very good relationship with the CQC.
There are significant opportunities for the whole patient safety landscape. We are a tiny part of the patient safety landscape. We need to all work much more collaboratively right across the regulatory space—ourselves, the investigatory bodies and the wider system. The National Quality Board will have a significant role to play in that to share learning and identify key patient safety risks. That is already happening in our work with the CQC. This legislation will not significantly change that.
Helen Morgan
Q
Dr Benneyworth: First, we do not replace local investigations. If something goes wrong, the local teams are very much responsible for investigating their work. Dr Dash talked about the new processes around PSIRF and the new investigation processes, which we fully support. In fact, our education team have had 40,000 people enrolled over the last three years, free of charge in the NHS, to support them in developing those investigation skills, really supporting that excellence in local investigation. We have a long way to go there, because they are variable in quality.
We do not replace that immediate, “There has been an incident and it needs investigation.” We know that, quite often, the things that need to change are not sitting within one provider. We know that the same things are happening in Cornwall and Cumbria and everywhere in between, and that they often need national solutions to change.
As a recent example, we published a report a few weeks ago looking at the care of people in mental health crisis in emergency departments. That showed that the legislation around the care of mental health patients is not supporting people in emergency departments to look after these people properly. That is not something that can be changed by a regulator. The CQC going to look at that emergency department will not impact that. It is not something that the individual provider can change, but we can make national recommendations about it to change the national system to enable people on the ground working in health and care to do their job properly. We can make sure that the systems and processes really consider how things work, and really change them so that providers and systems locally can do their job.
Helen Morgan
Q
Dr Benneyworth: There needs to be much more clarity about governance and how that will work in the legislation to protect independence. There are potential compromises that could happen, such as a Healthwatch-style model that has its own independent leadership within the CQC, its own governance arrangements and, importantly, its own identity. That would enable it to keep its independence, while being part of a larger organisation. In the legislation, it is vital that there is a legal duty for the CQC to protect safe space.
Sureena Brackenridge
Q
Dr Benneyworth: One of the things that we see regularly in our investigations is that people fall down the gaps between organisations. We have the ability to look right across the system and understand a person’s journey. As a recent example, we looked at medication errors on discharge from hospital. There are a lot of medication errors, and we looked at the process of how information was being shared and what was happening. Those are the type of things where we see a lot of concerns about patient safety. There needs to be much more clarity about accountability for patient safety.
No one is accountable for the discharge of a patient. There is not one person—no single individual—who is accountable when someone is discharged from hospital to social care. You go through multiple layers of accountability. We are keen to learn from other industries that have effective safety management systems. Part of those safety management systems is having much more clarity about accountability, which is lacking across the NHS. I very much hope that, with the changes to ICBs, they really do think about accountability for patient safety.
Edward Argar (Melton and Syston) (Con)
Q
Dr Benneyworth: No, we do not make recommendations to provider organisations at all. All our recommendations go to national organisations. I completely agree with Dr Dash that there are too many recommendations. In fact, HSSIB raised that concern through our work two years ago and flagged it to Dr Dash. We wrote a report called “Recommendations but no action”. We are very concerned about the plethora of recommendations going to providers, which create a huge amount of noise but, distressingly for the families involved, do not lead to the changes needed.
I completely agree that there are far too many recommendations. I am leading some work to address that—we are setting up a recommendations hub with the Department of Health and Social Care—but we are not that problem. We have made 39 recommendations since investigations launched and HSSIB started three years ago, and they are all to national bodies. We might reduce the burden on national bodies by taking that away, but it will not have any impact on providers.
Janet Daby (Lewisham East) (Lab)
Q
Dr Benneyworth: Yes, absolutely—we have seen that in so many of our investigations. It can often be exacerbated by different parts of the system working together.
To give you an example, we looked at mental health in-patient settings. There is national guidance that says that people should not use risk assessment tools around self-harm, but when we looked we found that, on the ground, everyone was using these tools. We asked why that was, and we were given two reasons. One was that the IT systems were set up such that you could not move past the front screen without ticking one of the risk assessment boxes, and the other reason was that people were fearful about being in front of a coroner and asked about risk assessment tools, so we took action on both those fronts.
Another thing that we see is about speaking up. There are definite inequalities at play when people are speaking up. We have seen significant racial discrimination. We wrote a report about temporary workers. We find that people working as locums or agency staff often feel a lot less able to speak up if there are patient concerns. If you are black or from other global majority groups, to be able to speak up is even harder. On the back of that, we made a recommendation to the National Guardian’s Office, and it has done a lot of work with temporary workers, looking at how we can improve their ability to speak up. We still have a huge way to go on culture generally, but particularly on discrimination and the inequalities that we see in every one of our investigations.
Gregory Stafford
Q
I have two questions. The first is about the safe space. We have seen written evidence, and we have heard when others have attended the Health and Social Care Committee, about the fact that if HSSIB is placed inside the CQC, you could have the farcical situation of one set of CQC lawyers, who are representing HSSIB, suing or attempting to sue another set of CQC lawyers, who are looking out for the CQC situation, because they are trying to get information out of part of their own system. Is that parody or is it a possibility and real problem?
Dr Benneyworth: It is a problem and something that potentially could happen. I hope that we would work effectively to try to avoid that. Essentially, and just to reassure the Committee, if we see something of a criminal nature, if there are significant regulatory concerns, we have protocols in place to be able to escalate that. But there is a real risk that potentially, if we held information that the CQC needed in part of its regulatory function, in its enforcement function, we would not be able to share that, because of our legislation, and we would not want to share it, because we want to maintain the trust in the system. It would need to go to the High Court to be able to get hold of it.
Gregory Stafford
Q
Dr Benneyworth: No.
Gregory Stafford
Q
Dr Benneyworth: NHS England has an investigations unit that commissions regional and national investigations, sometimes from private organisations. We work very closely with the NHS England patient safety team. As I said, we have supported their work in rolling out local investigations around the patient safety incident response framework. We have been instrumental in supporting the training and education around that. We are the only safety investigator with protected disclosure. There is no other body that is like us and can do the same type of investigations in this country, and we are internationally looked at. In fact, I am doing a podcast with Canada tomorrow. Numerous countries are looking at us and saying, “We want the same thing.” There is a handful of investigators like us in Finland and Norway, and they have excellent safety outcomes for their patients, but the rest of the world is looking at us and trying to learn from us, and I am frequently asked to speak internationally about this.
Gregory Stafford
Q
Dr Benneyworth: We are—
The Chair
I am afraid we have come to the end of the session. I am sorry and I apologise to colleagues whom I did not manage to accommodate this time. Thank you very much for joining us, Dr Benneyworth. That was most helpful.
Examination of Witness
Sir Jeremy Hunt MP gave evidence.
The Chair
We shall now hear oral evidence from Sir Jeremy Hunt MP. Again, we must stick to the timings and we have to finish at 11.25, so we have got just 15 minutes to put our colleague through the mincer. For the benefit of the record, would you like to identify yourself?
Sir Jeremy Hunt: Jeremy Hunt, former Health Secretary.
Dr Johnson
Q
Sir Jeremy Hunt: As the Committee knows, the principle of HSSIB was modelled on the airline industry, where the air accidents investigation branch has a superb track record of identifying safety breaches. There is a very good rail accident investigation branch that does the same for the railway industry, to make sure lessons are learned. My concern was that the NHS and actually health systems across the world are not very good at learning lessons when there are tragedies.
The heart of what the AAIB has is this concept of safe space, where people can talk to it completely without fear that what they say will get passed on or used against them in a court of law, and so they are very open about what may have gone wrong, allowing a rapid conclusion to be drawn. So that was the principle behind it.
I am against the transfer of HSSIB to the CQC for two reasons. First, I am worried that it will undermine that safe space principle. I think the safe space principle is the bit of HSSIB that is working very well and I am worried this will undermine that. Secondly, the Bill does not do anything to address the bit that is not working well, and that bit is that the NHS is still very poor on acting on recommendations that are made, and by the way not just by HSSIB but by public inquiries, prevention of future death notices, by maternity and newborn safety investigations reports.
We are the world champion at doing inquiries and reports. Unfortunately we are also the world champion at allowing those reports to gather dust without anything actually happening. What I would really like the Bill to do is something, whether through the National Quality Board or whatever, so that the public know that when HSSIB or MNSI or a Select Committee or a public inquiry makes a recommendation, the Government have to make a formal decision within a limited time period—“yes we are going to do this” or “no we are not”; no sitting on the fence about “this is under review and we will consider it, come back to it”, but a positive or a negative decision—and then if it is a positive decision, a timeline by when it will be implemented. That is not a party-political point, because this is a problem that was not fixed when I was Health Secretary and it has remained outstanding for many years. Families just put their heads in their hands in despair that they get these inquiries, get these recommendations, and nothing changes.
Dr Johnson
Q
Sir Jeremy Hunt: What HSSIB has done is positive but it is still trying to solve a bureaucratic problem with more bureaucracy. What there needs to be is a formal system with a legal obligation on the Government. I felt this when I was chair of the Select Committee as well—that Governments would kick recommendations that were awkward, usually things that cost money that they did not want to spend money on, into the long grass without actually saying whether they agreed or disagreed with them. There is a terrible phrase that is often used: “agree in principle”. I may have been the one who invented it, but it is really bad for accountability because it allows the Government to say, “Yes, we really understand where you are coming from, but we are not going to put any timeline or give you any commitment as to whether we are actually going to make the change”. I think we need a proper system—and if it is the National Quality Board, that would probably be a good place—for formally assessing all public inquiry recommendations, all Select Committee recommendations and HSSIB recommendations, and saying, “Yes, we’re going to do this” or “No, we’re not”, but if it is yes, it will happen by this date with this person being responsible.
Karin Smyth
Q
Sir Jeremy Hunt: I would just like this to have teeth, because I think people are fed up, as I say, with Governments of all colours receiving recommendations and then nothing happening. I would like the Bill to place a legal obligation on the Government, for a certain category of recommendation, that within a period of time a proper decision will be made with a timescale. If the decision is no, because the money is not available, that is fine, and the Government should say so, but people would prefer to have a decision than for Governments to continually say, “We are reviewing this.” Frankly, I am worried that inertia in the system, and the fact that it is always easier for Ministers to kick things into the long grass rather than give a yes or a no, means that a vague commitment that the NQB will do this job will not be enough. If it is the NQB, I would like there to be a legal obligation that, within six months of recommendations being made by public inquiries, Select Committees and HSSIB, the Government will give a proper yes or no, with a timescale if it is yes.
Karin Smyth
Q
Sir Jeremy Hunt: I set up NHS England, following the Lansley reforms, and it may surprise you that I have not opposed the Government’s decision to abolish it, for this reason. When it was set up, it did have a very valuable function, which is that it depoliticised a lot of very contentious issues. Typically, those were things such as the closure or downgrading of an A&E that was clinically advised as important, but very difficult politically, or, for example, which drugs are made available through the NHS and which are not. I felt that putting those decisions at arm’s length from Ministers was helpful. However, I think it became too big.
My real problem is that I think the NHS has become the world’s largest health bureaucracy, in which it is very hard to get anything done because 1.5 million people are accountable to one person. The way the DHSC does this, as you know just as well as me, is through the ruthless imposition of targets, so every hospital has 18 monthly operational targets. That makes it very difficult to have any kind of local innovation or local autonomy, because everyone is performance-managed with incredible strictness—their whole career depends on it—by these targets. I felt NHS England was beginning to embody that targets system, so when the former Heath Secretary said he was planning to scrap it, I said, “That’s absolutely fine, as long as this is a decentralising move, and you don’t simply transfer that ruthless central control from NHS England to DHSC.” I have to say I am concerned that that is, in fact, happening—or that we are just getting all those targets recreated by DHSC, rather than NHS England, as I think former Health Secretary Patricia Hewitt has also gone on record as saying.
Helen Morgan
Q
Sir Jeremy Hunt: Ideally, when something goes wrong, what you want is for there to be an investigation and for lessons to be learned, so that grieving families can say, “Well, at least we are confident that this wouldn’t happen again.” What happens in the health world is that families still think the only way they can get real change is through a public inquiry, so there is endless demand for more inquiries, rather than for things to actually change. If HSSIB was allowed to flourish, and there was confidence that its recommendations really would be acted on quickly, I think that would reduce the demand for public inquiries. They are very expensive, and the fact that they often take five, six or even seven years also means that there is enormous delay before anything changes.
Helen Morgan
Q
Sir Jeremy Hunt: It is not dissimilar to my earlier reflections. It is really important that patients have a voice, but it is even more important that their voice is heard not just through a bureaucratic process that listens to them, and gives them a sense of being listened to, but then nothing happens. The problem with the Healthwatch structure we have is that it is very good at the listening bit, but I do not think people have confidence that things actually change.
Dave Robertson (Lichfield) (Lab)
Q
If you are concerned that accountability ends up too close to the Department, where else should it land? I am quite comfortable with a Minister being accountable for that decision, because they are accountable to MPs, who are ultimately accountable to the people that it affects. Can you pare back your answer a little bit and talk about where that accountability should lie, and how we can ensure that it works?
Sir Jeremy Hunt: That is a story I think every single Member of Parliament could repeat, and it is a fundamental flaw in the system. Do you not think it is completely ridiculous that you have to go to the Health Secretary, who is responsible for a budget of £160 billion—the largest healthcare system in the world—to sort out something like a GP surgery lease in your constituency? That is a perfect example of a problem that we should be able to sort out locally, and that is why I think the bureaucracy has got completely out of hand.
Joe Robertson
Q
Sir Jeremy Hunt: Maybe I should just clarify, because I think Dr Dash referred to those comments. The CQC is incredibly important to hospitals and GP surgeries because it gives them a rating—“outstanding”, “good”, “requires improvement” or “inadequate”—and they really care about that. If a staff member is talking openly to HSSIB about a failure of governance in their organisation, and that is the same organisation that could decide whether they get stripped of their “outstanding” rating and downgraded to “good” or “requires improvement”, my concern is that some people may worry and say, “Maybe I shouldn’t be open, because this could affect my hospital’s rating.” Obviously, I would always want staff members to be completely open with HSSIB, but we have to be really careful that people still have confidence in the safe space function if this merger goes ahead.
The Chair
Sir Jeremy, thank you very much for coming—once again, we are out of time, but we are indebted to you. The Committee will sit again in this same room this afternoon at 2 pm. The room will be locked, if Members wish to leave papers or anything else in here.
Ordered, That further consideration be now adjourned.—(Emma Foody.)
Health Bill (Second sitting)
(1 day, 4 hours ago)
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The Chair
We will first hear oral evidence from the NHS Alliance and the Royal Berkshire NHS foundation trust. We have until 2.30 pm for this panel. Gentlemen, I will be grateful if you would be kind enough, from left to right, to introduce yourselves for the sake of the record.
Sir Ciarán Devane: I am Ciarán Devane, chief executive of the NHS Alliance.
James Blythe: I am James Blythe, chief executive of the Royal Berkshire NHS foundation trust.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Q
Sir Ciarán Devane: First of all, the ICBs have had their 50% cuts and they are in the middle of reorienting themselves and joining up, so there has been a degree of distraction. The second thing, though, is the idea that the ICBs should be strategic commissioners, working well to commission plans that genuinely reform services. I think we all support that, and the move to give them GP commissioning, pharmacy provision and so on. All of that is good.
The challenge will be that the baseline for the current year is not necessarily the outturn of last year, because there were some one-off savings in that, so our members across the NHS are saying that this is the year when the trade-offs have to be made. Some of those trade-offs will be good, in the sense of we can reconfigure this service, move some services into the community and do some good things—I am sure we will hear about some of those—but some of them will require difficult decisions to do with whether we shut down the service in this hospital and double down on the one over there. Making those decisions will need political cover locally as well as nationally, so we are in a tricky place.
What we are saying is that we all understand the state of the public finances and suchlike, but we need some capital to allow places to reconfigure and redesign their services, whether that is new IT, AI or diagnostic services. Those are the things that will allow the transformations to take place, which is where the productivity and the money will come from. What we and chief executives, finance directors and chairs across the NHS are saying is that there is only so much heavy lifting that asking people to run around the hamster wheel a bit quicker can do. We have to make some of those big decisions.
Dr Johnson
Q
Sir Ciarán Devane: We are unclear and concerned about what the nature of those interventions could be. In theory, we fully understand that the Secretary of State and the Government need the ability to say, “In the unlikely event an ICB goes rogue, we have to have the right to sort it out,” but we need to guard against the alternative of a Secretary of State who is intervening too much and making decisions on particular services, commissioning decisions or reconfigurations. We want the legislation to prescribe the circumstances in which the board of an ICB can be overruled. That should be transparent, it should be published, and intervention should be rare. We recognise that that backstop needs to be there for the sake of good governance, but we need checks and balances. The powers are needed if somebody is operating outside their licence, but we need to guard against the Secretary of State or the regions or the new departments reaching in and second-guessing local decision making. If this is really about empowering strategic commissioners to do what is right for their populations, working closely with local authorities, interventions that second guess their decisions need to be very rare.
Dr Johnson
Q
James Blythe: Councils of governors across the NHS have added significant value since they were instituted and brought into foundation trusts. The foundation trust councils of governors play two roles. The first relates to the appointment and holding to account of the non-executive directors on the board. The second relates to securing public and patient involvement and voice in the organisation and the management of our services.
Since councils of governors were instituted, we have developed increasingly sophisticated ways of getting public and patient voice into services. If you look at innovations such as maternity and neonatal voices partnerships, which really involve service users in how services are developed on the ground and are very close to the teams that are running them, that gives us different ways of involving patients and the public in services where possibly councils of governors have not been able to do in the past. Councils of governors have played a really important role in foundation trusts, but certainly in terms of that patient and public voice function, we have moved on as a system and developed more sophisticated ways of doing that.
The Minister for Secondary Care (Karin Smyth)
Q
Sir Ciarán Devane: The biggest difference should be that the local providers and ICBs are incentivised to get together to make collective commissioning decisions. That means that, whether you call it a neighbourhood, footprint or local authority area, they make those decisions based on population evidence, which is why the single patient record is important, and they have the autonomy to do that with a lighter-touch centre that is set in guidance saying, “Look, this is broadly what we’d like you to do.” That guidance should be developed in conjunction with the people who have to do the job on the ground. That is what it should be; if the Bill allows that, that is fantastic.
The second bit is that the mechanism—it is not necessarily a legislative thing—by which the NHS is managed day-to-day will still need to exist. Who is going to be keeping an eye on things 24/7, 365 days a year? What happens if there is a fire—maybe even a literal fire—in a hospital? How is the NHS going to be corralled and brought in to help out a trust where something like that happens? That management function—the day-to-day operational management—needs to remain strong enough in the target operating model, as it is called, in the Department. If it is not, that could prove very difficult. Not necessarily day to day or in the short term, but in the long term, that bit has to be got right. One of the big risks of the legislation—there is not a legislative solution to this risk—is how day-to-day management works. We all have views on the relative strengths of the regions, of NHS England and so on, but how is that going to work in the new world? If one loses “grip”—that word is used a lot—then the risk to service delivery is quite high, and the risk to financial control is even higher.
James Blythe: Put simply, as an NHS organisational leader I think there are always a lot of things from which you can take your guidance on what you should be prioritising and focusing on as an organisation. If the result of this legislation is that we as organisational leaders have a really tightly defined set of priorities to deliver, articulated as far as possible as outcomes for local people and our population as a whole in terms of waiting times, quality and improving population health, I think that will allow us locally to get on with the partnerships that we already have as a day-to-day part of running local public services. We can focus on that very small set of things and do them really well.
Over the last year, there has been a sense of increasing clarity about those priorities as NHS England and the Department of Health and Social Care have worked more closely together. The NHS has delivered on those priorities to a large degree, but it all comes down, as my colleague says, to how senior officials and Ministers operate the system, because there is to be significantly more freedom to set priorities, and to design and run the system that essentially delivers them for the NHS. How that is done, retaining clarity about the things that we want to have delivered through the system and empowering local systems to do them will be really important.
Karin Smyth
Q
Sir Ciarán Devane: No, we are not.
Karin Smyth
Q
Sir Ciarán Devane: Yes, completely.
Karin Smyth
Q
James Blythe: I think the single patient record offers enormous opportunities to improve patient care. We know that we see patients every day whose quality of care and patient experience would be improved through having access to a continuous record that ran through primary and secondary care, mental health care and other services. To my mind, having had experience of working with systems that have introduced to some degree the single record or a single care plan, it will be extremely important that we take the time to train our clinical staff and adapt our operational systems so they use a patient record productively and consistently in the interests of better patient care. If we just put a single patient record into clinical settings without doing anything with the staff or services to make it useful, at best it will be inconsistently used and sometimes it will just be missed altogether. If we are going to invest, which I think is right, in a single patient record, we also have to invest in those systems and human factors around it, and make sure that we train people to use it well.
Helen Morgan (North Shropshire) (LD)
Q
Can I ask about Healthwatch? We heard this morning that ICBs will be taking on a chunk of the current operations of local healthwatches, but that they will not have any additional budget to enable them to do that. In fact, we know that their budgets have been significantly reduced. Could you elaborate on how you think that will work, and will it be as effective as the current system?
Sir Ciarán Devane: The ICBs have a capitation fee of £19.40, which they have to do everything out of. This is an additional duty placed on them. They will have to work out how to do it if there is no extra money coming, but it will be pressured.
I hear the argument that local healthwatches were variable. This function has been slightly outside and independent, playing back into decisions; we have to ensure that the level of independence remains somehow in how this is constructed, but that the variability is not just transferred from local healthwatches to how it is done within or across ICBs. Again, the implementation will need to be done well. That leads into the question about local authorities and the connection with them, making sure the democratic voice is brought in and equally the local voice. The legislation does not stop an ICB doing this well. Therefore, without the legislation, part of what we can be doing collectively is trying to make sure that what was good about healthwatches is preserved and is understood by ICBs. There are only 25 of them, so it should be a manageable task for the rest of us.
The effectiveness comes back to whether you believe this is a good thing. One of the things we have to do is secure that the benefits of having the patient voice in there, along with the clinical voice and the voice of the manager, at the same time, so that it is not a case of saying, “Oh, now we’ll go and consult the patients on the font size of the report,” but is authentic. That puts a lot of work on to the ICBs and on to those of us who believe passionately in engaging with the patient voice, but there is a risk because of that pressure. Done well, it will enable strategic commissioning and ensure the quality remains, but they are starting, if maybe not from scratch, from a new place.
Helen Morgan
Q
Sir Ciarán Devane: According to the ICBs we are talking to, which is all of them, they are saying that they believe in local authority engagement. We will be saying, “You may not be told you have to, but we would encourage you to do it.” I am sure that should be coming from the Department as well.
The witness to my right is an example of that; we know that when the NHS has really good local connections, you can get things done in the interests of your patients much more easily. The belief is there, but we need to make sure that the legislation is not seen as a signal that this is unimportant. That is a risk. As a representative organisation, we have to say to people, “We hear you saying that you really believe in this. Therefore, you need to demonstrate, not least to the Secretary of State, that you are following it through.”
I have a small additional point about mayors in unitary authorities being able to appoint somebody who is both the chair of the ICB and the local health commissioner. That should help. Those individuals will have to work out how to serve two masters, but that is okay—other people learn how to do that, too.
James Blythe: I would focus on a slightly different part of the Bill in terms of how this needs to work. There are 25 ICBs; that is quite a large footprint. From my experience of delivering meaningful collaboration and joint working between health and local government, I think it tends to happen at a more local level than that. The neighbourhood health plan in the Bill becomes extremely important. As a system, we should be very ambitious for those neighbourhood health plans. They should go a lot further than just describing what should happen in terms of improving health outcomes at a local level.
We should set an aspiration as a system that there should be a responsibility on health bodies and local government bodies to describe how changes will be made. The role of ICBs is to enable groups of providers and other organisations in local areas—most ICBs will have several places—to come together and not just work out what a local population needs, but actually do it. That will mainly be about relationships on the ground between an acute hospital team, a community services team, a mental health team and a social work team.
The role of ICBs is very much to give the contractual tools and mechanisms to local NHS organisations to work effectively with their local authorities so that there are really good neighbourhood health plans. Most importantly, they should not just write them but actually see them through.
Liz Twist (Blaydon and Consett) (Lab)
Q
Sir Ciarán Devane: I go back to our having to convince people. Many people are convinced—that is probably the first thing to say. But we have to convince people of the benefit of doing this. Delivering the ambitious neighbourhood health plans that James describes will happen only if everybody is in the room and doing it.
I do not necessarily think that the legislation can mandate that belief or the way to do that. However, it can set an expectation for the ICB that, in developing its plans, it should be able to demonstrate that it has engaged with the local authorities, patient organisations and the public local to it. The legislation can set an expectation that the ICB is using population evidence to make the right commissioning choices and that, if reconfigurations, which may well be locally contentious, are to happen, engagement happens beforehand. As elected Members, the Committee will know that those conversations should start early and that local populations should not just be bounced into something.
It will be incumbent on the new department to set those expectations with the ICBs about the new way of working. That is the only way we are going to create an NHS that will be able to cope with the number of frail, elderly people with multiple morbidities. Those people are a consequence of the success of the NHS over decades. People are living longer with cancer; the prevalence of cancer—the number of people alive with cancer—has doubled in 20 years. But that means that there are four million people who are not necessarily well. The only way to cope with that is to make a significant and radical change to the neighbourhood health plans and bring the public with us. That will happen only with proper patient and public engagement.
Liz Twist
Q
Sir Ciarán Devane: Yes, I do. I was in Epping recently, at St Margaret’s. I talked to the lady who runs the patient engagement: she is a volunteer and is a patient herself. They are a very good example, because they have said, “If we want to provide good services and avoid people turning up at the A&E in Harlow, we can do a neighbourhood diagnostic service.” The patient representatives got in very early. They ran some public meetings ahead of it and said, “We are thinking of doing this: what do you think? We’ll feed it back.”
Everything good is happening somewhere. It is the variability that is causing the problem. We need to make sure that good practices are deployed across the sector. That has to be the expectation: if this reform, which is huge, is to deliver value, that is the value that it has to deliver.
Gregory Stafford (Farnham and Bordon) (Con)
Q
James Blythe: With a lot of foundation trusts, as the NHS has moved into a period of increasingly tight financial control and as we have needed to recover from the covid pandemic, far closer working has been required between all NHS providers and the centre, to manage both the financial implications and the pandemic’s implications for patient access and patient quality.
Having recently moved from a senior leadership, board-level role in an NHS trust to two roles as chief executive in a foundation trust, I do not feel that in the day-to-day relationship with the centre and with our local and regional representatives there is an enormous difference in how we balance quality, finance and performance now. Those foundation trust freedoms were most relevant when we were in a system in which expenditure on health could grow and we were not trying to recover from the challenges that we have had recently.
Day to day, the relationship between NHS trusts and foundation trusts feels quite consistent now, so I am not sure that the changes proposed in the Bill will necessarily make a huge difference. As I said in response to an earlier question, it depends entirely on whether the provisions of the Bill are used to set a small number of priorities and let NHS organisations get on with delivering them, or whether they are used more regularly to intervene more directly in our day-to-day operations. A lot comes down to how the regime is operated.
The Chair
Sir Ciarán and Mr Blythe, thank you very much indeed. Sadly, we have just about run out of time for this session, but we are most grateful to you.
Examination of Witnesses
Sarah Tilsed, James Cooper and Professor David Croisdale-Appleby OBE gave evidence.
The Chair
We will now hear oral evidence from the Patients Association, Together for Short Lives and Healthwatch England. We have until only 3.10 pm for this panel of three people. Would you be kind enough to introduce yourselves for the record? Let us start from the left.
James Cooper: Hello. I am James Cooper, associate director of external affairs and membership at Together for Short Lives.
Sarah Tilsed: Hello. I am Sarah Tilsed, head of partnerships and involvement at the Patients Association.
Professor Croisdale-Appleby: Good afternoon. I am David Croisdale-Appleby, chair of Healthwatch England.
Dr Johnson
Q
James Cooper: I think that there are both opportunities and threats for families of seriously ill children and the professionals and services that provide them with palliative and end-of-life care. When we talk about seriously ill children, we mean children with life-threatening conditions, life-shortening conditions and severe medical complexity. They have a range of emotional, psychological, social and physical needs that need to be met across health, education and social care services.
Part of that care involves specialist children’s palliative care, which is predominantly provided at a regional level by teams led by specialist paediatric palliative care consultants. They often have Grid training, and there are not many across the UK—there are only about 24 whole-time equivalents. They are often based at children’s hospitals or children’s hospices and are often co-located across both. These specialist teams also comprise senior nurses and other specialists involved in emotional, psychological and practical support for families.
Our issue is that these services are often quite patchily commissioned at the moment; even though there has been a specialised children’s palliative care specification from NHS England since 2012, we think that money and commissioning has flowed to these services to only a very limited extent. For example, we have a successful service in the east of England, which provides 24/7 end-of-life care at home for seriously ill children, supported by nurses and these specialist consultants. But the provision is really patchy across England.
The Bill presents some opportunities through the additional powers for the offices for pan-integrated care board commissioning—the OPICs—to mandate ICBs to work together to commission these services. We would like to see that. However, because of the small numbers but highly complex needs of these children, the services often need to be planned and funded at a regional level, although they often are not.
We are concerned by the increased devolution to ICBs because of the extent to which other children’s palliative care services—the core services—are being commissioned at the moment. We have a range of evidence that shows that it is possible in some areas for that care to be commissioned well—for example, 19% of ICBs currently commission end-of-life care for children at home 24/7, provided by nurses and specialist consultants. However, at the moment ICBs are not taking on their full functions and implementing national guidance.
I would like to see much more rigour and accountability from the centre, the Government, to make sure that such specialised commissioning works for this particular group of complex children and families.
Dr Johnson
Q
Professor Croisdale-Appleby: Obviously, I am not here to speak on behalf of the CQC, although I am a non-executive director of the CQC. You are quite right that it has been in a challenging position, from which it is taking very substantial steps to recover, principally in changing back to a system of having chief inspectors who are very knowledgeable about their particular area of expertise that they can apply. The Department has asked the CQC to take on additional responsibilities in its regulatory capability and, to some degree, in an inspectorate capability. I cannot really agree that it is too much for the CQC to take on, but a substantial amount of work is certainly being added to the CQC.
Dr Johnson
Q
Professor Croisdale-Appleby: It is quite interesting to think that we have had 52 years of independent organisations representing the patient voice, as well as that of the carer. I think everyone here will be aware of it, but there was a step change in impact after the Mid Staffs situation, when Healthwatch—both Healthwatch England and the 153 local healthwatch bodies—was set up. We have produced over 20,000 reports; if anyone is interested in accessing any of them, we can certainly provide access by the end of the week.
Since I joined Healthwatch in 2023, in my view it has been very successful in reaching out to those communities often referred to as “difficult to reach”—diasporas and so on, where we all know the health inequalities are often the deepest. I think Healthwatch has been very successful in ensuring that we have not just listened to the easy-to-reach groups but deliberately sought information and views from those other parts of our society, which form an increasing part of it.
The research being done with those communities has recognised that there is quite often an investment of some six months for one of our people go into a particular community—whether a cultural community or an ethnic community—and win the confidence of the people so that they actually talk to us about the problems. I have to ask how that depth and focus is to be replicated under the arrangements suggested in the Bill. That is my extended first point about Healthwatch.
I think we have had a lot of impact, and I use the word “impact” as a researcher myself. Impact is measured by the change that you make. When we produce reports, whether national or local, we include recommendations. The important thing is that we always follow up on those recommendations and ask, “Are they being implemented? Are they being listened to?” Each year, we produce a report that says, “What change has occurred as a result of the recommendations that we make?”
I think that is extremely valuable, because it is about independence and holding organisations to account. Clearly, those organisations report in line function to the Department of Health, NHSE or local authorities, but we are not only the ears of the patient and the carer; at times, we hold feet to the flames over whether something sensible is being done. We do not give up on this; we pursue it down the rabbit hole.
The Chair
Q
Sarah Tilsed: Professor Croisdale-Appleby said absolutely everything that I was about to say, so I will make just a few points without going back over everything.
The main thing is that we need to make sure that this does not divert attention from the main priorities, which obviously relate to patients: timely access to care, clear communication and involvement in decisions about their treatment. As the professor said, we need a truly independent patient voice. Abolishing healthwatches creates a fragmentation of patient engagement responsibilities across ICBs and local authorities. The evidence we see every day consistently shows that patients are not feeling informed, involved or treated as equal partners in care.
We need to ensure that any replacement model is, as Professor Croisdale-Appleby said, genuinely independent, transparently accountable and resourced equally across the country, to ensure that we do not lose sight of the people it is supposed to serve. Trust is really important here, and patients trust independent organisations. I feel that that trust might be lost in local communities.
Lastly, this is, as Professor Croisdale-Appleby said, about reporting. We need to consider the way that patient feedback data is reported, and ensure that that is not getting lost. Themes and demographics still need to be included to make sure that we know who we are listening to, and that services are provided for those who feed back and those who do not—usually, it is those who are not feeding back who we really need to consider.
The Chair
Thank you. Those opening comments were extremely helpful, but I now ask for brevity in your answers, as several Members wish to put questions to you.
Karin Smyth
Q
Professor Croisdale-Appleby: Sorry, I had some difficulty in hearing the question, but I hope I heard it correctly. Was it about the patient record?
Karin Smyth
Yes.
Professor Croisdale-Appleby: Fine. The Government’s move to the integrated patient record is absolutely excellent. Most of us have wanted that for a very long time, but we also recognised the IT difficulties in doing it, as well as the question of security. However, as digital has advanced, we have nutcrackers that we did not have before to crack that particular nut. I can but support that move.
From the point of view of the things that really matter, the ability of a person to feel that they can tell their story once—not time and again—comes up all the time in our research. With great respect to everyone here, we are very capable of standing up for ourselves and insisting that we get answers, but the people I deal with and have the privilege of representing are often not in that position at all. They are overwhelmed when they are repeatedly asked the same question, often in a language—medicalese, if you like—that they do not really understand and feel threatened by. The single patient record is going to go a long way towards helping with that situation. It is not the complete answer but at least it does the hygiene part, as opposed to the motivator part, very well.
Sarah Tilsed: It is an excellent initiative—1as the professor said, we have been calling for it for such a long time—but we really need to consider the consent and data elements. A lot of pieces of work that we have done with patients shows that people are happy with their data being shared for these electronic records, as long as they are transparent and patients know what is being done with their data—that is a really important point.
The care.data initiative and general practice data for planning and research—GPDPR—were great, but unfortunately, because they did not have genuine patient involvement right from the beginning, they failed. We need to ensure that the SPR does not fail. In terms of reaching underrepresented or less-heard communities, we need to ensure that we hear from those people straightaway. How do they want this to work? Do they want to know how their data is being used? How can we ensure that people who do not use the NHS app are involved and that their data is being shared? How do we approach people who are understandably very hesitant about digital technology and electronic records?
Helen Morgan
Q
Sarah Tilsed: I said a lot about that earlier, in response to a previous question, so I am not sure how much more I have to add. I think my main point is that we must not divert attention away from the urgent priorities that patients are facing at the moment, ensuring there is a truly independent patient voice and trust—there is a lack of trust among patients, as I keep saying. How are we going to ensure that the reporting system is there for this?
Ultimately, patients need reform to lead to better care, not simply to different structures, which I fear is what often happens. Sir Robert Francis said, following the Mid Staffs situation, that patients must come first. Throughout the passage of the Bill, the Patients Association question will remain simple, and we will ask it time and again: will these changes actually help patients to receive better care, and how will we know if they do? That is the first principle to come back to. When everything is happening—all this restructure—how are patients going to be affected and involved in it?
Helen Morgan
Q
Professor Croisdale-Appleby: Thank you for that question. One of the reasons there is a difference or variation among the 153 is that the amount of funding is very different. Some of them get 10 times the funding of others, which makes a difference to the scope of what they can do. What it does not allow—and I think Healthwatch England has an important contributory role in this—is a change in the quality of the way in which the research is done.
One of the things that I have encouraged very strongly—although it happened before I joined Healthwatch—is the use of qualitative as well as quantitative data. The system is awash with quantitative data, but that does not necessarily cut through to the way that people are, the way they think, the lexicon they use, the concepts they use in communication etc. One of the great strides that Healthwatch England and our 153-member network have made is the intelligent use of qualitative data. That is an art in itself—I would like to think that is a science, but it is certainly an art.
It would be easy to remedy that, in the sense that if the funding were more equitable, some of that variation would disappear, but the variation is not in the quality, the effectiveness of the listening or the ability to look thoroughly at the impact, and it does not affect the fact that the organisations concerned are held responsible for what happens to the recommendations in terms of implementation. That is uniform across the system—it is just the amount of it that will vary naturally, because of the differential funding.
Laura Kyrke-Smith (Aylesbury) (Lab)
Q
James Cooper: There are some big opportunities in the single patient record, with the caveats that Sarah mentioned on data governance and consent. For families of children who are seriously ill, it presents huge opportunities, as I said earlier, because of the complexity of their needs. Often, huge amounts of information need to be conveyed to any professional who the children come into contact with, wherever that is across health, education or social care.
Many professionals have a long-standing relationship with such families, whether they are NHS community children’s nurses, consultants with a speciality in the child’s condition or children’s hospice teams, but families often need to access emergency unplanned care, perhaps in the middle of the night or at weekends. In those instances, when they speak to paramedics and emergency doctors, it is imperative that they can convey the information as quickly as possible. In those instances, I can see huge benefits.
With issues such as advanced care planning, to reflect the needs and wishes of those families, in particular as the child is coming towards the end of their life, I think it is critical that the whole range of professionals involved in the care of children has access to that information. I will welcome much more clarity from the Government about when the families will benefit from that particular initiative.
Professor Croisdale-Appleby: May I add a short comment?
The Chair
By all means.
Professor Croisdale-Appleby: We have to recognise that a tremendous amount of work is done in the health and social care system with people who have multiple comorbidities—not just one thing, but a number of things that often interact together. Without a single patient record, we can find that a consultant or a GP has access to only one part of that multiple comorbidity, as it were. That can lead to all sorts of unforeseen errors. I think that that is an important point to make about the great advantage that we can get from a single patient record.
Joe Robertson (Isle of Wight East) (Con)
Q
Professor Croisdale-Appleby: You make a pivotal and focused point. The independence is vital, not just because of the quality of what Healthwatch produces, but because of the confidence that it gives people that they are speaking to an independent organisation. In the background, some communities distrust being critical about the care that they receive in case it rebounds on them. If the same organisation is responsible for marking its own homework, as you put it, that problem will be much greater than it has been in the past. In terms of what to do about it, I think that you stick to some basic principles. If we are moving forward positively, we have got to be locally driven. We must reach out to communities. They will not reach into us; we have to reach out to those communities and the individuals within them.
I mentioned the value of qualitative evidence. It is not always easy for big institutions to go through all the work of evaluating qualitative work. It is easy to look at quantitative statistics, but the patient voice must be highly visible and central to policymaking. That was the basic idea behind the Bill: it would be about the patient and the patient voice, putting the patient right at the centre of the multiple discourses. As my colleagues have said, we should be totally transparent about priorities, impact and holding people to account. If all five of those principles are followed, it will work. If they are not followed, it will not.
Sojan Joseph (Ashford) (Lab)
Q
After each incident, there is a recommendation or an action plan, but clinical staff or patients do not have much involvement with those and do not see any difference. Healthwatch helpfully finds the issues, but it may not actually go back and see what changes are made following its recommendations. The CQC physically goes into clinical areas to see the difference, and has the power to take action against those responsible, so is it not a good change that more accountability will sit with the providers, and the CQC—or local authorities and ICBs—can take action against them?
Professor Croisdale-Appleby: Forgive me; you asked several questions. Which would you like me to start with?
Sojan Joseph
I asked whether it is not a good change to streamline these bodies so that fewer of them have powers to take action like the CQC?
Professor Croisdale-Appleby: There is always a danger, if I may say so, in the use of the word “streamline”. We have to think what is lost in the streamlining process. I do not want to repeat what I have said and waste your time, but one thing that is important is whether there is a golden thread running through seeking out and listening to patients’ views, putting those together in a coherent form, making recommendations for improvement—that is what we do all the time at Healthwatch—and then holding people accountable for that. I remember Penny Dash saying that one of the points of the Bill is to bring this closer to those who commission and those who deliver. I am not sure that it necessarily takes it closer to that simply by embedding it—as a colleague asked earlier—within the formal structure. There is a danger in that that the patient voice is often a spiky voice. As a former chair of hospitals and so on, I know that patients do not always say things that are convenient. That point about independence is vital. If I may, sir, I take slight issue with your term “streamlining” and would try to take that apart into the different components that might comprise it.
Sarah Tilsed: I cannot comment too much on the CQC, but on the point about a rise in complaints but nothing seems to be happening, we are finding that patients do not want to complain any more because they are finding that they are getting a worse service of care. That might be a slightly separate issue, but considering that there are so many complaints and that patients are not wanting to complain because they are scared, I do not think that streamlining is the right way. We need an independent voice that will focus solely on the patient voice, which I think we are completely losing at the moment.
Gregory Stafford
Q
Professor Croisdale-Appleby: If we talk about money— I will be quantitative here—Healthwatch England currently costs £3 million per year and the network receives £25 million per year. To people like me, £3 million and £25 million is a lot of money, but in the greater scheme of things it is not a significant amount, particularly when you think what is being produced for it.
I cannot speak appropriately, in my role as chair of Healthwatch, about Government policy. It is not my job to do that; it is the Government’s job. If you want to ask me a question on a purely personal basis so I can step outside of that role, I will be happy to answer, but I always have to draw a very distinct line on anything that I say. Everything so far has been said in my formal position as chair of Healthwatch as opposed to any personal views, because I certainly do not want to comment on Government policy.
The Chair
Let us see if either of your colleagues would like to be less cautious. Mr Cooper?
James Cooper: The key here is making sure that the independent patient voice is well-resourced, is held accountable for doing its job and works particularly for those the system finds it hardest to reach. Families of seriously ill children definitely fall into that bracket, so the interest of Together for Short Lives and the children’s palliative care sector is certainly in making sure that those structures do that.
Sureena Brackenridge (Wolverhampton North East) (Lab)
Q
Sarah Tilsed: I disagree with that. It is fine for ICBs to be involved, but it is all about local partnership working—bringing in the voluntary sector and really going into the community, and doing it in partnership. That is the only way of doing it. If you are bringing it into the ICB, consider how much funding there was when Healthwatch was doing it and—I do not want to repeat this point, but I will—the fact that it will be marking its own homework. For me, it is about partnership working going from the community—not within the system and not within the NHS, but going out to the community and feeding inwards.
Edward Argar (Melton and Syston) (Con)
Q
As a Minister, I was on the receiving end of some quite sharp recommendations from Healthwatch, but they were always constructive. Whether right or wrong, my fear is that this measure risks a perception among patients that it will be down to NHS managers and ICBs essentially to make recommendations that reflect their priorities, rather than the priorities and voices of patients. Professor, even if the principles that you have enunciated that might mitigate that risk were applied to the new model, are you really confident that they could mitigate the risk to patients’ confidence that their voice is genuinely and independently heard, loud and clear, however unhelpful it is perceived to be by bits of the NHS?
Professor Croisdale-Appleby: I cannot be confident of that, because we are in the foothills, not up the slope, and the details have not been given. ICBs have received something approaching a 50% cut in their running costs. I will not comment on the appropriateness or otherwise of that, but one has to be realistic and think about how high a really informed patient voice—particularly one that seeks out the views of both communities and individuals where the health inequalities are the greatest—will be on the priority list. I would question that, but I will leave it there.
Liz Twist
Q
James Cooper: It is key that ICBs are given that support. In the conversations that Together for Short Lives and the services we represent have with ICBs, we certainly get the sense that they want support. They want to know how much they should be funding certain services, and they want to know how to plan. A lot of guidance is already out there, particularly in children’s palliative care, where we have service specifications and NICE guidance and quality standards—there is even a legal duty to ensure that ICBs commission palliative care for children and adults. That accountability and support from the centre, and making sure that resource is there, is key.
The Chair
Q
Professor Croisdale-Appleby: I just want to reassure colleagues here that Healthwatch England and the Healthwatch network are still fully functional—I think that is important for you to know. Although we are sensibly on a reducing trajectory in line with the Government’s abolishment plans, we will maintain that full functionality and the ability to meet our formal mandate right through until the Bill is enacted, and until the guidance that will probably follow is in place. I just wanted to reassure the Committee of that.
The Chair
Thank you very much. On that note, Mr Cooper, Ms Tilsed and Professor Croisdale-Appleby, thank you very much for attending, and for your guidance and wisdom—we appreciate it.
Professor Croisdale-Appleby: Thank you for the opportunity.
Examination of Witnesses
Councillor Megan Wright, Sally Burlington and Maria Higson gave evidence.
The Chair
Good afternoon. We shall now hear oral evidence from the Local Government Association, the Association of Directors of Adult Social Services, and South East London ICS. We have until 3.50 pm for this panel. Could you identify yourselves for the benefit of the record, please?
Maria Higson: My name is Maria Higson. I would like to state for the record that I am here to bring to the panel the experience of a director of transformation within the South East London ICS. I do not represent the organisation, but hopefully I bring that experience.
Councillor Wright: I am Councillor Megan Wright. I am the vice-chair of the Local Government Association health and wellbeing committee.
Sally Burlington: I am Sally Burlington. I am chief executive of the Association of Directors of Adult Social Services, which represents directors of adult social care in England.
Dr Johnson
Q
Councillor Wright: I assume that was directed at me, as I am a representative in local government. We feel it is going to weaken it. Having someone on the ICB is useful to help shape health strategy and ensure that the wider determinants of health are taken into consideration when planning health. We would like to see some kind of structure where local authorities and other partners involved in determining health from a wider perspective have a voice within the NHS delivering health locally.
Dr Johnson
Q
Maria Higson: Whenever we introduce these changes into the system we have to remember that we are talking about a group of professionals who are trying to deliver for the NHS, citizens and patients. This Bill was first announced back in March 2025. It would be fair to say that since then, for an awful lot of people, there have been organisational and personal unknowns. The best intentions to deliver against the agenda and the three shifts can be hindered by that uncertainty. As with everything, implementation is absolutely critical.
Dr Johnson
Q
Sally Burlington: The better care fund is a really important source of funding for statutory core services. It funds about 80% of social care—in terms of the use of the better care fund by social care, 80% is statutory. While the ability to use it differently could be really valuable, we would be worried about diverting it from those core services into other functions. We have also benefited from the fact that the better care fund is uplifted at the same rate as NHS funding. If we lost that, it would be significant, because social care is systematically less well funded over time compared with some other services.
Dr Johnson
So you are losing a protection with the Bill.
Sally Burlington: Exactly.
Karin Smyth
Q
Councillor Wright: The main problem the abolition of NHS England has caused is upheaval and uncertainty with our health partners. Many of the health partners at our health and wellbeing board meetings or our place committee meetings are almost saying to us, “I don’t know if I will be here at the next meeting.” Such turmoil in the changeover creates instability from a lack of being able to plan what will happen next. That is one of the challenges that we feel. We are working with our health partners and getting assurances that there will be continuity, but it is quite hard when the person we are working with is changing.
We are really excited about neighbourhood health sitting under health and wellbeing boards. We love the idea of neighbourhood health looking at the wider determinants of health and having a very localised health response to the issues that that community needs to help it. One of our anxieties is that a lot of ICBs have become bigger and have less connection with the place. They are also shrinking; I think NHS England is losing 30%—
Maria Higson: Larger geography, fewer people!
Councillor Wright: Exactly. We have had a letter from our ICB giving us the heads-up that they might not be able to guarantee that they can send the right person to our health and wellbeing committees, which will obviously make it difficult to plan neighbourhood health.
The other challenge we find in neighbourhood health is that local authority boundaries might not necessarily match neighbourhood boundaries. I will give an example from Bracknell, where I live. Bracknell is very clearly a neighbourhood, but the south of the borough, which is within the Bracknell Forest council area, probably sits within Bracknell and Wokingham and a little bit within Reading. It will be hard to bring in true neighbourhoods with the current structure, but that is something we are working around, and we are hopeful that we will be able to sort it out.
Karin Smyth
Q
Sally Burlington: Health and wellbeing boards will probably become even more important following the removal of local government representation from the ICB. It will be the only place we have NHS and local government partners with the specific statutory responsibility to work together on social care. As others have noted, they are at place level and will therefore be crucial for connecting with the neighbourhood.
The other factor that is helpful to note is that there is a huge amount of pressure on systems at the moment, and the cuts to ICBs are having a profound effect on the relationships they have with local government partners. We are hearing from our members that continuing healthcare is a real point of concern, with reviews leading to the withdrawal of that care, placing challenges on local authorities. In that context, making sure that we are supporting health and wellbeing boards to be as effective as possible for neighbourhood health, and in that strategic joining-up role, becomes even more important.
Karin Smyth
Q
Sally Burlington: Neighbourhood health is a really important vision that we strongly support. In a way, it is obviously the right thing to do to move services closer to the people they serve and to work very closely with communities. Health and wellbeing boards have an opportunity to drive that neighbourhood health agenda because they are responsible for neighbourhood health planning and have the connection to local government, to the voluntary sector in many cases, and to the NHS. It feels like that is a real space of opportunity to drive neighbourhood health and realise the benefits that it could offer.
The Chair
Q
Maria Higson: A couple of things. One is that it is not possible to overstate the importance of the partnership working between the NHS and local authorities. If we want neighbourhood health and the shift to prevention more broadly to be successful, working closely with local authorities, including the public health teams—which were not in the question but deserve a mention—is imperative. I am sure we will come to the question about the relationship with the mayoralties. There is something about that geography question. The insight and experience that local authorities bring is really important. That is the one thing that I think ought to be mentioned.
Helen Morgan
Q
I am really concerned that that will become even more problematic because they cannot work together, given that we are not a combined mayoral authority, that we will not have a mayor sitting on our ICB and that our ICB merged footprint does not fit with our local authority geography. How can the health and wellbeing boards work between the two organisations to deliver good social care?
The Chair
Let us start with our councillor in the middle.
Councillor Wright: It is a challenge. I completely hear that; continuing healthcare is a really difficult one. It is right to say that residents are seen as a financial burden, which should not happen. That is why we need strong health and wellbeing boards. We need strong, honest conversations between local authorities and the NHS for ensuring that good continuity of care.
Obviously, I think the overall aim of the 10-year health plan is to move much more to a model of prevention and treatment in the community, where we hope that we could intervene earlier and set up good standards of care before it gets to a stage where it becomes so adversarial. That is what we are aiming for. We have challenges in our local authority and have had to push back on a few cases where we felt the NHS should be helping those people.
Sally Burlington: The problem is getting bigger over time. We did some joint work last year with the NHS Confederation to look at those difficult issues on the boundaries between health and social care, including continuing healthcare and mental health aftercare. That identified some good models. We see arrangements for joint commissioning of continuing health care, which can work well. We have seen a little bit of withdrawal from that by some ICBs.
Part of the issue has to be that we are seeing a real intention to cut costs, and that leads to lots of reviews taking place that do withdraw continuing healthcare. We have seen that trend while the demographics are pointing to potentially more demand, not less. I do not think there is a substitute for better relationships. The legal framework is pretty clear. A helpful way into the problem would be to find a way to have a set of conversations at a national level about what the right solution for people is—start there and then think about whether the reviews are right in the ways that they are taking place.
Maria Higson: The only thing I would add is that it is tricky when we apply a broadbrush approach of, “Well, it’s going to be about the mayoralty and so on.” In reality, certainly within London, we can describe ourselves as a system of systems. We work with six local authorities across one ICB, now partnering with south-west London as well. It is not as easy as “one approach fits all”. As this Bill goes through implementation, it will be important to be conscious of that to get the best out of those relationships.
Helen Morgan
Q
Councillor Wright: I chair a health and wellbeing board, and everyone comes to those; there are really good conversations and really good reviews of what is happening. I think they are in a really good position. What I worry about is how much influence they will have over NHS wider strategy.
I was at a King’s Fund day, and someone said something that I thought was so true: the Health Bill and the NHS 10-year plan is the NHS 10-year plan. The NHS will be judged on how it achieves what it is meant to achieve. Although, as local authorities, we want to help with prevention and those wider determinants of health, ultimately the responsibility sits with the NHS.
It is about trying to work out how we have better conversations with the NHS, to say, “We have done neighbourhood health for years; this is what we do as local authorities. We look at all these things and we use public health and our adult social care system to create healthy environments. We need you to be on board with us.” I therefore think there is something about the power dynamics regarding health and wellbeing boards and how we address them. But overall, I feel that they are the best way of ensuring community health.
The other thing is about geographies. Health and wellbeing boards might not match neighbourhood health geographies, so there are also some challenges in working out how that will work.
Edward Argar
Q
I was the Minister who created ICBs, and I sat on that Bill Committee with the current Minister for Secondary Care. I am getting a sense of déjà vu—we are on different sides of the Chamber now, but we sat through the Committee stage of the Health and Care Act 2022 together. I deliberately created ICBs to match the geography of upper-tier authorities because health and social care is essentially one system. If one bit does not work, the other bit does not work.
Since then, we have seen significant mergers and larger areas, further removing them from that direct relationship and read-across. Although the good ones do, I fear that a lot of NHS ICBs do not fully reflect the intention behind their creation, which was to see them as a genuinely collaborative exercise with equal voices in the room.
My question is: if we see ever-larger areas or fragmented areas, whether through neighbourhood health plans or mergers and acquisitions among ICBs, how do we maintain genuine local accountability and the relationships that underpin any structure written in law, on a piece of paper or in guidelines?
Notwithstanding what is being done about the health and wellbeing boards’ increasing involvement, do they actually have the teeth they need? In my experience, however good the collaboration, it is within the ICB boardroom that the decisions are actually made. However well things have been discussed beforehand, the ICBs will make their own decisions based on their own priorities. Does the removal of that voice from the ICB strengthen or weaken the ability to see this as one local system and to deliver a genuinely holistic local solution?
Councillor Wright: It will probably weaken it, unless we are given more say in our local health and wellbeing board. Our Thames Valley ICB has one director of public health. Thames Valley ICB I think has nine local authorities, and one chief executive and one director of public health sit on the board, so already the voice on it is quite small. If we lose that voice, where would we have those conversations? That brings me back to the whole thing about health and wellbeing boards needing to be stronger, definitely.
Sally Burlington: We would agree with that. If you take away the voice that is able to speak on behalf of social care, public health and wider public services, it will be harder and an additional job to bring in that consideration. It will be even harder to expect there to be notional teeth in that relationship, so we have concerns about that.
Maria Higson: It is also worth recognising that the delivery of any strategy or plan will require partnership working with local authorities, so whether or not they are in the room, they will be needed for delivery, and the proof is always in the pudding. For me, the partnership is somewhat non-negotiable in order to achieve delivery.
Sureena Brackenridge
Q
Councillor Wright: At the LGA, we are arguing for a single person record, so that we have a single patient record that brings in social care providers, or at least the local authorities’ social care statutory provision, too. Someone discharged into the community would therefore still have access to records and know what was going on, while others would know what has happened to that person and what they need. Yes, we agree: we hope that a single patient record would make things as smooth as possible from hospital discharge to home and would help when someone comes into hospital, so that the clinicians have a better idea of what the patient’s quality of life was like, what treatments they were on, and so on. We are definitely in support of the single patient record for that, and we would like it to become a single person record.
Sally Burlington: We are supportive as well. The Bill itself is unlikely to solve all the problems in this space. A huge number of practical cultural system problems exist in data sharing, so the regulations that follow the Bill will be important to enable that to work for social care providers and commissioners. It is worth noting that there are thousands of social care providers, so the implementation of the Bill and subsequent regulations will be important. We are keen to ensure that any approaches are co-produced with the social care sector, as well as the NHS. It will be a lot of thinking, a lot of planning and a lot of hard work to get it right, and social care providers will need lots of notice to upgrade their systems in the right, consistent way to enable them to speak to each other, if we are to see the vision of the single person record delivered. I guess it would also be helpful to think about the role of carers as we move into that space, because we know from covid that data sharing among carers was one of the issues that came up.
Gregory Stafford
Q
Maria Higson: Any time we go through an NHS reorganisation, it is distracting—that is the reality of such situations. It is unfortunate that, over the past 15 months, this has been a large distraction for people who are genuinely trying to deliver the three shifts—prevention, digital and neighbourhoods. It is true that it has been a distraction. I am not sure that this Committee is the right space to go into these, as I am aware that we are here to discuss the Bill, but there are probably opportunities to go further on some elements, which may help us in future.
Gregory Stafford
Q
Maria Higson: To take one example, I would love to see an NHS where we step away from short-term activity metrics, and towards outcomes—that is mentioned in the Bill. The constant firefight on activities is quite challenging, so how can we move that dialogue to ensure genuine transformation? That is an example of where we could potentially go further than the Bill suggests, but I am conscious that I am supposed to comment on the Bill, not give my own random thoughts.
Jo White (Bassetlaw) (Lab)
Q
The Chair
I could not hear the question from this end of the room; I do not know if our witnesses could.
Jo White
I was talking about bed-blocking in hospitals and how neighbourhood health plans can work more cohesively with hospital trusts.
Councillor Wright: I think we can answer this together. The whole point of neighbourhood health is to bring in everyone in the voluntary sector, your patient transport and all that, so that your joint strategic needs assessment has a good understanding of what is available to someone in the community when they come home. We talked before about having a strong single patient record so that good communication is there, and neighbourhood health is able to strengthen that. Neighbourhood health should be not just about shifting the need from hospital to community, but about reducing that need in the first place so that fewer people need to go to hospital. At the same time, we are seeing some good developments in the NHS, such as frailty teams and hospital at home teams, all of which help to prevent people from being admitted to hospital in the first place, and to ensure that when people come home, there is a team to visit them.
You are right about the communication issue, although it has not been an issue where I am, as we have very good communication with our local ICB about the people being discharged, to make sure that someone is there to meet them and that nurses come out to see them when they come home—I cannot remember the word for that. We have the right systems in place and they are working. I do not know how neighbourhood health will work everywhere, but in our borough we have a step-down unit called Heathlands, which people quite often go to when they come out of hospital and which does quite a lot of rehabilitation. That already starts the plan to get them home: to go from hospital, to the step-down place and then to home. It is about having good systems in place, all of which should hopefully be supported by neighbourhood health, which should have a good knowledge of what is available locally.
Sally Burlington: It should definitely help, if it works well; we should see more capability and capacity available in the community, closer to where people live, to help them when they come out of hospital. There is a lot of good practice and understanding about good discharge and how you plan from the point that somebody is admitted to when they come out of hospital. The emphasis on integrated neighbourhood teams will be important. It would be helpful if we could all remember that those must include social care and wider local government services and connections in to those, not just integration within NHS teams. It is definitely a positive step forward and, if we can try to make sure that the relationships between health, social care, public health and wider services are brought to life in neighbourhood health, that will help us in this way and in lots of others.
Janet Daby (Lewisham East) (Lab)
Q
Sally Burlington: As I understand it, the safeguards around data sharing remain in place under the Bill—they do not change. The part of the single patient record that is really attractive to our world is that people will not have to repeat themselves to every professional they meet; they will not have to tell their story again and again or be retraumatised by explaining the detail of what they have been through.
The potential advantages are there, but there are obviously concerns about data protection and how data is used. It is incumbent on us all to take those seriously, think them through and make sure that safeguards are appropriately implemented locally and in all the institutions that have access. That is probably a matter less for the Bill and more for the implementation and supporting regulations, but we and other partners will be keen to be a part of that process to make sure that the safeguards are appropriate.
Laura Kyrke-Smith
Q
Maria Higson: I think we are all agreed that working at the neighbourhood level is absolutely the right way to go about that. That is where health inequalities can best be addressed, because that can be most nuanced and tailored. Working on that smaller footprint is really important. You mentioned voluntary, community and social enterprise organisations, and I think that is a hugely important part that has broadly been missed out from the conversation around these changes. We work closely with VCSE partners and we know they deliver huge amounts for the communities and understand the communities in which they are embedded very well, so making sure that the VCSE voice is part of those neighbourhood teams will be important for that nuance and tailoring in the local element.
Councillor Wright: I agree entirely. Local authorities are in a good position to engage the voluntary and community sector. But again, we are fighting for a voice with the NHS and they are fighting for a voice with us, so we need some honest conversations with ICBs, and a real strategy looking at those health inequalities and what is driving them. It will not purely be access to hospitals; it will also be access to meaningful employment, housing, transport, mental health or social isolation—there will be so much driving those wider determinants of health that are affecting healthy life expectancy. Local authorities are in a prime position to do that, and they need to be listened to. I think the challenge will be how we collectively say, “What needs to be done, other than implementing the Bill? How do we look at the whole health inequality picture and address it?”
Sally Burlington: I would agree with the others: tackling health inequalities is really difficult. Doing it the same way in every area would not work, particularly in a world where there is not enough resource to do everything we would all like to do. You have to tailor how you approach local service delivery and what is needed locally according to local needs, the local community capability, how people work and what their preferences are locally, and the neighbourhood health agenda is our best shot at tailoring in that way.
I think you will come on to Healthwatch, but we would have concerns that, in separating the Healthwatch duties to look at NHS and social care, we risk missing some of those who are most likely to need both, and that that could exacerbate health inequalities rather than make them better.
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
Q
Councillor Wright: That is quite interesting; I was at a session this morning looking at communities, and there was a comment that for the NHS communities are about buildings, whereas for the local authority they are about people. I think it would be the ICBs and whoever they commissioned to provide neighbourhood health centres. I hope there would be enough input from the voluntary sector, the local authority, adult social care and public health—from everyone—but I see the ICBs as the commissioners and the people who organise them.
Peter Prinsley
Q
Maria Higson: If we want to be as open to change as possible, my argument would be that that should be decided locally. Would it not be fantastic if, for example, some of them were led by VCSEs that worked in close partnerships and had clinics where GPs came in? You can envisage a whole number of different scenarios, led by local communities and local organisations. This plays back to the health inequalities point, but that is how you do it, although it relies on you being open to different models and not trying to do a one-size-fits-all, which is really tricky when you are trying to implement.
The Chair
Last word, Sally Burlington.
Sally Burlington: I strongly agree with that. If you were asking who is best placed to run them, the answer would be that it probably looks different everywhere, because it will rely on local leadership and local capability and capacity, which varies across all our sectors, so this is a really good opportunity to make the most of that leadership ambition and skills and capacity locally.
The Chair
Thank you, ladies. The Committee is most grateful to you.
I will just explain now, while we are changing over witness panels, that after I introduce the next panel there are likely to be—in fairly short order, because the Minister is on his feet—four Divisions in the House. I shall suspend the Committee from as soon as the first Division is called until 10 minutes after the start of the last Division, when we will start again. I hope that is clear. It does mean, I am afraid, that we will have to ask our witnesses to be very patient. It is extremely tedious and very discourteous, but that is the way this place operates, I am afraid.
Examination of Witnesses
Emily Holzhausen, Paul Farmer CBE and Kath Abrahams gave evidence.
The Chair
We will now take evidence from Carers UK, Age UK and Tommy’s. Could you introduce yourselves for the record, please?
Paul Farmer: I am Paul Farmer. I am the chief executive of Age UK and also the chairman of the Richmond Group of Charities, which comprises 15 of the larger health charities as members.
Kath Abrahams: I am Kath Abrahams. I am chief executive of Tommy’s, which is the pregnancy and baby charity looking to stop the heartbreak and devastation of baby loss and make pregnancy and birth safe for everybody.
Emily Holzhausen: Hello, everyone. I am Emily Holzhausen, director of policy at Carers UK, representing England’s 4.7 million unpaid carers. I also have lived experience as a carer.
Dr Johnson
Q
Paul Farmer: From the perspective of older people and people with long-term conditions, the single patient record will be, broadly speaking, welcomed. I will explain very briefly why. If you are an older person with multiple long-term conditions and you find yourself in hospital, you often have to explain your experience and health needs, time and again. That is often because of a lack of join-up between the current data systems. Single patient record means the individual patient does not need to repeat their stories or lived experience—and, more importantly, it allows clinicians to have a clear overview of an individual patient’s health records. There are issues that need to be considered, particularly around making sure that people are not digitally excluded, and I am sure that we will get into those, but at a high level we would welcome the introduction of a single patient record.
Kath Abrahams: There are some very similar themes for us. A lack of shared patient record is a particular issue in pregnancy and maternity. You are being seen by your GP, early pregnancy unit and maternity unit. You might have other conditions that affect pregnancy or could affect the outcome of your baby being born. At the moment those systems are very disjointed. The other piece in maternity, which will not come as a surprise to you, is that, if you have lost a baby, you end up having to retell your story over and over again and that can be very traumatic. Sometimes that can lead to people disengaging from care, but also in many cases being retraumatised.
We broadly welcome the single patient record, but with lots of caveats around people feeling able to trust the data and trust that their data is safe. Overall we are very supportive.
Emily Holzhausen: Again, similarly to my colleagues, we are supportive. When we ask unpaid carers what matters to them, sharing of information is really critical, but we have a slightly different perspective here.
First, carers would like to have access to the record, with the right permissions. That is not on the face of the Bill, but it is suggested that that may be covered in regulations, and we would like to see some assurances of that. It would change things, again, because of not having to retell information, which carers call “triggering” and “exhausting”. They will be more able to spot errors or things that are not quite right, which is important for the person they are caring for. As an unpaid carer, when you are responsible for caring for someone, that is a huge weight on your shoulders and you really want to make sure that it is being done right. Finally, most of us care remotely—we do not all live with the person that we care for. This could really help to transform carer’s lives and the pressure they feel.
I have one statistic for you: just under one in eight carers spend over 40 hours a month on NHS admin. If the NHS app and the single patient record can reduce that, that would change things. The only other point I would like to make is that where this tips over into social care, this is something that we need to build with social care and all those people who go across all these different services.
Dr Johnson
Q
Emily Holzhausen: Yes. That is a lot of different questions. It has to be done with the right permissions, with the patient being in control of their data—that is a very strongly held principle within the NHS. There will be situations where people do not have capacity and their primary carer, who might be their partner, their son or daughter, might need access. We have lasting power of attorney in England, which could be used as a mechanism, or other assurance mechanisms.
As for digital access, that is an issue that I am sure Paul will want to come on to. Especially when digital access costs money and we have people in poverty, we have called for that to be supported by Government to ensure that everybody has digital access. People have to feel confident about it. While we have seen a doubling in the number of carers using the NHS app to manage their own health and care in the past two years, there are key groups that are being excluded: older carers, people on lower incomes and people who feel less confident with technology, for a whole range of different reasons.
Some of this stuff is delivered very well through voluntary and community services—I know that Age UK has helped my family locally, for example, but I will stop there, because I am sure Paul will want to come in on that.
The Chair
Paul Farmer, you have been given the floor.
Paul Farmer: I would very much like to come in on this subject. We see probably the greatest risk and the greatest opportunity here, in the context of digital exclusion and digital inclusion. The risk of digital exclusion is that older people in particular, although it is not exclusively an older people’s issue, will lack the access to their own care record, as it is electronically based. We need to bear that in mind when we think about the roll-out of that and the availability of the content of that patient record to people who are digitally excluded.
I do think, however, that this is a significant opportunity. It is part of a much broader question about digital inclusion more generally, and inclusion into accessing public services more generally, which is a key theme of the work we are doing at Age UK. We had funds from DSIT to support the work of our local Age UKs, where we run a number of digital champions programmes—Members are very welcome to come and visit them at any time. We worked with 8,000 older people in a two-month period; we engaged more than 1,000 of that group into our digital champions programme, and two thirds of people took up the offer of engaging in a training module on accessing the NHS app.
In particular, we were able to enable people who are partially digitally excluded. We are publishing a report later, which we will share with the Committee in time, about the opportunities for people who are not fully excluded, but partially excluded. We think people are able to go on that journey, but it does need support. We encourage the Government to think about putting a really thorough programme of digital inclusion alongside the implementation of the single patient record, to support older people, people with long-term conditions, people with learning disabilities and other conditions who might need extra help and support to access the NHS app. There is a risk here of people being excluded, but also an opportunity for inclusion.
Mrs B, in Lincolnshire, was helped by Age UK Lincolnshire. She was a carer to her husband, who has had a stroke; she had a home visit from the local Age UK and they were able to set up the NHS app for her. She said she would not have been able to do that without that extra help and support.
Dr Johnson
Q
Kath Abrahams: On digital exclusion, the same risks apply, although there is a different age demographic. If you have somebody who has a particular disability, has English as a second language, or has difficulty reading, we need to ensure that alongside the single patient record we are not excluding people without meaning to. Having said that, there are real opportunities to reduce inequities as a result of this change, such as by ensuring that everyone’s information is there, and that people do not have to retell their story if they find it difficult to speak to their clinician.
What the single patient record will not do is solve all the problems found in the national maternity and neonatal investigation. An action plan will come out of that investigation, and it must be looked at really seriously. A single patient record does not replace compassionate care or somebody really being looked after well, but it can potentially provide a safer environment—I am very happy to go into detail on that.
The national maternity ambitions have expired, but we are pushing very hard for them to be restated. There is potentially an opportunity to use the data at a broader level to measure progress. If it was possible to use the single patient record to understand how things were going towards improvement, that could be very helpful.
Karin Smyth
Q
Kath Abrahams: Right now, the situation is really tricky and people are being failed in their pregnancy and maternity care. Women report constantly having to retell their story—highly sensitive or traumatic experiences of loss—and that repetition can happen across the early pregnancy unit and maternity services. There is a common misconception that the NHS is one system, so when they find that people in another bit of the system do not know something, that can be really frustrating and annoying, because they assume that it exists.
There is also a lack of continuity. A clinician can be completely unaware of a sensitive or traumatic experience that somebody has had, and there can also be genuine dangers in outcomes. We know from the reports into Morecambe Bay, Shrewsbury and Telford that the lack of joined-up sharing of information and good communication between different parts of the system has led to some really difficult outcomes, particularly if somebody also has gestational diabetes, for example, or another condition and they are taking a particular medication that could cause harm to an unborn baby.
There are lots of situations in which not having the complete history is preventing people from getting not only really good, compassionate care, but the safe care they need. If someone is in an emergency situation and they are bleeding out, or their baby is not moving as much as they should, there is not time to start from scratch; they might not be in a position to explain what is happening to them and what their history is. They might not even know all the relevant bits of their history. Having that complete record, if it was done really well, would give clinicians the information that would allow them to make really timely decisions. Maternity can often be high risk—I do not need to say that to you; you know that—but these are often fast-moving situations where time is absolutely of the essence.
Emily Holzhausen: To build on what I said earlier about the amount of co-ordination and admin that people do, I will just refer to some carers’ words. One said that if they had to phone, they would end up in a long waiting queue or having to travel to the GP in person. There are people juggling work and care, so this has real, everyday impacts on their lives and their time.
When I refer to errors, I mean things such as medication errors or diagnosis errors. When you care for someone with very complex conditions, you can have health appointments every week—sometimes twice a week—and it is so hard to stay on top of it. When I say it is so hard, and talk about unpaid carers, we know that caring is a social determinant of health: in itself it is a single factor for poorer health outcomes. We know that 600 people a day give up work to care.
We have done a report on the tipping point: what tips carers out of work? One such thing is social care; another is how they are treated in the health system. If we reduce the pressure on carers and put information at their fingertips to help them to manage care, we improve outcomes for everybody: the health and wellbeing of the carer and the safety of the person that they care for. People are trying to do their best in quite a difficult situation.
One of our members, Norman Phillips, has talked about that a lot. He was in contact with more than 24 professionals, knitting up care around his wife who had advanced multiple sclerosis and dementia. That is an incredible amount of co-ordination of care. You can see how a single patient record, as it is envisaged in the future, could really help to support people who provide care. It is critical, given that we have an ageing population, that we recognise and support families in what they do.
Paul Farmer: I would start by talking about people with long-term conditions. Let us bear in mind that by the time we are 65, 82% of us will have one long-term condition, and half of people aged 70-plus have more than one long-term condition. Most of those long-term conditions are diagnosed within primary care, but of course they have a huge impact on access to secondary care services. For a clinician not to be able to see that whole picture and for the individual to have to explain again and again their physical health issues, and potentially their comorbid mental health issues, creates a huge challenge for people in getting access to the right help and support in a timely manner.
I would build on that to think about two areas that particularly affect older people: frailty and dementia. In this context, we know that assessment for frailty can make a big difference to ensuring people receive the right kind of help and support. That should be done in primary care, but often, sadly, people with frailty will present in hospital with a range of conditions. Understanding the frailty assessment score and what help and support is needed is key. For people with dementia and their family carers, having access to the right information for the clinician and for the individual concerned can make a huge difference. A disjointed experience just exacerbates what can often be a very challenging time.
Helen Morgan
Q
Paul Farmer: Listening to patients is an incredibly important part of any health system. It is necessary to make sure that the right mechanisms are in place at both the individual and the systems level. The aspects of the Bill that cover patient experience need careful consideration.
Many people were fans of what Healthwatch delivered, and others were not, but it had a clearly established system and mechanism in place to ensure that patient voices were heard. It is important that clear systems are established to ensure that that patient experience is heard. I have operated around the health system for a number of years, seeing a number of incarnations of patient voice organisations and representation; you really have to think about it from the individual and the whole-system level—from top to bottom.
It is important that the Committee looks at the provisions in the Bill in that context to make sure that where there are good supports, they not only are preserved but can be built on. For example, how do you make sure that patient voice is heard at ICB level, in providers and, in particular, in the new world of neighbourhood health?
Kath Abrahams: Helen, it is a great question. Clearly, the Bill itself, and certainly the single patient record, are never going to replace wonderful, kind and compassionate care where people feel they are listened to. As I have already said, but I will say again, a combination of people not being listened to at all, despite knowing their own health better than anyone else, or having to retell their stories has very challenging consequences. Both leave somebody feeling that nobody really cares or understands them.
I spoke to a supporter of Tommy’s this morning who has had five miscarriages. She was saying it appears to be quite a small thing, but every time she went to see a clinician, they said, “Oh, you’ve had four losses” or “You’ve had three losses.” It was about them not understanding, and her having to correct her records and getting letters through. It is about that sense of not being listened to.
As we develop the Bill, women and birthing people, from a maternity perspective, should have the opportunity to contribute to the way something like the single patient record is shaped. You could have a digitally accurate system that did nothing to reassure women or help them feel looked after or listened to, or you could have a beautiful system where the information was recorded in such a way that it really helped.
Alongside that, clinicians need to continue to receive the right sort of training. They need to have enough time. As Paul said, you need those patient voices involved in overseeing how things are going, and able to contribute and help. The Bill itself, as a mechanism, will not do enough. This is about designing it carefully with patients in mind and, in the case of maternity services, involving women right from the start.
Emily Holzhausen: There are provisions in the Bill that transfer responsibilities from NHS England to the Secretary of State in relation to involving patients, and it is very explicit that this also involves carers. It is very important that explicit Healthwatch duties to involve carers have been transferred into the Bill in relation to integrated care boards. That matters because their portfolio of commissioning different services is increasing, as is that of local authorities.
Those are strategic duties. The reason why that is important, to be very specific about carers, is that they provide £152 billion-worth of care. They outnumber staff three to one. They are experts in care over time and they want to be involved. Of course, what colleagues have said about good practice is critical to look at.
The changes to Healthwatch—others have raised this—do not consider the person’s journey across different services, health and care. There is an independent voice that we do not have, and will not have, in quite the same way. A very small proportion of carers felt that, if they raised a complaint, it would be acted on. That kind of independent voice is actually very important.
As Kath said, those duties are really important, but we need top-to-toe listening to patients. We also need to be explicit about listening to carers, not just on behalf of the patient, but by asking, “What is your experience as a carer of managing this care?” because that is very different. To be honest, I do not think we have the right data flows behind that to collect and understand people’s journeys and improve things. I hope that that is also something that will be looked at.
The Chair
I do not think there are any further questions. I am sorry to have kept you waiting so long for what has been a relatively short period of time, but it was important that all Front Benchers, and any other Members who wished to do so, had the opportunity to question you. Thank you all very much for being so patient and for giving us the benefit of your thoughts and wisdom.
Examination of Witnesses
Dr Michael Cocker, Dr Towhid Imam and Dr Nicola Byrne gave evidence.
The Chair
If everyone is ready, we will proceed to the next panel; as you will see, one of our guests is on the screen. We have Dr Michael Cocker, from East Lancashire hospitals NHS trust, Dr Towhid Imam, from Croydon health services NHS trust, and Dr Nicola Byrne, the National Data Guardian for Health and Social Care. We will get through this as reasonably swiftly as we possibly can without cutting corners, if that is all right. I will try to bring this to a logical conclusion within—[Interruption.]
The Chair
For the sake of the record, starting with the two people in the room, will you identify yourselves, please?
Dr Imam: Hello, I am Dr Towhid Imam. I am a consultant geriatrician, working in Croydon university hospital, where I set up the front-door frailty service. I am also a clinical lead in South West London ICB and an adviser to NHS England.
Dr Byrne: I am Nicola Byrne, the National Data Guardian. I am also still a practising clinician, as a consultant psychiatrist in south London.
Dr Cocker: I am Dr Michael Cocker. I am a consultant obstetrician in the north-west of England, in Burnley general hospital. I am the clinical informatics officer for maternity at my trust.
Dr Johnson
Q
“rather than data being transferred from where it exists at the moment to a new system, it will remain where it is—in GP surgeries, hospitals and so on—but it will be linked up so that one person, including the patient, can see all that data”.—[Official Report, 1 June 2026; Vol. 786, c. 890.]
How easily will that work in practice? In the trust that I work in, we have different systems for blood results, results, tracking patient appointments, maternity and A&E. Is it realistic to expect someone to be able to log on from one part of the country and to understand all the different systems in all the other parts of the country, or do you think that it needs to work in a different way?
Dr Imam: About a month ago, we published some NHS England guidance on best practice for frailty. Included in that are examples of shared care records, where people who are living with frailty who have been assessed by health services can actually view one record. The way those work is to take information from multiple different records and place it into one shared care record, in order for clinicians from various different backgrounds and multidisciplinary teams to work together.
Dr Johnson
That would be moving it on to a new system.
Dr Imam: That is in a separate shared care records system.
Dr Byrne: As I understand it, the architecture is not yet decided, so how we solve those technical challenges will be determined by the choice of architecture.
Dr Cocker: Similarly, I believe that the technical solution for how that will be delivered has not been finalised. When we did the maternity-based pilot in the north-west, the wireframe prototype that was developed pulled information from all the separate systems—the maternity system, the hospital central electronic patient record system, the GP system. The pilot was based on pulling it from each individual system into one place where it can be viewed, but that is a future aim. The focus is on phased implementation, so it would not all be immediately available like that, but that is the vision.
Dr Johnson
Q
Dr Cocker: That is a pertinent question. I know that that has been the focus of a lot of concern since the Bill was publicised. I believe that the structure of the SPR would be recognised as a critical national infrastructure-type of project, so it would have access to more resource to protect it. But there will always be inherent risk, when you have something centralised, that it is a single target rather than multiple targets that could be attacked—for example, in a cyber-attack.
Role-based access would be important—for example, having an understanding that the information should be accessed only for the provision of clinical care. How it would be delivered on a technical level would have to be finalised; that was not the type of the prototyping work we did, because it was more about a proof of concept than those more minute technical challenges.
Dr Byrne: I am glad that Dr Cocker took that question first, because he has given you a helpful technical answer. As National Data Guardian, my mission and concern is primarily around public and professional trust. Trust in whether this system can be relied on in terms of people’s confidentiality is something that concerns me very much, as well as people’s trust and confidence in secondary purposes, how the system will be used and what the safeguards around it will be. I would be happy to answer from that perspective when it comes to people’s confidence.
I think you have heard a lot about the potential benefits of this system, but it is important to bear in mind that if people do not trust it, the programme will fail, however great the potential benefits are. As a clinician, I would share the excitement, and I am very supportive of the ambition, but people will not trust it if they perceive the risks to the security of their data and confidentiality to be too great.
With that in mind, I want to draw attention to two things that concern trust. I want to emphasise that trust is not simply important—I know that the word “trust” has come up repeatedly today—but absolutely foundational to the success of this. The question about how demonstrably trustworthy the system is should be the primary foundational question; all other questions, including the technical ones, flow from that one question.
On the confidentiality aspect, I think there is a provision under clause 47 that potentially has very significant unintended consequences. I understand that that is not the intention of the drafting, but I have concerns about it and I have a potential solution to suggest. In clause 47, proposed new section 250E(3) creates the power for the Secretary of State to remove the duty of confidentiality for any processing in the SPR in line with regulations. I need to register my concern about that wholesale lifting of the duty of confidentiality from the entire system.
At a system level, there are two risks. One is to patient and professional confidence in the confidentiality of the data once it is accessed or in a system. Confidentiality is absolutely the cornerstone of all clinician-patient relationships. It means that people are comfortable to share the most sensitive information about themselves and often loved ones—it is not just information about ourselves on our records; it is often also information about our loved ones. If people do not trust that that confidentiality is a constant ethical constraint for anyone accessing the record further on, they may be less able to share information about themselves or their loved ones. Clinicians may also be less likely to document that information if they have ethical concerns about who may access it further on if it is particularly sensitive. That will negatively impact on care and the quality of data for any secondary purposes in future.
The second point I will make about that confidentiality provision is that I understand that the drafting intent is to remove any ambiguity in terms of people’s concerns about duty of confidence when allowing access to their data at an organisational level. However, as currently drafted, the provision could be interpreted to remove the duty of confidentiality for not just direct care but secondary purposes. Secondary purposes in future could be dealt with by regulations. That lack of clarity poses a risk.
The solution I suggest is to redraft that provision, drawing on the precedent already set in the Health and Social Care Act 2012. Section 259 prevents disclosure of data from an organisation from being a breach, so people could allow access at an organisational level with confidence. You have removed that ambiguity, but it does not remove wholesale that duty of confidence—that ethical safeguard for the data in the system itself. I think that that is important for people’s own direct care, and, as I said, it is particularly important if there are any questions around secondary uses in future.
Dr Imam: That was a comprehensive answer; I have nothing to add.
Dr Johnson
Q
We keep hearing that it is difficult for people to have to repeat their story. I understand that stories can be traumatic and repeating them can be unpleasant, particularly if it must be done many times, but is there sometimes a clinical value in asking people to go through their story? If so, what is it?
Dr Imam: My specialty is frailty, which is a medical condition characterised by a loss of independence. Although it is associated with ageing, it is not an inevitable part of ageing. The treatment that I deliver as a clinician is called a comprehensive geriatric assessment. It is evidence-based and we know that it improves patient outcomes and maintains independence. What it describes is a multidisciplinary team approach to a holistic assessment that focuses on what matters most to the patient.
One of the issues that we have right now, however, is that the NHS does not consistently identify people who are living with frailty right across the system from community to hospital. If we are identifying people and diagnosing them with a condition, you would expect treatment options to be offered, yet we do not consistently do that across the country. That is essentially driving ineffective and inefficient care. Sometimes, therefore, when a crisis sets in—we have seen this in other reports around corridor care—that can ensue in older people living with frailty.
In my day job, where I look after people in a busy A&E department, I see people who have may have had a fall or become confused, or where there has been a breakdown in their social situation. My practitioners and I are spending hours trying to piece together information from multiple different sources. Those could be paper-based, digital or telephone—we could be trying to phone people to get up-to-date information. As you can imagine, sometimes they do not pick up the phone, so we are sometimes working from incomplete information and things that are not up to date.
Once we have done that, we try to create a care plan for a patient that allows them to be looked after in the community. However, that care plan may not follow the patient, because everyone uses different electronic patient record systems. Some important partners in that care, like social care or ambulance services, cannot actually see the care plan that I have developed for my patient.
Unfortunately, if a patient with frailty then succumbs to a crisis of some kind, the default setting is, in many cases, to trigger an admission to hospital. If a patient does not need to be in a hospital environment and they are frail, they can end up becoming more frail and weak, and lose their independence. That means that they will need even more social care than would otherwise have been required.
Where the solution comes in is that a nationally rolled-out single patient record system could fundamentally reshape this form of care, because we would be moving it from the fragmented, reactive model that I just described to one that is proactive, co-ordinated and truly centred around a patient. Another thing about frailty is that there are so many different people involved in that person’s care, so we need to try to restore the continuity of care for that type of patient, which has become eroded over time. The SPR addresses that with a single up-to-date view of a patient. It enables earlier risk identification, faster clinical decision making and that whole-system integrated response I have been describing, which is lacking at the moment.
There is often duplication; one of the other issues is that assessing patients in this manner can take a long period of time—up to two and a half hours is often quoted by the British Geriatrics Society. You can imagine that if you had an electronic record that could be auto-populated or could rely on the most recent, up-to-date plan done by someone else, that would avoid reassessment as we would be working from contemporaneous information.
Over time, you can see how, for frailty and many other conditions, that could lead to a more preventive approach that is more community based, that reduces the need for admissions, and that provides a better overall experience for staff and patients. Importantly, there needs to be a shift towards neighbourhood working on frailty, and this allows the multidisciplinary team to work towards one plan. You have also heard today about patient voice and carer voice, and this type of care plan also gives them the opportunity to become partners in looking after themselves.
Dr Cocker: The brief answer to the original question would be that communicating and getting a history from a patient are the cornerstone of the patient-doctor relationship. I do not think that the SPR is ever intended to replace that. Where I see its value within maternity, although I am sure that this is the same across all specialties, is that it would form a reliable means of cross-referencing information and being able to get information that—as we have alluded to previously—is often held on many separate systems. As a clinician, you will often not have the ability or the credentials to access that.
For example, in maternity care at my trust we use a certain piece of software. If you do not work in maternity, although you might be able to get generic access to it, you might not be able to navigate that system. The idea of the SPR is that it would pull out those key bits regarding current concerns about the pregnancy or what follow up has been arranged—all those kinds of things. That would not rely on the ability to use lots of different systems; instead, the information would be available. If there is information that requires cross-referencing or checking, it would also give you the ability to do that rather than replacing the process of taking a history and working out what is wrong with someone.
Dr Byrne: It is a terrific question. Healthcare is a relationship; it is not simply a transaction of facts. At its best, it is a working relationship between a clinician and a patient, but that is also why it is so hard sometimes. Our stories are a combination of two things: the facts and the interpretation of those facts. We heard a moving example earlier of someone saying that they had had five miscarriages and those facts were then not known and how distressing it was that they were not. That is a good example of why getting the facts from conversation to conversation could be really helpful.
Our life story changes over time, however, as does the interpretation that comes up in a conversation. As a doctor in the moment with a patient, I am sometimes as interested in what they are choosing not to tell me at a particular time as what they are choosing to tell me. For all of us, the story changes and is fluid. I think that is a potentially helpful distinction to make.
Karin Smyth
Q
Dr Cocker: Having seen the maternity-focused prototype that NHS England developed in the north-west, we learned that it is technically difficult because there are lots of systems. There needs to be a level of interoperability that allows you to pull the data or it is not going to be much use as a reliable system.
The other thing was about trying to ensure that we design those systems for the patients most in need. That might be social or medical need, and there are many different facets to that. That was one of the other challenges. A lot of the focus went into trying to determine a set of theoretical patients who were very high need, and ensuring that you have encompassed all those possible needs, so that if you design the systems for those in most need, they will cater for as many people as possible.
Dr Imam: To expand on Dr Cocker’s point about the identification of problems, people living with frailty often have multiple under-identified issues. In the prototype we have been shown, the SPR has the potential to analyse the wealth of data on a person and summarise it in a manner that makes sense to the clinician logged into the record. It can also piece together a timeline of what has been happening with a person.
As I said earlier, we often follow a manual process to try to understand what has been going on recently for a person. The SPR will not only enable the automation of that process, but give us the ability to know who the key individuals involved in that person’s care are, so when that person is in a crisis or emergency situation, we know exactly who to call and who the last person to touch the patient was.
There are other important functions. It is not only about sharing information across an entire pathway and having the whole-system approach that I described—from community to hospital, and vice versa. Importantly, many people living with frailty require multiple different referrals and the involvement of multiple different people in their care. The SPR will be able to streamline some of those processes and make recommendations for certain referrals that a clinician, who, under an earlier version, would have logged into the record, may not have otherwise thought about, so it may even improve outcomes for patients by providing solutions to improve their care that we would not have come up with otherwise.
Karin Smyth
Q
Dr Byrne: You have to show that you take the risks and people’s concerns seriously, and give a credible analysis of the risks. The key thing is to engage with the risks meaningfully. You should then think about what safeguards you could put into the Bill and future regulations that would actually be effective and be seen as credible, depending on what risks you are trying to address.
I know it is difficult to get into the detail on the primary legislation at this stage, not least because you are trying to sequence things when we do not yet know what the SPR will be, which I appreciate is a further constraint. I would suggest that you consider putting in the Bill one particular safeguard relating to secondary purposes. People have concerns around two main things: confidentiality and their privacy, and secondary uses—who might access their data in future, and why and for what purpose, other than for their direct care. Focusing on that second factor, there are lots of things that might come up that you could do in regulations, but right now, I would suggest that you could build in the safeguard of an independent oversight mechanism for how decisions are made on who gets to access the data and why. In that, you can involve public and layperson representation to bring in that consideration of the risks that matter to the public, alongside the potential benefits.
That could be helpful for two reasons. First, it would be a safeguard against having any unchecked decision-making power on access, whether now or in future. Secondly, it recognises the reality of human systems and organisations. No one expert or small group of experts, however wise or whatever their integrity, can see the whole picture and have a 360° view of what matters to the public. It would be a meaningful way to give the public agency and representation in that decision making—a meaningful exercise of citizen control, if you like. As humans, we are at our best and our decision making is at its safest and strongest when we get a diversity of perspectives involved—as, indeed, the Committee is doing right now. In this context, that should involve patients and the public.
My second point, which is perhaps germane to your wider discussions around the Bill, is that no one organisation can effectively and consistently scrutinise and challenge itself. That goes for questions around data use and access—and wider, as well—in your considerations.
Helen Morgan
Q
Do you have any advice for us on the development of that single patient record and how we make sure that the data is clean and consistent between trusts and different systems, so that the single patient record is actually meaningful? I will ask Dr Cocker first, if he is the technical expert.
Dr Cocker: I would not go that far—my involvement in this whole project is clinical, rather than having any sort of particular technical expertise. I think that is a pertinent issue, however, because, as has been discussed previously, if an error enters the SPR—say, a code is incorrectly followed through into the system—that error can then perpetuate. That is the risk of a single record: a documentation error can ripple out, rather than being contained within the system it originated in.
Does safeguarding that involve putting requirements on the providers of systems to mean that data can be exported in, maybe not a standardised format, but a set of formats that the SPR recognises? It is a technical question that I do not know the answer to, or the possible solutions to, but that would be one of my suggestions. Rather than having hundreds of different systems that all require slightly different solutions in order to be fed into the SPR accurately, there could be some sort of framework setting out requirements on the providers of the software products used by all the different organisations that will feed into the SPR.
Dr Imam: Like Dr Cocker, I am not technical but, from previous pieces of work that I have been involved with, some of it is to do with the data architecture and making sure that you can agree on the fields being used across the various systems. On frailty specifically, we have had the question of, “If we have multiple source systems that have the same field, which one should we be showing within the single patient record?” Our thinking at the moment is that we would show various entries, with who they have been done by and at what time, so that the clinician could decide how to interpret that data.
Helen Morgan
Q
Dr Imam: That is a really important question; it is something that needs to be thought about very carefully when it comes to the implementation. From my previous NHS England experience, where we have had digital innovations implemented in the older age group, or among those who are perhaps traditionally digitally excluded, that has included partnerships to enable people to have the option of someone coming around, and there has been a thought process regarding people who perhaps cannot engage with technology as easily. That could involve people from the voluntary, community and social enterprise sector—for example, we had Age UK in the previous panel. There are lots of good examples of that type of work to ensure that people are not disadvantaged.
Dr Byrne: There is an opportunity here in the context of digital exclusion. In a digital-first NHS, it is really helpful to think continually about what the analogue version of the system is in the event of further cyber incidents and outages of the system. We need to continually build and maintain a resilient system for the times when digital-first is not available. It is an important opportunity to do so if we think about that question of exclusion.
Sojan Joseph
Q
Dr Byrne: Those things are very important, yes. There are some technical solutions. Again, the SPR is an opportunity to look at that across the system, because systems vary greatly in the sophistication of their audit function, for example. Even when there is an audit function, if someone has legitimate access through their role as a doctor or a nurse, it can be difficult to know whether their access in any particular case is legitimate. These are not common occurrences, but it is extremely distressing for patients if their confidentiality is breached for any reason.
It is not simply a matter of technical controls. We need to look at how we build stronger, more effective deterrents across the system by having effective sanctions when incidents do occur. I am keen to look at that and delighted that the Department of Health and Social Care and NHS England are, I think, very interested in having that conversation with me. At the moment, it certainly seems that there is a variable response across the system to inappropriate access.
Looking ahead to the SPR, we need to look at that make improvements, so that the public can have faith that, given the harm that it can cause them, it will be taken very seriously if anyone does access their records inappropriately. There are technical, cultural and system aspects to think about here. The SPR is definitely an opportunity to do that, and I am very keen to work with other stakeholders on that.
Peter Prinsley
Q
Dr Byrne: It is an interesting idea, but I am not sure. I heard your question earlier about data controllership specifically in this regard. You will not necessarily like my answer. There are two ways of answering the question; perhaps straightforwardly, legally, but also clinically. I will start with the legal answer, which in some ways is easier. Data controllership in data protection law is a very technical term; it is determined by who is making the decisions about processing the means of the data. An organisation running and controlling an electronic patient record would be the data controller. Obviously, this is ultimately a question for the regulator and the Information Commissioner’s Office to determine, but that would be the legal position, nevertheless.
Clinically, we have to come back to thinking about what a patient record is for. Primarily, it is to provide good care in the context of the clinician-patient relationship. If you prioritise the needs of either side of that relationship, I think it is problematic; the needs of one must not outweigh the needs of the other.
The clinical record is there to enable clinicians to record what someone is presenting with, the difficulties they are having, what investigations are appropriate, the findings and what the plan is. It needs to be there for that tool to work. To take you on a slight thought experiment, if it was entirely held within a patient’s control—however loosely we use that term, legally or otherwise—and we could all amend, correct, change or add our diagnoses, findings and treatments, that might be clinically problematic. That may not be the answer you want, but it is the straight answer, if I am honest, from both a clinical and legal perspective.
Peter Prinsley
Q
Dr Byrne: I totally support that ambition. Patients and the public having more agency in their care, strengthening that relationship, and them being able to access their information through the NHS app is a great thing. That is hugely helpful, and there is real potential with the SPR to strengthen that. We have landed on agreement.
Dr Johnson
Q
Dr Byrne: At the moment, I think it is too early to say. Those are absolutely important questions that will have to be addressed in the design. At the moment, I am not sure how the programme intends to deal with those questions, but clinically, that needs to be thought about. There are complications that need to be thought about very carefully in terms of the record and the access. Sometimes that is clinically complicated, but I am not aware of what the plans are for that.
Dr Johnson
Thank you. You are nodding, Dr Cocker.
Dr Cocker: I was just going to say that we did do some exploratory work in relation to safeguarding, because that is quite a key part of safe maternity care, but because of the issues with confidentiality for other involved parties—say, a mother’s partner or someone else in the family—and the risk of that information being pulled through to someone else’s single patient record, it was felt that we could not include any information that contained information about anyone else. That aspect has been considered, but as Dr Byrne said, it would need careful consideration of all those different sources and whether there would be any option to change what feeds in. The only one I am aware of that we have looked at specifically was safeguarding, and it was primarily due to confidentiality issues for other involved parties.
Dr Johnson
Q
Dr Cocker: Yes, and those are concerns with the existing systems. There are multiple sources of information we record on a clinician-facing basis that might be deemed sensitive or confidential that are not available from a patient-facing perspective. It might be sexually transmitted infections or previous pregnancy history that a mother does not want someone else to be able to access on the patient-facing aspect of the record. Being able to provide that is very important in realising the end product of the SPR.
The Chair
Dr Byrne, Dr Imam and Dr Cocker, thank you very much indeed for your patience and for affording us the benefit of your experience and wisdom. The Committee is most grateful to you.
Examination of Witness
Jon Restell gave evidence.
The Chair
We will now hear oral evidence from Managers in Partnership. We have until we have exhausted ourselves—I will say that for the moment—for this session. Would you be kind enough to introduce yourself for the record?
Jon Restell: I am Jon Restell, the chief executive of Managers in Partnership.
Dr Johnson
Q
Jon Restell: There are lots of different ways to answer that. Obviously, some functions of NHS England moving into the Department, with powers going to the Secretary of State, feels like a centralising measure. I know that the ambition of Government is to give local NHS bodies more freedom and autonomy, but the Bill is very careful and goes into a lot of detail to leave powers with the Secretary of State to intervene in the running of those local bodies. On the whole, it is probably more of a centralising measure.
Another way that some changes outside the Bill process are centralising is through the merger of ICBs and, arguably, quite a lot of providers. Whereas before you might have two or three ICBs covering an area, you now have half the staff covering much bigger geographies. I would argue that that centralises decision making to a higher level than formerly.
Dr Johnson
Q
Jon Restell: This, for us, is the crux of what is going on. The Bill is the Bill, but there is a finite management resource in the health service. I think that, internationally, it is considered to be quite low. Certainly, Lord Darzi, the Institute for Government and Institute for Fiscal Studies have all pointed to a shortage of management being one of the potential weaknesses of the NHS, so what is going on right now is knocking another big hole in an already limited resource of managers in the health service. That has the potential to create very large workloads for people in the new system, such that, inevitably, certain things will not get done or will not get done well enough. It certainly feels like we have gone into an environment where we are cutting a management cost without thinking about the management capability the health service needs to innovate, deliver reform, and do basic safety and resource management.
Dr Johnson
Q
Jon Restell: Our members have been on a bit of a journey on this one. I think that they would broadly support the regulatory proposals that the Government will bring forward after the consultation. I think the real impacts will be very limited, covering a relatively small number of people and being used in very exceptional circumstances, so I do not think that they will transform management culture and deal with the management capability issue we have. They are a very personal form of professional regulation that will have very limited impact.
Dr Johnson
Q
Jon Restell: That is probably driving most of the anxiety and uncertainty that people are experiencing, and it is why, for some members, this is becoming psychologically very difficult. You have a change programme that started in March last year with the announcement by the Prime Minister of the abolition of NHS England and the halving of the staff of NHS England and ICBs. For 18 months, that process has dragged on, with lots of design decisions still to be taken about how the organisation will look, what functions it will have, what will be going to the Department and what might be going elsewhere, and what will potentially go to trusts from ICBs and from ICBs to regions. Despite all that uncertainty, people are being told to make decisions about voluntary redundancy and the future where they do not understand where that future potentially sits for them. That is undoubtedly driving a lot of people to feel psychologically unwell and distressed, and they are leaving. People are beginning to leave, because they need to protect themselves.
There is another part to this. Obviously, that is a very personal issue for our members, but the other thing is that they are really worried about the service to the public, the safety of the changes and what will happen to various functions that they are responsible for, if teams get halved and responsibilities are taken to a higher level in that more centralised model.
For example, we have a lot of members working in ICBs who have really hands-on roles in the care of individual children, particularly where providers fail. Those kinds of concern are not being properly addressed in terms of risk and continuity of service to those people. We are going to survey our members—we will share the results with the Committee—in the next week or so about what specifically is worrying them about the way that change is being managed. With due respect to the Minister, this was all announced without a plan, and we are now waiting for a plan to emerge, 18 months into the process.
Dr Johnson
Q
Jon Restell: Obviously, we have the 10-year health plan, which most people broadly see as a good vision for the service, but there are too many key design questions around the new department, the role of the department’s regions, what ICBs will be doing and what trusts will take on as part of this reorganisation. Behind it, there is a lot of capacity and resource organisational memory being taken out of the system.
We do not talk nearly enough about the work of the commissioning support units staff, who are providing internal consultancy and a huge range of business services to the health service, including overseeing child immunisation programmes in some cases. It is really unclear what the future of those functions is. We are taking out a lot of staff who have skills, expertise, organisational memory and commitment, but we do not quite know yet what the precise form of those organisations will be. It is a very difficult change to manage.
Karin Smyth
Q
We had a lot of change with the Health and Social Care Act 2012, and the Bill seeks to reverse that in terms of the architecture of the NHS. We absolutely appreciate as a Government that that is very difficult for staff working in it. I appreciate that the operating model and so on is coming forward, but could you say a bit about people’s feelings about the Bill? There will be more clarity to the centre and the role of providers is not changing, while the real change is around commissioning functions and, as you said, commissioning support organisations. We heard earlier that everything is being reorganised. That is not true, but there is a big change in the geography and the functions of ICBs and commissioners, and the Secretary of State’s role will clearly be different. What might people’s approach to that be?
Jon Restell: Clarity, definitely. No one wants to start with the system that came in in 2011 and 2012. Successive Governments started to correct it almost as soon as it was put in place. I think most people would welcome sorting out the clarity around commissioning there, but I do not think that is the same thing as cutting 50% of those organisations’ staff and running costs. You are clarifying the relationship between the centre and ICBs, commissioning and providers. You still need enough managers with enough skills working in the right system to deliver. That is the nub of what we are doing.
For us it is not really about how the Bill will eventually pan out; it is about the cut and how that is being administered by NHS England, the Department and ICBs. The whole system of management is under strain across the health service. You say that providers are not changing but they are also being asked to take out quite significant amounts of management resource. They are merging to form bigger, potentially more centralised units that may be less responsive and less innovative. I think that organisational form is really important, even if the headline of the Bill might tidy up and clarify those relationships, which would be welcome.
A point made by a lot of members, particularly those in ICBs, is that they do not think that the model design—where we started with ICBs, then went to regions and we are eventually going to get to the target operating model for the Department—is being done at a time where you can see the proper connections that need to be made between those organisations. When the system is up and running, how well will it work together to share information, share risk and so on? It feels like the Bill is very high level and the detailed design of the organisations is being undertaken in a completely fragmented way. People see that as potentially requiring the next round of reorganisation. You are a former NHS manager, Minister; you know how often reorganisation is reached for as the solution. I genuinely feel that people have got to the point where enough is enough. That kind of continual change will create more and more problems for doing the things that the public actually want to see: innovation, improvement in the quality of service and happier staff—all the things that managers should be focused on, not the merry-go-round of organisational change.
Helen Morgan
Q
Jon Restell: It certainly needs to be clarified. Whether it needs to be clarified in legislation, I do not know. Leaving aside the fact it took a very long time to get permission to move forward with their consultations, ICBs were thinking about what they needed to do around May or June last year. They will have made a lot of decisions and a lot of staff will have gone already based on the then understanding of what an ICB was supposed to be doing, based on the ICB blueprint that was published by NHS England, so I think that resource has gone. The people who may be connected with the functions that you are talking to have also gone in many cases. The question for me is: if the ICBs are to get more things to do, what is the implication for their running costs? As you know, they are currently capped at about £19 per head. If they get more functions, will they get more resources to do that? Will there need to be other ways of delivering those functions? I do not think that a lot of them can stop doing statutory functions, but that means all the good stuff that we want to see done in health systems—the innovation and the discretionary stuff, much of which is already on hold—will probably be the stuff that goes while they deliver their statutory obligations.
On the providers side, we need urgent clarity about what is going to go to the providers’ responsibility because they are taking out a lot of costs. I do not think that all, or many, providers know that these plans are afoot for them. That will create quite a shock. Again, they are choosing people to go now based on their current understanding of what is needed.
Helen Morgan
Q
Jon Restell: A lot of the concern is to do with the political make-up of mayoralties in the future and what that might mean; if mayors have an ever-growing responsibility and say in the who, what and where of health services, that is probably different from the more representative, advisory function that they have had. That really needs to be thrashed out: is that the new democratic accountability for health services, or does it remain, as now, with the Secretary of State, accountable to Parliament, making provision for healthcare? It feels a little unclear how much decision-making power those new local government voices will have on ICBs. Have people raised that as a concern? Of course they have; it is uncharted.
Helen Morgan
Q
Jon Restell: I cannot comment specifically on the BCF, but a general theme coming out of what our members are telling us in surveys, and in the regular surgeries and meetings that we have with them, is the sense that policy at the moment is trying to get you thinking in terms of your own organisation again, and thinking less about system-wide transformation, innovation or co-ordination. ICBs are getting bigger and providers are getting bigger. It is some of the system stuff, where I think a lot of our members would say the innovation will come in the way different organisations try to solve problems around patients and populations, that they feel is at risk, by the way—not just from the Bill putting things together, but from the stripping out of resource to do anything different.
The Chair
Thank you very much indeed, Mr Restell. Thank you for your patience, thank you for coming and thank you for the evidence you have given. It is greatly appreciated.
Examination of Witness
Sir Andrew Dilnot gave evidence.
The Chair
We shall now hear oral evidence from Sir Andrew Dilnot. Sir Andrew, for the benefit of the record, could you identify yourself, please?
Sir Andrew Dilnot: I am Andrew Dilnot; it is great to be here.
Dr Johnson
Q
Sir Andrew Dilnot: It is largely absent from the Bill—indeed, when I was asked to come and give evidence to this Committee, I was initially somewhat puzzled, since it is so largely absent. The question you ask is absolutely to the point: certainly, we can improve the efficiency of the NHS without doing anything about social care, but we cannot really address many of the fundamental problems facing the NHS if we do not sort out social care.
That is partly because not having a good social care system means that we are not achieving the levels of human flourishing that are the objective of the health service and the social care system. It is also the case that the social care system is now under such pressure that it is leading to direct challenges for the NHS. We hear a lot about delayed transfers of care, which are an important part of this, but it is not just those; it is people who end up needing healthcare because they have not had appropriate social care support.
The short answer to your question is that we can make the NHS a bit more efficient without reforming the social care system; but until we address social care we have at least two hands, and probably one foot, tied behind our back. It seems pretty astonishing to me that we have a 10-year NHS plan but no real plan for social care.
Dr Johnson
Q
Sir Andrew Dilnot: I would not claim to be expert here, but I have read the Bill and the briefings. The role of local authorities in social care is a very interesting one. If we were to stand way back and honestly answer the question, “Why is social care managed by local authorities at the moment?”, we would say, “Because it was forgotten in 1948, when the rest of the modern welfare state was created.” At that stage, social care was a pretty small activity, and it was just left with local authorities. What has happened since then is that it has grown and grown, and it is now putting enormous strain on at least many local authorities.
I think we should draw a clear distinction in something that is definitely appropriate—that is, care being provided within a local context. The kind of care that is appropriate in Camden will be different to the type of care that is appropriate in the highlands of Scotland. Local delivery seems relevant, but whether local financing makes sense in 2026 is a very big question. That is the context.
On its own, it is hard to see the potential reduction in the role of local authorities in ICBs making things better. It will not necessarily make things significantly worse, but I do not think it will help local authorities and the NHS in trying to integrate these two essentially non-integrated functions.
Karin Smyth
Q
Sir Andrew Dilnot: The question of the fine details of how legislation should be passed is certainly outside my skillset, so I have to be agnostic about whether the Bill should have addressed the wider questions of social care. On the question of whether we could address social care or not, the answer is definitely yes. After all, several Governments over the last few years have promised to do so. The former Secretary of State for Health and Social Care, when he was the shadow Secretary of State during the election two years ago, promised that he would do it. Such measures have received Royal Assent twice, but they have still not taken place, even though they were promised by the then shadow Secretary of State for Health and Social Care, before he became the Secretary of State.
Yes, we definitely could do it. The amounts of money involved, while of course significant, are small relative to the aggregate costs of the NHS or the uplift in spending on the NHS that, with my full support, we have seen in the last couple of years. I think it is a genuine puzzle and a black mark for all of us, including me, that all these years have gone by and we have done nothing. We have a social care system that is supported by millions of wonderful informal carers and about 1.5 million formal carers, benefiting hundreds of thousands of people, but it is creaking under intolerable strain. It really makes no sense to me, and I really do not know why or how we have managed to go for so long without addressing it. We should do so, not only because it is the right thing to do, but because it is now so bad that it is doing direct, instrumental damage to the NHS.
Helen Morgan
Q
Sir Andrew Dilnot: I think there are two main ways. The first, and perhaps the one that has received most attention, is that there are people who have been hospitalised, perhaps following a fall or infection, who have some mobility challenges and need some care, but who cannot leave hospital because a social care package is not available for them in the community. That is extremely damaging for the NHS, because if we have somebody in a bed that they do not need to be in because they have nowhere else to go, not only are we spending money having them there but we are then not able to use the bed for other activities.
If you have somebody with a delayed transfer of care that means they are stuck in hospital, when they do not need to be, for 20 days, which is not uncommon, very large numbers of elective procedures cannot take place because that bed is being used. That is a dead-weight loss from the system.
There is another thing that I think is at least as important, which is that, because of the lack of good social care, we have people falling, injuring themselves and needing to be hospitalised. We have people sustaining more urinary tract infections than they perhaps would if they had good social care. That is adding an additional burden, which the NHS deals with as well as it can, but all of this just seems unnecessary.
Social care appears to be so invisible to us all. It is easy to blame politicians, and of course it is politicians like you who ultimately have to vote for these things, but the electorate—the whole of our society—have to look at ourselves and ask, “Why can’t we make this challenge, which is so significant, better?” Any of you who have experienced it in your own family know how brutal and difficult it can be.
If I can be allowed one more general point, we should reflect that this is the result of the great triumph of the last 150 years. At the beginning of the last century, across the world, average life expectancy at birth was 32, and now it is 73. In this country, average life expectancy at birth in 1900 was 46, and now it is 81. We have added 35 years to the expectation of life from birth, which is an astonishing transformation. Some consequences come with that, one of which is that there is much more social care to be done, but we should be celebrating this, delighting in it and doing it well, instead of hiding it away and ignoring it for so long that it is doing real damage to the NHS, let alone to the lives of people who need social care.
Helen Morgan
Q
Sir Andrew Dilnot: Yes, it is very odd. It is worth doing the odd thought experiment: imagine that the bit of healthcare that was underfunded and available only subject to a means test, and not free, was for heart disease. We cannot imagine it. The fact that it is dementia and severe arthritis means we have drawn an arbitrary line, and while that line still exists and there is still inadequate funding, even in a means-tested system, we are hamstringing the NHS. Now, that is not the most important problem, which is that we are failing to give people flourishing lives and allow them to live to the full, but it is now so bad that it is actually making it hard for the NHS to work.
Joe Robertson
Q
Sir Andrew Dilnot: That is a very good question, to which I do not have a very immediate answer. Well, I do have an immediate answer, which is that, as far as I can see, it is nothing very substantial.
The single patient record offers some prospects here, and it is terribly important for people receiving social care, which again reflects how much longer we are living. There is much more multiple morbidity now. Many of the people who can and are benefiting from social care will have quite complicated medical experiences and histories. That is the kind of group that could particularly benefit from a single patient record, so that we are not having inappropriate prescription and so on. That is going to help, but it will be a second-order issue.
Let me be very blunt. There are two fundamental challenges facing the social care system. The first is that the means-tested bit of it, where we say, “If you don’t have any resources of your own, the state will look after you,” must be a minimum for any humane society. Essentially every year for at least the last decade, the Treasury has announced emergency funding for that in year. That money then does not get spent well. Honestly, if you are announcing an emergency package every year for 10 years, it is not an emergency package. You should wake up, pay attention, have a mature response and fund that system properly. That is the minimum.
The second is that the only big risk we all face that is not pooled is social care. Our risk of healthcare is pooled by the state, our risk of having a car accident or our house burning down is pooled by private insurance. This is the one risk that is not pooled, and the reason is that the state does not, and the private sector cannot. The reason the private sector cannot is that it is too far ahead for a private insurance market to deal with it, so only the state can pool the risk. If there is any area where the case for social insurance is absolutely clear, it is social care; the case is even more powerful in social care than it is in health.
At the moment we have a situation where often people will feel that the best thing that can happen to them, if they think they might have a social care need, is that they die before too long. It is a bit like standing in the middle of the road with a lorry driving towards you and hoping that the best thing that might happen is that you die before it hits you. That is not a good way to be running any kind of society or country. Those challenges—the lack of adequate funding of the means-tested system and the lack of any risk pooling for the population as a whole—lead directly to the kind of experience that you are describing in the Isle of Wight, where there is simply excess demand and so we are trying to ship people across to the mainland. It is a reflection of the fundamental challenges that we have ignored for 35 years.
Dr Johnson
Q
Sir Andrew Dilnot: You are absolutely right to emphasise the importance of non-elderly adult social care, which is roughly half of all of the expenditure and growing. One reason that we see particular pressures in the elderly care sphere is that the less-elderly need has grown very dramatically, again because of the scope for increased human flourishing.
On the whole, as far as I can see, there is very little understanding of the integrated nature of these costs between social care and the NHS, so I think there is very little thinking in budgetary terms about the consequences of the squeeze on social care leading to increased expenditure and needs elsewhere in the NHS. That is not easy to resolve. Moving to a system that properly integrates those trade-offs will be difficult, and it requires a different sort of funding regime, but while we do not, those costs exist. My sense is that they are second order at the national level, but where they are certainly not second order is for the individuals concerned and their families, for whom this kind of thing is an eruption of anxiety and grief, in the context that families are already under pressures that most of us would find hard to imagine.
The Chair
Thank you very much indeed, Sir Andrew, for affording us the benefit of your considerable knowledge in this area, and thank you again for your patience. We are most grateful to you.
Sir Andrew Dilnot: Thank you. I am delighted that you are thinking about social care in the context of this Bill.
Examination of Witness
Karin Smyth gave evidence.
The Chair
Minister, for the sake of the record, would you identify yourself, please?
Karin Smyth: I am Karin Smyth, the Minister of State at the Department of Health and Social Care.
Dr Johnson
Q
“The reorganisation of health services always distracts from people’s jobs, destroys morale and wastes money”.—[Official Report, 22 September 2020; Vol. 680, c. 809.]
In response to a written question this week, though, which asked what assessment you have made of the disruption of development of new services caused by the abolition of NHS England, you said:
“The abolition of NHS England is causing no disruption to the development of new services.”
I wonder which of those statements you agree with the most and whether you want to change your mind in the light of any of the evidence you have heard today.
Karin Smyth: I do not know exactly what year you are quoting from, but I am happy to take that full on. Of course, change, reorganisations and changes in legislation have consequences at different times depending on what they are. That will determine changes to some services at local level.
I think that quote probably relates to the 2012 changes, which, as I have often said, brought me into Parliament. The entire infrastructure of the health service was destroyed and changed in order to bring forward that legislation. I can never find anybody—I think I have heard Lord Lansley say this—who thinks that was a good thing. I am very happy to say that part of the rationale was the fact that, despite lots of warnings about the damage to that infrastructure, that lesson was not learned. We will not go through the history of the passage of that Act. It even had to be paused mid-way through to enact other ways of making things work.
I am sure that you will come back in your second question to decisions about some of the provisions in this Bill. It is true, and a matter of record, that as an incoming Government we did not intend to abolish NHS England as an organisation; in our determination to change the outcomes of the health service, that decision was made some eight months into our being in government. Today, we have not heard a single person suggest that that decision is wrong. Dr Johnson is from the Opposition. The Bill was not opposed in principle on Second Reading. There is overwhelming consensus on the major provision in the Bill—the abolition of NHS England—and on the single patient record.
I am mindful, on a personal level, of the consequences for individual people’s jobs and of trying to get that right. I accept much of the criticism from Mr Restell about how it would be better to do it much more quickly, and about making sure that it is done in a different way, but the consequences of abolishing NHS England are some of the things that we are seeing.
Dr Johnson
Q
Karin Smyth: In terms of service delivery—I think the written question was about delivering services— I stand by that.
Dr Johnson
Q
Karin Smyth: Do you mean the future state of ICBs?
Dr Johnson
No, I mean the system as a whole. My right hon. Friend the Member for Melton and Syston spoke earlier about how ICBs were designed to link in with upper-tier local authorities, and he gave a reason why. Under these reforms, Lincolnshire ICB, which was part of a mayoral authority, will now link in with Derbyshire and with Nottinghamshire, which are part of another mayoral authority but not a complete mayoral authority. You have things jumbled up. I wonder whether that is because, rather than having a vision, you have started to unpick somebody else’s work because you did not like it. Likewise, with the single patient record, we have heard that lots of necessary decisions were not made before the Bill was introduced, so people are being asked to deliver things that have not been properly considered. Is that fair?
Karin Smyth: I think they are two separate things. On the provision made in the Bill, abolishing NHS England brings with it a lot of technical detail to ensure that the legal responsibilities and duties are placed, rightly, on the Secretary of State and into ICBs. It clarifies the landscape on very technical matters such as licences and foundation trusts, and there is a large chunk of detail on the consequences of abolishing NHS England.
Alongside that, there is a move to give ICBs a larger footprint, in parallel with the Government’s agenda on devolution. I accept that that is a lot of change in all our constituencies and for all our areas. We are making sure that we make the most of mayoral authorities to allow mayors to be on ICBs, as they are largely determiners of a lot of economic development, transport and indeed the wider determinants of health. We are still going through some of that change; you will recently have been written to for your views on it as local Members of Parliament, along with local government. We need to make sure that that is embedded as quickly as possible so that we can stabilise that side of the system.
On the single patient record, the Bill will provide enabling powers to bring it forward in regulations. There will be further detailed consultation both with clinicians and with patients and the public, as we have heard, because building trust is critical. That will come next, which is usual in parliamentary terms: as legislators we understand that primary legislation makes provision and secondary legislation sets out regulation. I thought Dr Byrne was very helpful earlier on the point about bringing public trust with us and explaining the two stages of bringing this forward.
Dr Johnson
Q
Karin Smyth: There is a fundamental philosophical, and perhaps political, difference in the approach that this Government are taking compared with what has gone before, in terms of the notion of responsibility and accountability for both commissioning and delivering services, and the position of independence. We talked earlier today about perception and reality.
The system has not worked. To my earlier question— I think I said this on Second Reading—we have had what is called an independent voice in some of these bodies for over 50 years, and we have had numerous recommendations. I disagree with Jeremy Hunt on this. Under his stewardship of the new NHS England, we had a plethora of recommendations and new organisations, and layer upon layer of bureaucracy, totally remote from any kind of democratic accountability or oversight. That is not working, and I do not think that anybody is really defending that.
It is the job of the NHS—both providers and commissioners—to include patient voice and patient experience in their work. I think Ciarán Devane from the NHS Alliance said that getting boards right, in terms of their managerial, clinical and patient experience work, is their responsibility. Outsourcing lots of that work to other bodies has not worked, and I think it is outsourcing that responsibility. We have to make boards work at a local level; they have to step up to the plate, and I think they want to. They are certainly equipped to be able to do that—not taking into account that people will need some skilling in some of these areas. There is a debate to be had about independent organisations, and I think we will have a good debate on it in Committee.
As a final comment before you come back, this is a bit of a bugbear of mine, and perhaps as I am speaking on behalf of the Department I should not say it, but I will: none of my constituents are hard to reach—not a single one of them. We know exactly where they are; we largely know what is wrong with them; we largely know what their health outcomes are going to be; we know their ethnicity, demographics and so on. What are hard to reach are the remote organisations that have not served them well, and that is what we are determined to put right. Putting that right in this Bill is the start of doing that.
Dr Johnson
Q
Karin Smyth: I will come back to the waiting lists, but you are absolutely right about trust. In saying that I expect this to be the board’s job, I think it is its job to get this right, and we need to support it to do that. We heard a bit from Penny Dash about the national quality board and the patient experience directorate inside the Department of Health and Social Care reporting directly to the chief executive and the permanent secretary. That has to be part of the wider architecture, which is of course outside the Bill, so we need to be able to tell that story to the wider public.
We know from all the recommendations, reviews and the support that we give as Members of Parliament to our constituents that trust is really important. Getting that right and bringing people on that journey with us will be really important. Independence helps with that, and that it is why it is good to debate it as we consider the Bill—it is good to be able to air some of it—but I think people accept that things are not working and have not been working.
I think your question about waiting lists is about the data and the information that says where we are at. It is really complex. To follow NHS England’s data, of which there is a lot—I commend the amount of data that is available—you need to be quite clever at spreadsheets, and at finding and articulating data, in order to bring it back to your own constituency and local place. These things are complex. It is complex to record, track and recognise how people move through a waiting list, for example.
It is good that we are transparent about that. One thing that I am keen to push out is data on performance in trusts. Making so-called league tables is controversial, but the more information that we have out there, and the more we have honest debates about how complex and difficult it is—I am happy to take your questions around how that moves in order to for us to explain that—the more that helps to build trust.
Liz Twist
Q
Karin Smyth: I will come to the single patient record because I think it is a gamechanger. We have heard today from some fantastic experts about the work they are doing to identify how it might work and how we might bring patients and the public with us. Again— I do not think we should just bank this—we have not heard anybody object to it.
We did have some evidence highlighting how things have gone wrong in the past. I worked at a primary care trust and clinical commissioning group at the time when care.data was brought forward. We can all point to where it has gone wrong, but nobody has said that this is not the right thing to do. That is good, but there is still a lot of detail to go through.
We need to keep highlighting the benefits. We heard from Peter Prinsley about whether patients have more control—we do think this is about empowering patients. That was what we said in the 10-year plan. The 10-year plan is about empowering patients in this very large system, for which they are now paying £200 billion of their taxes.
We heard from the excellent clinical panel. I defer to clinicians about what they need, both if they are dealing with chronic long-term conditions—we heard that it can sometimes take two and a half hours for an assessment—or if they are working in a busy emergency department. The fact that this is needed will be controversial. There will be a lot of questions about it and a lot of concern about privacy, data, cyber and so on. We need to hold on to those benefits, which are huge in clinical terms and for patients.
Another point we heard, which is also true, is that people think this already happens. People do not understand why, when they turn up at an A&E in Whitby, as we heard, or somewhere else, and then go back to central London, the systems cannot talk to each other. For me, that is about people’s trust and belief in what is a public service. It is a really important part of that.
On abolishing NHS England, I do not think anyone has come to one of my constituency surgeries and said, “Please do this,” or talked about it in great detail, but people do understand. My experience in opposition and so far in government is that MPs are perplexed when they try to intervene on behalf of patients, or to get an answer locally as to why on earth chief executives of ICBs or trusts sometimes do not respond even to a Member of Parliament’s requests for meetings. I find that shocking, but it does happen. How on earth is a patient or somebody struggling through the system expected to get a response? Getting it right is not black and white, and it is not easy to get the balance right between the Secretary of State’s democratic oversight and autonomy at a local level, but the Bill starts the process of doing that, and it is fundamentally important.
Regarding the other provisions, I accept that great work has been done by many people in Healthwatch and its predecessor organisations, and by people working in the patient safety landscape, but again it is not working. I think that those bodies have been allowed to abdicate responsibility for the core role of patient experience and patient voice. That is not their homework; it is their actual job. It is not something that should be outside, and that is why I think this Bill is really important.
Helen Morgan
Q
It would, however, be helpful to reflect on where there is not agreement: on abolishing Healthwatch and HSSIB. You make the very good point that they have not been successful in their current incarnation, but it is important to consider whether that is because they do not have teeth, or because the organisations that they are trying to change are defensive.
We heard earlier about the culture of fear, and I think that we have probably all had people in our surgeries who can describe being frightened to speak up about their own personal care because they feel that they might be victimised for it. I know of clinicians who are frightened to speak up about their own experience in the organisation in which they work, because they feel that they will be punished for it.
In the light of that defensive culture that we know exists in the NHS, and has been highlighted time and again—Mid Staffs; the Shrewsbury and Telford maternity scandal—is the answer not to put the patient voice in the organisations that have a culture problem, but to give those other organisations the teeth they need, or confer a duty on the ICBs or providers to act on recommendations that are given to them, because I think that might be a more helpful way of dealing with this problem?
Karin Smyth: I think that gets to the crux of some of this. We will discuss it a lot in Committee, and I am obviously very open to keep discussing it.
Thank you for your support on the main provisions. I do not take that for granted because, again, they are still controversial. However, as I think I said earlier, you are right, although it is not true everywhere. I am not blaming individuals, because I think that people have been trying to do a difficult job, particularly in getting us through the pandemic and beyond. But they are defensive. That is why Members of Parliament and others do not get responses to their phone calls or their emails. That is a culture that we have to change, and we need to support people to change.
One of the things that we will do is to bring in regulations—that is a manifesto commitment from the Government—but another commitment that we have made outwith the Bill is to develop a leadership college to support in particular clinical and non-clinical managers, who have a very difficult job, in having the right skills for the new world, which patients and the public rightly expect to be more open and more transparent. We have to change this defensive culture.
However, even since Francis, the adding of bodies and the adding of recommendations, and with the bad experience that you have done so much around, something different has to happen. Again, what we heard from Jeremy Hunt was that we needed to put more prescription into the system and yet more requirements to do something without actually making that someone’s central function and job.
Now, it is a source of disagreement. As I have said, I think that there is a philosophical disagreement about the best way forward. It is not an antagonistic disagreement; there are fundamentally different views about what to do. We will continue to have discussions, because I think that ultimately we all want the same thing: a more open, transparent and supportive culture. By the way, nobody wants to work in a defensive culture, so I think people want that outcome.
It is up to us as politicians to support difficult conversations and trade-offs that happen locally. My view has always been that politicians will support difficult conversations and trade-offs—we heard a little bit about reconfigurations earlier—if the system provides good clinical rationale, good data and good evidence, but those bits of it do not always line up.
That is what I would like to get to. I absolutely understand and hear what you say—we will hear more about it and discuss it more, and I have read all the amendments about the best way forward. I think that we all want to get to the same place, but what is the best way to do that, given that we all know that this is really not working and cannot continue?
Helen Morgan
Q
Karin Smyth: I will need to come back to you on the detail of that. In much of the Bill, we are trying not to over-prescribe. However, we need to get foundation trust licensing right. There are some things that are needed in the Bill, which is what we have put in as far possible, and some things that are not. Can I come back to you on that specific point if that does not answer your question?
Jo White
Q
Karin Smyth: That is a good question. When I was in opposition, I spoke frequently about accountability and democracy, as the hon. Member for Sleaford and North Hykeham was trying to highlight—I am sure that we will hear some more quotes. I cannot speak for the former Secretary of State, as he is not here, but it did surprise us going into the financial year when, despite very clear direction and expectation about the financial situation that the Government inherited and what needed to happen, we were still faced with a very large projected deficit. The duplication meant that there were a lot of people in the room and clearly things were being handed off and that was not working. Ultimately, this is a question that always lurked. I know that the right hon. Member for Melton and Syston is here, and during the passage of the Bill that became the Health and Care Act 2022, we said to the Department that that might have been the opportunity to act. I think that previous Secretaries of State, as was alluded to earlier, thought that they might do that. Ultimately, the benefits of doing it now outweigh the risks and that is the only way to make the system change. We heard from the King’s Fund about opportunity costs and that the benefits do not outweigh the risks—we do not think that is true.
The Chair
That brings us to the end of the time allocated for the Committee to ask questions. On behalf of the Committee, I thank the Minister for her evidence.
Ordered, That further consideration be now adjourned.—(Emma Foody.)
Westminster Hall
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Community Hospitals
(1 day, 4 hours ago)
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Dr Roz Savage (South Cotswolds) (LD)
I beg to move,
That this House has considered community hospitals.
It is a pleasure to serve under your chairship, Sir Jeremy, and I am grateful to have secured this debate. I want to begin by thanking Jo Posnette and Dr Helen Tucker from the Community Hospitals Association, who have been an enormous help in preparing for the debate. I welcome Jo, who is in the Gallery.
Last year, according to the Royal College of Emergency Medicine, around 15,860 patients died in NHS A&E departments in England while waiting for care that could have saved them. That is roughly 1,300 people every month—nearly 10 times the figure recorded in 2015. Every week, more than 300 people died a preventable death simply because they waited too long. Those numbers are shocking, but behind every number there is a real-life tragedy. Let us remember that human aspect throughout the debate.
I am sure I do not need to point out to colleagues that in rural areas the situation is often even more challenging. The ambulance takes longer to reach people, the journey to A&E is longer and, when services at a community hospital have been reduced to a limited number, as is currently happening in my constituency, there might be no early safety net to catch the patient before a crisis becomes a catastrophe.
Manuela Perteghella (Stratford-on-Avon) (LD)
I thank my hon. Friend for her passionate speech about community hospitals. In my constituency we have a fantastic community hospital with a minor injuries unit, but the unit is open only on Tuesdays, Wednesdays and Thursdays, with reduced hours. It could treat thousands more patients each year. Does my hon. Friend agree that opening minor injuries units for extended hours would help to relieve pressure on A&E departments in acute hospitals?
Jim Shannon (Strangford) (DUP)
I commend the hon. Lady for securing this important debate. I apologise to her and to you, Sir Jeremy, for not being able to stay; unfortunately, I have to be somewhere at 10 o’clock that is about 10 miles away. Like the hon. Lady, I wish to shine a light on the quiet heroes of our health service: our community hospitals. Places like Ards community hospital in my constituency are not just buildings but the bedrock of local care. They are the vital bridge between the high-tech intensity of a major acute hospital and the sanctuary of a patient’s own home. I support the hon. Lady in making the case for community hospitals, because my community hospital does all the things she wants community hospitals to do across this great United Kingdom of Great Britain and Northern Ireland.
Dr Savage
I thank the hon. Gentleman for his perceptive intervention. Community hospitals often do feel more like a home from home. They are more accessible for a patient’s friends and family to visit, and they deliver better outcomes for patients and clinicians alike.
In the south-west, ambulance handovers at acute hospitals took more than 30 minutes in more than half of cases in January 2025—nearly 30% above the England average. A few months ago, I had the privilege to ride in an ambulance for a day. In what ended up being a 13-hour shift we attended only three call-outs. Maybe it was a quiet day—I am definitely not saying I wish there had been more grief out there—but we spent much of the day on the road and/or waiting outside hospitals, which did not seem the best use of a highly qualified ambulance crew and an expensive resource.
It will not be news to anybody in this room that our NHS is under pressure, yet, against the odds, community hospitals continue to perform. The Care Quality Commission reports that between 75% and 92% of community hospitals are rated good or outstanding, which is remarkable given that the number of district nurses working in them fell by around 55% between 2009 and 2024, with underinvestment and the loss of EU staff after Brexit cited as key causes.
John Milne (Horsham) (LD)
I recently met the chief executive officer of the newly combined Surrey and Sussex integrated care board, and urged her to consider the potential for expanding Horsham community hospital on Hurst Road into a neighbourhood hub, including a women’s health unit, to mitigate the lack of a general hospital in the area. Sadly, her first task has been to reduce her staff by more than half. Does my hon. Friend wonder, like me, what happened to the extra £29 billion that the Government invested into the NHS? It does not seem to have got anywhere near Horsham.
Adam Dance (Yeovil) (LD)
I have had loads of emails from staff who were worried that Crewkerne community hospital was shutting down, because the communication from local NHS leaders has not been good enough—a problem we also had with the maternity unit. Does my hon. Friend agree that communication from NHS leaders needs to be a lot better?
Dr Savage
I absolutely agree that a lot of the frustration felt on the frontline is due to lack of clarity of communication. Community hospitals are institutions, and I pay tribute to the people who work at them, who do more with less, year after year. They deserve better than for services to be quietly wound down.
I invite Members to imagine for a moment that they are 80 years old—it is less of a feat of imagination for some of us than for others—and living in a village outside Cirencester. Maybe they can no longer drive due to poor eyesight. They wake up one morning with chest pain. There is a hospital in town, but the services have dwindled one by one: no A&E, acute ward or surgery, and the theatre may be currently paused. What is actually needed—prompt assessment, a bed close to home and blood tests that do not require a 25-mile journey to Cheltenham on rural roads—may not be available. That is the reality for many people across my constituency right now, and it is getting worse.
Community hospitals have been an honoured part of our healthcare system for over 150 years. Research published in the Journal of Community Nursing in 2024 describes them as bridging
“the gap between primary and secondary care.”
They are person-centred, nurse-led and multidisciplinary settings that help people to recover, maintain independence and enjoy visits from friends and family. They are not a quaint historical relic; they are precisely what the NHS says it wants more of.
The Cirencester community hospital was exactly that kind of place. Since the day surgery unit was suspended last year, I have heard so many moving stories from constituents, their fond memories of being in hospital, and how much that hospital, right at the heart of their community, meant to them when their children, parents or spouses were sick. But over the years the services there have been eroded one by one: first A&E, then acute wards, paediatrics, maternity and blood services. In 2025, the day surgery unit was paused as part of NHS Gloucestershire’s centres of excellence trial. Each change came with reassurances, but each one left residents further from care. My constituents have become deeply and rightly sceptical that a trial closure will ever be reversed.
Alison Griffiths (Bognor Regis and Littlehampton) (Con)
The hon. Lady is making a powerful point about trust and promises being made but not delivered. Twenty years ago, Littlehampton hospital in my constituency closed, with the promise that a replacement health service would follow. In Rustington, there has been a lack of consultation and the hospital has closed; we are hoping it will reopen. Does the hon. Lady agree that consultation, trust and following through on promises are so important?
Dr Savage
I absolutely agree with the hon. Lady’s point. I have been pressing the NHS to find out the criteria by which they will judge the trial closure, but the criteria have not been forthcoming. I am concerned that there is a circular logic: “Well, you’ve managed without that ward for six months or a year, so you can continue to manage without it.”
A constituent described a cardiac arrest at Cirencester, handled with what she called “absolute skill and excellence” by a team of senior staff working together to stabilise the patient before transfer to an acute hospital. She told me that the nursing care on the wards is excellent, and that patients nearing the end of their lives are cared for with compassion and great dignity. That is what we are talking about when we talk about community hospitals, and that is what the trial closure of a ward potentially puts at risk.
Another constituent—a former GP who started practicing in Cirencester 40 years ago, in 1986—told me about a child who, after the surgical ward closed, waited 20 hours in Cheltenham for an appendix operation. Previously, that operation could have been done in Cirencester much more quickly. That is a family sitting in a corridor in an unfamiliar hospital at 2 in the morning, feeling anxious and far from home, because the local service they relied on had gone.
A month or so ago I launched a petition, in collaboration with a local county councillor, to protect community hospitals across the Cotswolds. Within a couple of weeks, well over 3,000 people had signed it, and last week we handed it in at No. 10. The South Cotswolds population is growing rapidly, largely due to the Government’s housing targets. Thousands of new houses are being built around Cirencester, and there are plans for many more housing developments that will swallow up nearby villages. It does not make mathematical sense for communities to grow while the services that support them shrink. The numbers just do not add up.
NHS bodies often describe these changes as reconfigurations—a shift in how care is delivered rather than a reduction in what is available. For a rural resident with no car and negligible public transport, a 25-mile journey to Cheltenham is a significant barrier to care. The Government’s own 10-year plan talks about “neighbourhood health” and care “closer to home”, but Gloucestershire is heading in the direct opposite direction. I would like to hear from the Minister how those two things can be reconciled.
A few miles to the north-west of my constituency, post-natal beds at Stroud maternity hospital were suspended in 2022. That year, the Care Quality Commission rated Gloucestershire’s maternity services as inadequate—a rating they retained on reinspection the following year. The hon. Member for Stroud (Dr Opher), who is a GP, has made the valid point that post-natal care saves money downstream because it is the time when mothers and babies bond, when breastfeeding is established and when families who need extra support get it on a timely basis. If we lose that support, the costs will appear elsewhere later on. Will the Minister provide a timeline, with dates, for the full restoration of maternity services in Gloucestershire, including the Aveta ward in Cheltenham, which is currently closed for labour and births? Will she provide details of the specific workforce support the Government are providing to make that happen?
In other countries, the decline of community hospitals is not seen as inevitable. Other countries are under the same pressures, but they are making different choices. In Sweden, research found that rural GPs value community hospitals because they provide exactly the things that cannot be replicated in a large acute centre, including proximity, continuity and a holistic understanding of elderly patients and others with multiple conditions. Heart failure and pneumonia rehabilitation can be managed closer to home by staff who know the patient and their family.
In Italy, the Government have committed to building or renovating 400 community hospitals using European recovery funds, backed by research from the Emilia-Romagna region showing that they deliver better integration among care sectors, between primary and specialist staff, and between healthcare and the communities it serves. Last October, more than 150 people from 23 countries joined an international webinar co-hosted by the Community Hospitals Association, and the conclusion was consistent: community hospitals anchor care in local communities, support home-based care and help people to live better for longer.
The Government’s NHS 10-year plan commits to shifting care from hospital to community. That sounds like a very good idea, but a Nuffield Trust report published in September 2025 makes a point that needs to be heard: this ambition is not new. Successive Governments have promised to move care closer to home, and most have fallen short, almost always because the community infrastructure needed to enable the shift is simply not there, and nor is the investment. Ireland, which has pursued reform for nearly a decade, had the wisdom to invest up front in new facilities, digital systems and community workforce capacity.
Unfortunately, the Nuffield Trust found that England’s 10-year plan contains no equivalent ringfenced funding. The expectation appears to be that hospitals cut waiting lists and simultaneously release funds to build community capacity. Again, the maths just does not work.
The starting point is already challenging. More than 1.1 million people are currently waiting for community care in England, with the steepest rise among children and young people. A hospital where the theatre has been paused cannot absorb more community care. A maternity unit closed for three years cannot deliver neighbourhood health. A community health system with 1.1 million people already waiting cannot become the landing ground for patients displaced from acute settings unless it is properly resourced to do so. As so often, rural areas pay the highest price when the gap between ambition and delivery opens up. There is no slack in the system and no easily accessible option down the road.
Manuela Perteghella
My hon. Friend is very generous to give way again. In my Stratford-on-Avon constituency, the Ellen Badger community hospital in Shipston-on-Stour served the community for hundreds of years. The Coventry and Warwickshire integrated care board removed the in-patient beds, which were really important in rehabilitating and looking after patients from acute settings before they went home. Those beds were close to their home. Does my hon. Friend agree that the Government must invest in care in community hospitals to relieve the pressure on acute settings?
Dr Savage
I absolutely agree with my hon. Friend’s point. We need a more joined-up approach. From conversations that I have had with nurses in my constituency, I know that those on the pointy end can see very clearly where the bottlenecks in the system are. We need to relieve the pressure on those bottlenecks.
I will conclude with five asks for the Minister. First, will the Government give a clear commitment to protect and properly resource Cirencester hospital as a local health hub, with the operating theatre restored, not paused indefinitely while the trial closure quietly becomes permanent?
Secondly, will the Government give a timeline, with dates, for the full restoration of maternity services in Gloucestershire, including post-natal provision at Stroud?
Thirdly, will the Government give an honest account of how the shift from hospital to community will actually be delivered in rural areas? What oversight will there be? What protections are in place? What prevents the same pattern of managed reduction from continuing in the name of the 10-year plan?
Fourthly, will the Government commit to work with the Community Hospitals Association towards a national definition and dataset for community hospitals in England, so that our 500 community hospitals can finally be planned for, funded and properly valued?
Finally, will the Minister agree to a meeting? I would very much welcome the opportunity to sit down with her, alongside local NHS leaders and the Community Hospitals Association, to discuss the long-term future of Cirencester hospital, its role and resourcing, and its place in the vision of care closer to home, which this Government say they believe in.
My constituents are not asking for anything exceptional. They just want to know that, if they get ill, there is somewhere to go that they can get to. The NHS was founded on that promise, and that promise must be kept.
Several hon. Members rose—
Sir Jeremy Wright (in the Chair)
Order. I thank the hon. Lady for opening the debate, and remind all Back-Bench colleagues who wish to speak that they should continue to bob—not right now, but as the debate continues—so that I know they want to speak. I am hoping we can avoid any time limits this morning. We have five Back Benchers wishing to contribute, and if they limit themselves to about seven or eight minutes each, we should be fine.
Katrina Murray (Cumbernauld and Kirkintilloch) (Lab)
I commend the hon. Member for South Cotswolds (Dr Savage) for securing this debate and for giving me the opportunity to talk about my experiences of the benefits and challenges of community and cottage hospitals. I do so in the knowledge that healthcare in Scotland is devolved and so is not under the purview of my hon. Friend the Minister.
Prior to my election to this place, I spent nearly 23 years working with volunteers in the health services in Lanarkshire, a job that was highly pressured, but also highly rewarding. An absolute highlight of my day or week was visiting the volunteers in either Kello hospital in Biggar, in the constituency of the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), or Kilsyth Victoria Memorial cottage hospital, in my constituency. This debate is timely, because it was in the day room at Kilsyth Victoria that I heard the horrific news of the murder of Jo Cox, 10 years ago today. Attempting to stay professional and encourage two new teenaged volunteers to have conversations with patients while trying to digest what I saw on the large screen less than 10 feet away will stay with me forever. I send my love to Jo’s family today.
Like many cottage hospitals, Kilsyth Victoria dates from before the NHS was created. In our case, the hospital was created by the local miners as a miners’ hospital in 1903; the part of the hospital that can be seen from the road dates back to that time. The main patient areas are within a more modern extension—I say “more modern”, but it is still older than me. The hospital now comprises a day room, a dining room where all patient who are able can have meals together, and a range of two-bedded and four-bedded bays, as was standard at a time when patients were not used to the space or the individual and ensuite rooms that are considered the norm and expectation today. The minor injuries unit disappeared in the days before covid, and the physiotherapy and out-patient clinics have been moved to the health centre.
In the brief time that I have, I want to talk about how the benefits of hospital services in the heart of communities, which are often remote from big district general hospitals, are outweighed by the considerable challenges that they face. As times have changed, our expectations of healthcare have changed. When I started working at Kilsyth cottage hospital, the patients were all registered with Kilsyth general practitioners. It was unusual for patients not to be from Kilsyth; if they were not, they were from the neighbouring villages, Croy, Queenzieburn or Banton. The GPs knew the patients, and they provided medical care for the hospital. The staff were all generally local people themselves. Patients were admitted for intermediate, respite and end-of-life care.
My experience is that where hospitals have closed, it is because GP cover has been withdrawn. The GPs in Kilsyth still provide the medical care, but in reality it is nurse-led care, with medical cover on the end of a telephone line or a video call, and which presumes good technological connections in a former mining village.
Do not get me wrong: I am a big fan of nurse-led care. Registered nurses who work in community hospitals are highly skilled in the types of care that these patients need. It is heavy work, as patients need a lot of physical care, but it can also be isolating. On a night shift, there might be only one registered nurse in the hospital, which means no break on a 12-hour shift and, with many of these hospitals are miles away from assistance, they might not be able to get help from a registered nurse on another ward.
Patients are more likely to have a dementia diagnosis than 20 years ago, which means that the type of care provided has changed. It was in these hospitals that I learned how important it is to look at a patient’s feet: if they were wearing slippers, it probably meant that they were not meant to have their hat, coat and handbag and be on their way out of the door. Even having barriers with entrance codes did not manage to stop people, because they were all from the village, so they knew what the codes were—they did not forget those.
It can be difficult to recruit staff, who often have to travel long distances, because there is a lack of understanding of how rewarding it is to work in a cottage hospital in the middle of the community. However, what these hospitals provide is the epitome of care in the community. For those who are unable to look after themselves in their own home and who might be thinking about what it means to go into long-stay care or to move into a care home, community hospitals provide that transitional step. They are much more than buildings; they meet a need at a difficult time in people’s lives, and they are absolutely vital.
Richard Foord (Honiton and Sidmouth) (LD)
It is an honour to serve with you in the Chair, Sir Jeremy. I am grateful to my hon. Friend the Member for South Cotswolds (Dr Savage) for providing us with this opportunity to talk about community hospitals. In particular, I pay tribute to the fantastic NHS staff who work across Devon. They pull off an incredible level of service in spite of the constraints they are working under.
In my constituency, we have five community hospitals across Axminster, Honiton, Ottery St Mary, Seaton and Sidmouth. Years ago, they all provided in-patient beds, minor injuries units and rehabilitation services, acting as halfway houses after discharge from the acute hospital, which for us was the Royal Devon and Exeter hospital, and before home. They also provided support after operations, cared for the elderly and freed up beds in the RD&E and other acute hospitals.
Today, much of that capacity has been stripped away. Of those five community hospitals, only Sidmouth retains in-patient beds—and a mere 25 at that. For a region of 150,000 people dealing with constant discharge pressure from Exeter, that is plainly insufficient. Honiton is the only one of the five that still has a minor injuries unit. I wrote to the new interim cluster chief exec for NHS Cornwall and NHS Devon two months ago to demand assurance that our community assets and services would remain safe from closures; it concerns me that, two months later, I have not had a reply.
I ask Members to imagine being an elderly resident in Axminster faced with a medical emergency. A constituent who came to see me at a surgery in Axminster was dreadfully worried about the discharge of her husband from the acute hospital, the RD&E, because she was so frail and elderly that she felt unable to look after her frail and elderly husband. Apart from anything else, she was absolutely distraught with worry about not being able to look after him. The nearest major hospital from Axminster is an hour away at Exeter, and the journey there through the countryside is not just inconvenient for people at that stage of life; it is unmanageable.
In preparation for this debate, I spoke with the president of the Community Hospitals Association, Dr David Seamark. David is not only president of the CHA but a constituent and a GP based in Honiton. He told me that community hospitals were designed precisely to face down these sorts of challenges. Community hospitals are embedded in rural and coastal areas, which is particularly good for older and more vulnerable populations. Across the UK, there are around 500 community hospitals, and many of them are located in these sorts of places, outside of cities and where access to centralised care is far more difficult.
This is not the stuff of romance. These are not leftover legacies from a bygone era, and they are not historical; they are well placed assets for this era. They are adaptable, thanks to their autonomy, and they are capable of delivering wide-ranging, complex medical services. Our east Devon hospitals perform X-rays, surgeries and diagnostics. Despite losing their in-patient beds 10 years ago, they remain vital hubs of care for the local community.
We have seen proposals to close wings and services, and even to demolish facilities, as was the case in Seaton, where the local community understood what was at stake. It was impressive to hear about the petition that my hon. Friend the Member for South Cotswolds put together, which so many people signed in support of her community hospital. In Seaton, more than 9,000 people signed a petition to retain the community hospital there, and we had a public meeting in Colyford where people queued out the door to show their support.
These are cherished institutions, built on decades of trust and born from community investment. The chief medical officer, Professor Sir Chris Whitty, agreed when he spoke at the Community Hospitals Association’s annual conference last month. He echoed the words from his 2023 annual report, “Health in an Ageing Society”, which is well worth going back to, and said that ageing and the resulting increased frailty were key issues for the future of UK healthcare. He argued that community hospitals are in just the right places to be on the frontline and tackle this issue for generations to come in our rural and coastal communities, and described community hospitals as
“an essential part of provision for both inpatient and outpatient care for many citizens in England and the wider UK.”
That clashes with the Government’s insistence that centralisation and the creation of large neighbourhood health centres will deliver progress and better outcomes. Neighbourhood health hubs are being exposed as a contradiction in terms. They misunderstand both geography and demography: geography, because they do not fit rural and coastal areas and suck resources into the nearby conurbations, and demography because, if the challenge facing our health service is an ageing population, solutions must be about proximity, accessibility and the continuity of care.
The choice is plain for all to see: do we continue down this path of centralisation—closing, cutting and consolidating—or do we build on what we already have and cherish? When Seaton hospital was built in the 1980s, people were told that they should be a brick and buy a brick. We need to build on that legacy. Community hospitals should not be sidelined; they should be strengthened. They should be the backbone of genuine neighbourhood healthcare, not displaced by some remote health hub that, in an Orwellian turn of phrase, is moved further away and deemed to be a “neighbourhood health hub”. If the Government are serious about delivering care closer to home, supporting our ageing population and relieving pressure on our hospitals, they must invest in, not abandon, our community hospitals.
Rachel Gilmour (Tiverton and Minehead) (LD)
I thank my hon. Friend the Member for South Cotswolds (Dr Savage) for giving us all the opportunity to shine a spotlight on the challenges facing community hospitals, particularly in rural areas. Neighbourhood health and care in the community are the thrust of this Government’s health strategy. That is admirable and right, but good intentions alone are not a health strategy, and intentions mean very little if the infrastructure to deliver them does not exist. In constituencies like Tiverton and Minehead, it increasingly does not.
Let us take, for example, the removal of the CT scanner from Minehead community hospital. I have been stopped in the street more times than I can count by constituents expressing how big a blow that has been. The whole point of a scanner in Minehead was proximity—for it to be accessible to people across west Somerset who face long journeys to reach secondary care. Its removal is therefore curious, and a direct contradiction of the Government’s stated commitment to bring care closer to people. The strategy says one thing and the decisions say another.
It is not hard to understand why we are where we are. West Somerset is, in effect, a cul-de-sac, with limited transport, limited infrastructure and a long schlep to Musgrove Park hospital in Taunton for most things approaching secondary services. That has consequences beyond access; we are not an easy posting for healthcare workers either, precisely because of the geographic reality. There are no meaningful incentives attracting people to train and practise there, and there is no laser focus on local recruitment efforts, which I believe is our best bet. We live in a beautiful part of the world—it is true—but why would a newly qualified clinician choose a remote, poorly connected posting when better resourced options exist elsewhere? The south-west, as my colleagues know, is haemorrhaging healthcare capacity, and my constituency feels the effects acutely. Frankly, we are not being resourced as though those difficulties matter at all.
Every missed appointment is not just a missed check-up; it is a missed diagnosis. When people cannot reach care, conditions worsen. Some will inevitably end up in A&E, placing further pressure on an already stretched urgent care system, in a region with one of the country’s least accessible healthcare networks. We end up paying more for failure, and the approach has not acknowledged that an ounce of prevention is worth a pound of cure. When we talk of community care, it must reflect the needs of the community it serves. Rural areas tend to be older in demographic make-up, and healthcare provision is sparse. That cannot be treated as a marginal factor; it is the central planning reality. The rural premium in healthcare need is real, documented and consistently under-weighted in funding decisions.
My party has always been a proud champion of rural areas. We recognise the postcode lottery of care provision and the health inequalities it perpetuates. It is why we have called for the establishment of the strategic small surgeries fund, specifically designed to prop up buckling services in remote parts of the country and ensure that where someone lives does not determine the quality of care they receive.
Anna Sabine (Frome and East Somerset) (LD)
I thank my hon. Friend the Member for South Cotswolds (Dr Savage) for securing this debate. I will talk largely about Frome community hospital, but a lot of what she has said about test and learn and trial closures applies to Frome as well. I will also talk about the issues that occur when communities are served by organisations in different health authority boundaries and the impact of a lack of communications there.
Community hospitals, as we have heard, are the backbone of local healthcare. They keep people closer to home, ease pressure on our general hospitals and allow families to support loved ones through recovery without the burden of long journeys. That is especially so in more rural areas like my constituency, where travel times can be long and public transport is limited. For many of my constituents, Frome community hospital is an important community hub, where people access lifesaving care for themselves and their families. In fact, my husband’s life was saved by a team at Frome hospital earlier this year when he went into anaphylactic shock and was able to get to the urgent care department in Frome much quicker than he could have got to the general hospital in Bath. I put on record my thanks to the nurses who treated him that day.
Last summer, Somerset ICB cut the number of beds at Frome hospital as part of a test and learn consultation, the criteria for which seem very unclear to me. I know from visiting the Royal United hospital, our general hospital in Bath, that one of the biggest challenges facing it is getting patients discharged to appropriate community settings. My hon. Friend the Member for South Cotswolds talked about ambulances queueing; as I understand it, one of the main reasons that ambulances queue at our general hospital is because, at the other end of the hospital, patients cannot be discharged to community settings, yet we are cutting beds in those settings. I am therefore unconvinced that those cuts can be justified. I have continued to push for the restoration of the beds at Frome hospital, but I have also spoken to the ICB about the possibility of the hospital becoming one of the community hubs that the Government have rolled out, which I think could be a really good opportunity for semi-rural areas.
Across the country, ICBs are taking very different approaches to consulting MPs on the roll-out of these hubs. Some have engaged constructively and early, but in Somerset there was unfortunately no consultation with me at all. Instead, I was given a list of locations that had already been chosen, none of which were located in Frome and East Somerset. I do not believe that that is how engagement with elected representatives is supposed to work, which matters particularly for constituencies like mine.
Much of east Somerset sits across different local authority and health boundaries. Many of my constituents’ usual experience of hospital care is at a hospital that until recently was outside of our own ICB area altogether. When that hospital does not have proper joint working arrangements with our ICB, those patients find themselves effectively pushed to the back of the queue, simply because joined-up planning between the two systems is not happening.
That is no fault of the patients or of the staff trying to care for them. It is a structural failure that leaves whole communities at a disadvantage because they happen to sit on the wrong side of a line on a map. However, in the Somer valley in my constituency, things are working rather differently. There, the relationship between Bath and North East Somerset council and the ICB appears to be working well, with genuine collaboration shaping local services. It shows what can be achieved when councils, communities and ICBs sit down together as equal partners from the outset.
I ask the Minister to ensure that the Department reinforces to ICBs, including Somerset, that consultation with local MPs and councils on community hub proposals is not optional but essential if communities are to be properly heard. My constituents deserve a community hospital that reflects the needs of a growing town and a process that treats them as genuine partners in shaping it. At a time when the Government are closing down Healthwatch, I welcome the Minister’s thoughts on how we can prioritise patients’ voices in health provision.
Alison Griffiths (Bognor Regis and Littlehampton) (Con)
It is a pleasure to serve under your chairmanship, Sir Jeremy. I congratulate the hon. Member for South Cotswolds (Dr Savage) on securing this vital debate. I also commend the hon. Member for Cumbernauld and Kirkintilloch (Katrina Murray) for sharing her experiences in a community hospital setting, which were really interesting to hear.
When I think about community hospitals, I think about trust. I think about the residents in my constituency who lost Littlehampton hospital more than 20 years ago. They were told it would be rebuilt. They were told not to worry. Yet to this day, many local people, like my constituent Sandra, still talk about what was taken away from them. The site is still cordoned off, unused. When local NHS leaders ask my constituents to trust them today, they are speaking to people who have heard those reassurances before, only to see valued community hospitals taken away from them.
That brings me to Zachary Merton hospital in Rustington. For many of my constituents across Bognor Regis and Littlehampton and our villages, Zachary Merton is not simply a building: it is somewhere they received treatment, welcomed children into the world and visited loved ones receiving palliative care. It is somewhere that provided those services close to home when they were needed most.
The decision to permanently close in-patient services and remove beds at this much loved community hospital has caused enormous concern. Residents packed a public meeting that I organised last month. Hundreds more have signed petitions, written to me and contacted my office. They are not asking for special treatment; they are asking for a voice. West Sussex county council’s health and adult social care scrutiny committee has already determined that closing Zachary Merton was a “significant variation” in service provision. That is vital because Parliament has established a statutory process for a reason. Residents trust those of us who sit in this place to ensure that those processes are followed.
We are not talking about moving a cupboard from one room to another; we are talking about the permanent loss of healthcare services. What on earth is the point of Parliament setting rules around consultation if local NHS leaders can simply decide that they do not apply? What is the point of local authority scrutiny committees examining those decisions if their conclusions can be brushed aside? What is the point of telling residents that they have a right to be heard if services can be removed from them before they are ever given that opportunity? That is what my constituents simply cannot understand. Frankly, neither can I.
I have formally asked the Secretary of State to call in the decision to close Zachary Merton hospital. I raised it again at Health questions only last week, and I will continue pressing until my constituents get the answers, consultation and respect they deserve. My constituents have heard this story before. They were told that Littlehampton hospital would close temporarily, but temporary became permanent, and 25 years later people still talk about the services that were lost. So when residents are told not to worry about Zachary Merton, can Ministers really be surprised that they are sceptical?
Community hospitals should be part of the future NHS, and they should help keep care close to home. They support rehabilitation and reduce pressure on acute hospitals. Most importantly, they give people confidence that local healthcare services will still be there when they need them. They must not become easier places from which to remove services. My constituents have already seen one community hospital disappear. Their trust must not be taken for granted again, either by local NHS decision makers or by this Government. They are determined not to see history repeat itself, and so am I.
Sir Jeremy Wright (in the Chair)
I am grateful to all Back-Bench contributors to the debate. We now move to the Front-Bench speeches, beginning with the Liberal Democrat spokesperson.
Helen Maguire (Epsom and Ewell) (LD)
It is a pleasure to serve under your chairship, Sir Jeremy. I thank my hon. Friend the Member for South Cotswolds (Dr Savage) for securing this important debate on community hospitals.
Community hospitals have been a core part of our healthcare system for more than 150 years. They are rooted in a strong tradition of providing care and a range of clinical services to support their local populations. There are over 500 community hospitals throughout the UK, and they vary considerably in the services they deliver as their fundamental focus is to adapt to ensure that they serve the needs of their local area.
Community hospitals serve as multidisciplinary sites for immediate care across both health and social care, bridging the gap between primary and secondary care services. This adaptation and integration of services in particular makes community hospitals so valuable in bringing vital health services into the community and truly serving the specific needs of the community they represent, whether they have a significant older population or are situated in an area of high deprivation.
The value of community hospitals cannot be overstated, as we have heard today. They are ideally placed to support effective prevention and the management of long-term conditions. They have the ability to be flexible, change and adapt with their population. By reimagining what we can do with community hospitals, based around the needs of an ageing population and rising complexity, we can make a significant difference to patients.
I have seen the benefits of community hospitals at first hand in my constituency of Epsom and Ewell. Leatherhead community hospital, which is highly valued by the local community, demonstrates the importance of maintaining strong accessibility, continuity of care and patient flows across community health infrastructure. Leatherhead community hospital provides more than 33 specific consultation and out-patient services, including a stoma clinic, physiotherapy rehab, and speech and language therapy, for the diverse population it serves. We must support community hospitals to ensure they can continue to provide such services.
Community hospitals also play a core role in reducing the pressures on larger acute hospitals. Their role will only continue to grow in importance as demand on NHS services continues to rise. Community hospitals support earlier discharge and step-down care to patients who are medically fit to leave acute hospitals, but still need further support to regain their independence prior to being fully discharged.
The Health Foundation estimates that, in England, about 125,000 people enter intermediate care services each month. The cost of providing this care continues to rise, increasing the pressure on these underfunded services. The average local authority spend on a single episode of care in 2022-23 was 27% higher in real terms than in 2019-20.
Community hospitals provide intermediate care beds, so they free up hospital beds, reducing the high demand on A&E departments. That intermediate support is particularly important in rural and coastal areas where, as we have heard today, access to acute hospitals is often limited.
In 2021, the chief medical officer’s annual report on health in coastal communities provided official recognition of the range of healthcare needs across different rural communities. Those living furthest from healthcare services in rural and coastal areas are most at risk of experiencing inequalities, particularly when there are poor and unaffordable transport connections—not to mention the patients who, due to old age or disability, are unable to drive long distances to access essential healthcare.
It takes twice as long for people in rural areas to reach their nearest GP by public transport as it takes people in urban areas; it also takes about a third longer for those who drive, according to the Rural Services Network. Those findings were affirmed by Lord Darzi’s report on the NHS, which found that across much of rural England—including nearly the whole south-west as well as much of the east of the country—there are fewer than 46 dentists per 100,000 people.
A Liberal Democrat freedom of information request found that waiting times for life-threatening calls are 45% longer in rural areas than in urban areas. Community hospitals, like rural GPs, pharmacies and other healthcare services, have frequently been an afterthought. That situation is unacceptable: we must take action to change it, particularly given that the Government say they want to move services into the community. Access to vital community healthcare cannot be dictated by an unjust postcode lottery.
Community hospitals receive less funding and less attention than larger acute hospitals, resulting in workforce shortages and rundown estates. There has also been an escalating process of service reductions at many community hospitals. Often, these changes are introduced under the guise of being trials, but they almost always become permanent. Pragmatic changes to services because of shifting demand are sometimes necessary, but too often changes are made without proper consultation or a proper explanation to the communities affected.
The Liberal Democrats are clear that we wholeheartedly support the ambition to shift more care into the community, but we must get community hospitals to a place where they can complement and play a vital role alongside neighbourhood health centres. Rural communities know all too well the pressure that the healthcare system in their areas is under, and the important role that community hospitals play. Consequently, we have been calling for a rescue plan for rural health services, in which rural community hospitals would be an essential pillar.
As part of the plan, we have called for a strategic small surgeries fund to sustain services in rural and remote areas, as well as a strategy to close the gap in access to primary healthcare between urban and rural areas. We are also calling for an emergency fund to reverse closures of community ambulance stations and to cancel planned closures of services where they are needed, which would particularly benefit rural communities. We would put an end to the postcode lottery of care provision, which disproportionately impacts rural communities, through a national care agency. We need a new national drive for first responders in rural communities. We need to protect air ambulances, integrating them into the emergency care system, and to ensure that they receive adequate NHS funding in addition to charitable donations.
Will the Minister heed these calls and take the necessary steps to ensure that community hospitals that serve rural communities receive the support they deserve? The bottom line is that community hospitals are a service to us all. They are vital in the provision of care closer to home; they bring multidisciplinary services closer to the community; they bridge the gap between hospitals and GPs; they relieve strain on hospital beds and A&E departments; they support faster discharge and rehabilitation, and so help patients to regain their independence; and they improve healthcare access for elderly and vulnerable patients by reducing travel burdens for both themselves and their families.
I urge the Minister to reflect on the important calls that I, my hon. Friends and others across the House have made in this debate, to ensure that we are all doing all we can to better support community hospitals.
Dr Luke Evans (Hinckley and Bosworth) (Con)
It is a pleasure to serve under your chairmanship, Sir Jeremy. I congratulate the hon. Member for South Cotswolds (Dr Savage) on securing the debate.
It is fantastic to have the chance to champion community hospitals and what they stand for and provide. I put on record my thanks to the Hinckley and Bosworth Community Hospital, which does fantastic work in my area, in Hinckley. Also, only last week, I was lucky enough to go to the one-year anniversary celebration for my community diagnostics centre—a £24 million investment, set up by the last Government, that we have now carried through. To date, it has served more than 59,000 patients, and it is expanding the delivery of services that it can provide, meaning that services that are provided within the community and people do not have to travel to the likes of Nuneaton or into Leicester. That is exactly what the leftward shift is all about: bringing those services to the community.
It may come as no surprise that I have a personal connection to community hospitals—you might expect me to talk about my job, Sir Jeremy, but it actually began much before that. My father was a GP down in Dorset; on Christmas days, before we were allowed to open our presents, we used to visit the community hospital and do the ward round with all the patients. As a child I really looked forward to that—first, because I got to meet Father Christmas, but secondly, because of the family feel of that community hospital had. That is the essence of what these places provide: that ability to be within our communities, to give the support and the family feel that we want to keep hold of and treasure because it is so important. Especially when dealing with healthcare, we often forget about wellbeing, and that is what these community hubs can provide.
Looking at the Government’s direction of travel, it very much sets out how neighbourhood health centres should look, but it is not quite so clear about how that dovetails with community hospitals. How do integrated health hubs fit in with community hospitals? It is not clear in the 10-year plan, and it is certainly not clear in the documentation coming out. Given that the Government are expecting ICBs to commission those hubs, and given some of the stories that we have heard—for example from my hon. Friend the Member for Bognor Regis and Littlehampton (Alison Griffiths), who is championing and fighting for the services in her area—the worry is that the Government are not explicit on what ICBs should be doing on community hospitals. We have this intention and general belief, but the actual direction of how this will work is clouded.
I therefore pose a question to the Government: are they considering a national strategy for community hospitals—or even a definition? That is one of the biggest problems when we look up community hospitals. What is the definition of a community hospital? Are community diagnostic centres included in that, or not? What about intermediate care? What about step-down care? What about clinics that provide endoscopy? I must admit that, when I look at community hospitals, I am never quite sure what the definition is; looking into the detail, I struggle to find any definition that the Government have come up with.
Those are key questions about the leftward shift. I think we all agree that that would be welcome, but it is about the delivery plan. Of course, the 10-year plan has no delivery chapter, which again leads us back to the questions for the Minister today. I appreciate that this is not her portfolio, but these questions will keep coming time and again: how do we actually deliver, and what does this look like in the guise of neighbourhood health centres?
On that point, when it comes to delivery, I would like to pose something to the Minister: it was reported in the news over the weekend that NHS capital spend could be under threat to fund the defence investment plan. I hope she will be able to stand at this Dispatch Box and say that that is categorically not true—but that is going to be important.
That leads me on to another question that I would like to pose to the Minister. The response to a written question about the abolition of NHS England and its impact on services stated:
“The abolition of NHS England is causing no disruption to the development of new services.”
Will the Minister state that from the Dispatch Box? Certainly, from what we are hearing on the ground, the ICB changes—losing 50% through redundancies—are having a significant impact on the way in which services are planned and delivered. I am therefore keen to understand the rationale behind that statement.
To finish where I started, community hospitals really are the healthcare that feels human. They are local, they are close to home and they are something that we across this House should aspire to. That family approach is where we all want to be; it is how we get there that is the question for the Government.
The Parliamentary Under-Secretary of State for Health and Social Care (Mrs Sharon Hodgson)
It is a pleasure to serve under your chairmanship this morning, Sir Jeremy. I congratulate the hon. Member for South Cotswolds (Dr Savage) on securing this important debate. I thank all hon. Members who have taken part: we have heard from 10 Back-Bench Members on the issue this morning. We have heard powerful accounts of the value of community hospitals and community health services more widely, and the difference that these services can make to patients and their families. That can be particularly true for rural communities, as we have heard.
I also want to acknowledge my hon. Friend the Member for Cumbernauld and Kirkintilloch (Katrina Murray). I think she said that she had worked for 22 years in community hospitals, and she spoke powerfully about being at work in her community hospital 10 years ago today when the news broke about our good friend Jo Cox. I join my hon. Friend in offering deepest condolences to Jo’s sister, my hon. Friend the Member for Spen Valley (Kim Leadbeater), to the wider family and to Brendan and their children. We can all recall where we were on that awful day when we heard the horrifying news.
This debate goes to the heart of a wider question: how we deliver more care closer to home, and the role of community hospitals in that future. That is why the Government’s ambition to shift more care out of hospitals and into communities matters so much. As we look to the future of the NHS, we want a stronger neighbourhood health service, better integration between health and social care and easier access to support, closer to where people live. To do this, we will deliver 250 neighbourhood health centres, with 120 of them opening by 2030. That will make it easier for people to access care closer to where they live, up and down the country. These centres will provide easier, more convenient access to a wide range of health and care services on people’s doorstep. We want to see a neighbourhood health centre in every community.
Dr Luke Evans
The Government have set out a great ambition, but the Minister is talking about neighbourhood health centres and we are talking about community hospitals. Where do they dovetail and how do they fit? What definition is she using to put this together?
Mrs Hodgson
Hopefully, I will answer those very points as I make progress in my speech.
We are already taking forward the neighbourhood health centres. The first wave of 27 neighbourhood health centres has been announced across England, backed by £50 million. Community health services are a vital part of our ambition on neighbourhood health and in moving care into communities. As we have heard, community health services deliver a wide range of services, from adult musculoskeletal services to community paediatric services and more.
Recognising the vital role that community health services play in neighbourhood health, and the wider health and care system, we have set clear ambitions through our medium-term planning framework. For the first time, we have set a target for systems to reduce long waits for community health services. By 2028-29, at least 80% of activity delivered by community health services should take place within 18 weeks, bringing those services in line with targets for elective care.
In 2025, we published “Standardising Community Health Services”, which describes the core components of NHS ICB-funded community health services for children, young people and adults. ICBs will need to adapt based on local needs and priorities. Further guidance was published in February 2026 with additional detail on the community health services that ICBs should commission. This is hugely important: we know that there is variation between the services available across the country and that there are long waits. That is why the Government are taking action to reduce unwarranted variation and cut those waits, so people can access high-quality community services wherever they live.
Dr Evans
I am sorry to hammer this home, but every single point that the Minister has made has been about community services. She is spot on, but the question is where community hospitals fit in. Are they the correct vehicle that the Government want to use to help deliver some of those services, or are the Government moving away from the community hospital model and into further hubs? Both would be reasonable approaches and could be defended or pulled apart. The question is what the Government are choosing, because it is not clear from the Minister’s answers which it is.
Mrs Hodgson
As the hon. Gentleman has acknowledged, this is not actually my brief. As much as I can try to answer his questions, I think I might have to commit that the relevant Minister will write to him on that specific point.
For patients who still require hospital care, we are delivering millions of additional appointments and reducing waiting lists across elective care. The Government’s elective reform plan sets out commitments to reduce disparities across elective care access and waiting times, including by improving practical support for patients through better transport options. Virtual care models will offer patients in remote areas better access and more convenience by providing services that are more responsive to their needs. Expanding digital access is also crucial to improving the experience and health outcomes for rural communities. Digital services can improve access for many patients, but they must complement, not replace, high-quality, local face-to-face care.
Helen Maguire
I want to expand on that point because, as we have heard from Members, there are many elderly people in rural communities who may or may not have access to digital services. Will the Minister provide some assurances to me and my hon. Friends that elderly people will not be excluded because they cannot access services digitally?
Mrs Hodgson
Absolutely. Digital services will complement and not replace the face-to-face care, so we are developing the NHS app and expanding online consultations for those for whom it will be helpful. There will be digital triage and remote monitoring, allowing patients in rural areas to access more NHS services, but I take on board the hon. Lady’s point about ensuring that we do not exclude people.
It is important to recognise that decisions about individual services are made locally by NHS organisations, which are responsible for assessing the needs of their populations and planning services accordingly. As strategic commissioners, ICBs work closely with health and wellbeing boards, local authorities and other partners to identify the most impactful outcomes for their population. ICBs will choose the right delivery model for their local area to deliver these outcomes, enabling capable providers to lead local services designed to meet the needs of their patients. That means looking carefully at local need, rurality, the workforce, clinical evidence and the long-term sustainability of services, rather than applying a one-size-fits-all model. Those decisions must be accompanied by appropriate engagement with patients, staff and local communities.
The hon. Member for South Cotswolds highlighted an important challenge. Whether national ambitions are matched by what people say and experience on the ground is a question we must take seriously. If we are to successfully shift care closer to home, community-based services must be equipped to meet growing demand. In Cirencester, as we have heard, local provision remains very important. Existing services continue at the hon. Member’s local hospital, including in-patient and out-patient care, therapies and the minor injury and illness unit. Local NHS partners are also testing how services can better meet local need, including a specialist 15-bed frailty complex care unit alongside a 28-bed intermediate care ward. These changes are being tested locally and evaluated carefully; I am told that no permanent decisions have been made.
I have made a careful note of the hon. Member’s five questions, as I am sure my officials have. I will ensure that the relevant Minister writes to her with further details on her specific questions; I will also request that they meet her, as her fifth request was about when that could be arranged. On staffing in particular, I can update her: the NHS workforce plan is to be published imminently.
The pressures that hon. Members have described are familiar across much of the country. We have an ageing population, an increasing prevalence of long-term conditions, growing demand for rehabilitation and recovery services and, in some areas, significant population growth driven by new housing developments. These pressures make local community-based services more important, not less. Meeting those challenges will require strong, joined-up community services, with community nursing, therapies, rehabilitation, urgent community response, virtual wards, and primary care and social care working together across the needs of patients.
Ultimately, the future of community hospitals should not be considered in isolation. They form part of a broader community heath infrastructure that includes neighbourhood teams, community providers, primary care, mental health services, social care and the voluntary sector. The question is not simply how many community hospitals we have, but how we use our community assets and services to provide high-quality care closer to home.
I am very grateful to the hon. Member for South Cotswolds for bringing this important issue before the House. The debate has highlighted both the enduring value of community hospitals and the important role that they can play in supporting local populations, especially rural ones. As we continue our work to strengthen neighbourhood health services and shift care closer to home, the experiences and concerns raised by hon. Members today will make an important contribution to that discussion. I thank all hon. Members for their participation in this debate.
Dr Savage
I thank all Members who have contributed to this debate with wonderful and sometimes moving stories about the role that community hospitals have played in the lives of their constituents and who have shared their concerns. I also thank the Minister—I appreciate that this is not her brief—for stepping up today.
I echo the words of the hon. Member for Cumbernauld and Kirkintilloch (Katrina Murray) that community hospitals are “much more than buildings”. There is the expertise of the staff working there, and they are an important hub for healthcare in a community. While I welcome the announcement of 250 neighbourhood health centres, I would like the message to go back to the relevant Minister that we already have community hospitals that are well known and well loved in our constituencies, so I very much hope they will form an integral part of the NHS’s plans for the future. I thank the Minister for passing on my requests to the relevant Minister; I look forward to hearing more about them in due course.
I will end with a reminder to all of us that we are talking about human beings at a very vulnerable moment in their life. I was especially moved to hear about the urgency of the husband of my hon. Friend the Member for Frome and East Somerset (Anna Sabine) suffering anaphylactic shock. Local medicine delivery is not just sentimental or about harking back to a bygone era. It is so important to recovery that patients do not feel scared and do not feel far from home, their community, or their family, friends and neighbours, but feel that they are not so far from home and are still in the bosom of their community. Anything we can do to minimise their stress and maximise their sense of connection and comfort can only ever help the speed and quality of their recovery.
I thank all colleagues for their contributions today, and I thank you, Sir Jeremy.
Question put and agreed to.
Resolved,
That this House has considered community hospitals.
Road Maintenance Funding: Nottinghamshire
(1 day, 4 hours ago)
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Steve Yemm (Mansfield) (Lab)
I beg to move,
That this House has considered funding for road maintenance in Nottinghamshire.
It is a pleasure to serve under your chairmanship, Sir Jeremy. The issue of the condition of roads across my constituency is raised with me more than almost any other. Since becoming an MP, I have been contacted by hundreds of residents about potholes, crumbling surfaces and roads that have been left to deteriorate for far too long. Time and again the message from my constituents is the same: our roads are simply not good enough.
In Mansfield, potholes are no longer just a nuisance; they are becoming local landmarks. Some residents tell me that they no longer bother trying to avoid them. They simply recognise them, almost like old friends on the school run or the commute. That may raise a smile, but behind that humour is a much more serious reality, because potholes are not just harmless inconveniences—they are hazards that damage vehicles. They also increase costs for families, sometimes by hundreds and even thousands of pounds. In some cases, they put human safety at risk—and not just of injury but sometimes death, and there are examples of that in my constituency.
I have also heard from constituents about significant damage to tyres, which leaves people stranded late at night. In an email typical of the many that I have received, one resident described being left alone in Mansfield in the early hours after a punctured tyre, waiting until 5 am for recovery and assistance, and feeling vulnerable and unsafe. Another constituent wrote to me about her local estate, where a single pothole on her street is almost impossible to avoid. It has caused serious vehicle damage. She explained that she no longer reports issues to Nottinghamshire county council, the highway authority, because she has no confidence that it will lead to meaningful change. Instead, she sees the same pattern repeated: small temporary patches of tarmac that break down again after a very short period, or potholes simply marked with spray paint and left for weeks.
The sense of resignation is perhaps the most frustrating part of all, and is something that I have heard many times. Roads are patched rather than properly repaired, problems are identified but not resolved, and residents feel that they are paying more and more in council tax only to receive less in return. Let us be clear that this is not just about inconvenience. Roads are essential infrastructure that people rely on to take their children to school, access healthcare and get to work. When they are in such a condition, there is a direct impact on daily life and our local economy. It is not acceptable that residents should be left facing repair bills, avoidable damage and safety risks because our roads have not been maintained properly.
How did we get into this situation? The basic issue is quite simple: roads do not last indefinitely without planned maintenance. They require resurfacing at regular intervals, yet that cycle has been allowed to slip far beyond what is sustainable. The Asphalt Industry Alliance reports that roads in England are now resurfaced on average every 39 years for principal roads, 60 years for B and C roads, and sometimes over 100 years for unclassified roads—far beyond the recommended 10 to 20 years. The gap is not just a technical detail; it is a structural failure. It means roads are being allowed to deteriorate until they break down completely, leading to expensive and reactive repairs. Once that happens, the cost spiral is immediate. Patching potholes becomes more expensive than prevention, and each intervention lasts less time. We are, therefore, spending more for worse outcomes.
Across the country, including in Nottinghamshire, that has created a repeating cycle of deterioration followed by temporary patching, further breakdown and repeat intervention: a managed decline that never resolves the underlying issues. Nationally, that has built up a substantial backlog, with independent estimates placing the cost of restoring local roads to proper condition at many billions of pounds, and large parts of the network close to the end of their structural life. In plain terms, we are dealing with not just potholes but the accumulated consequence of years of deferred maintenance and under-investment—not the result of a single bad winter or short-term disruption.
Under the Conservative Government from 2010, central Government funding for local authorities was significantly reduced, particularly during the Cameron and Osborne years of 2010 to 2015. We all saw the impact of that on our local councils across various services. Capital expenditure on local road maintenance in Nottinghamshire fell from £16.6 million in 2011 to just £12 million by the time Boris Johnson became Prime Minister in 2019.
Revenue expenditure on local highway maintenance, funded through council tax receipts and business rates, remained below 2010 levels in every subsequent year, and in some years reduced by more than 50%. In the final five years of Conservative Government, some additional and welcome funding was provided but, after taking inflation into account, the real-terms cumulative loss in funding in Nottinghamshire alone over those 14 years amounted to tens of millions. Furthermore, because highways maintenance is not ringfenced, rising pressures from other areas forced local authorities to divert their limited resources to meet their obligations elsewhere, further weakening any capacity for preventive maintenance.
A double pressure emerged: increasing demand on council budgets and a road network requiring more investment just as preventive maintenance was squeezed. The result, after years of Conservative under-investment, is a road network in Nottinghamshire that is increasingly worn out, more expensive to repair and reliant on temporary fixes instead of lasting solutions.
That responsibility does not stop at the national level. My residents and others across Nottinghamshire will remember when our county council was led by the Conservatives under my predecessor, Ben Bradley, who was simultaneously leader of Nottinghamshire county council and Conservative MP for Mansfield. As council leader, he failed to reverse the deterioration of local roads or secure the additional funding needed, despite being in a prime position to do so.
It is against that backdrop that the Labour Government have had to decide what happens next: whether we continue to manage decline or we finally move to a system where repair and maintenance of roads are done properly. Therefore, I am pleased that the Government have chosen the path of investment in our roads in Nottinghamshire, instead of the path of further deterioration and decline.
I welcome the fact that the Labour Government recently set out a record £7.3 billion national multi-year settlement for local road maintenance across the country over the next four years. That is not just a headline figure; it is long-term and guaranteed funding that gives councils such as mine in Nottinghamshire the ability to plan properly, move away from crisis management and invest in proper preventive maintenance. That is on top of the Government’s investment of £1.6 billion for this financial year, which is a £500 million increase compared with the last financial year. This is real year-on-year growth, rather than managed decline.
Under the previous system, funding for 2024-25 in Nottinghamshire stood at just £18.6 million. I repeat that figure for emphasis—£18.6 million. However, under this Labour Government, who have worked with the East Midlands combined county authority and Mayor Claire Ward, that figure has risen to £44.7 million in 2025-26, including £15.2 million of additional mayoral investment. It will rise again to £46.9 million in 2026-27, including £17.4 million from the mayor. That is tens of millions of pounds of additional funding in Nottinghamshire to help fix our roads. The contrast with what came before could not be clearer: investment under Labour, and decline under the Conservatives.
I therefore place on record my thanks to Mayor Claire Ward and the Minister for the leadership they have shown. Partnership between central Government and regional leadership is exactly how to fix long-standing problems properly, because for years our councils were asked to do more for less. As mentioned earlier, preventive maintenance was completely squeezed, long-term planning was undermined and, as a 2019 Transport Committee report made clear, the system was “fragmented”, “reactive” and failed to deliver the certainty needed to maintain roads properly. Recommendations that were made clearly at the time were not acted on by the previous Government.
Labour investment means that Nottinghamshire county council has both the resources and the responsibility to deliver, and what matters now to my constituents in Mansfield and to people across Nottinghamshire is delivery. I accept that there is a major backlog of repairs and that not every road will be fixed overnight. However, with these record funding settlements, Nottinghamshire county council cannot claim that it is not able to get this done due to a lack of funds. The money is coming in, I am glad to say; the question now is whether it can be used effectively at local level.
We are investing more than ever before, we are changing a system that has failed for too long, and we are giving councils the tools they need to succeed. However, I also make it clear that this funding must translate into visible improvements on the ground, because residents in Mansfield do not measure success in budget lines or policy papers. They measure it by whether they can drive to work without damaging their car, whether parents can safely take their children to school and whether their roads are finally fit for purpose. That is the standard that I believe the Labour Government are now setting, and I will continue to hold the council to account for making sure it is met.
The Parliamentary Under-Secretary of State for Transport (Simon Lightwood)
It is a pleasure to serve under your chairmanship, Sir Jeremy.
I am grateful to my hon. Friend the Member for Mansfield (Steve Yemm) for securing this important debate. He spoke with real passion about the state of roads in Nottinghamshire, and rightly so, because this is not an abstract issue. It is about the roads that people rely on every day to get to work, to take their children to school, to support local businesses and, above all, to travel safely. For too long for people across Nottinghamshire, those everyday journeys have been made harder by roads that simply have not been good enough or safe enough.
My hon. Friend highlighted that this has not happened by accident. It is the product of years—indeed, over a decade—of under-investment in our local road network: potholes left unrepaired, surfaces deteriorating, preventive maintenance deferred again and again. We are now dealing with the consequences of those decisions. This Government are determined to turn that around. That is why we are providing a record £7.3 billion for highway maintenance over the next four years, giving councils the long-term certainty that they need to plan properly to resurface our roads and tackle the pothole plague once and for all.
Crucially, we are also backing the east midlands by providing £2 billion in transport for city regions funding through to 2031-32. Delivered through the East Midlands combined county authority under the leadership of Mayor Claire Ward, this substantial investment, devolved to the region, will enable transformational investment in local transport infrastructure, including roads, and empower local leaders to make decisions that reflect real local priorities, because we know that better decisions are made closer to the communities they serve. However, funding alone is not enough. It must be matched by delivery. That is why we have introduced a strengthened system of accountability, built on transparency, clear performance ratings and incentives for local highway authorities.
First, transparency. Councils now have to publish clear annual reports showing the condition of their roads, what they are doing to maintain them and how public money is being spent. That includes not just how many potholes they have fixed, but how they fixed them, whether repairs are built to last and whether they are investing in prevention, such as maintaining drainage and using surface treatments to stop potholes forming in the first place. My hon. Friend mentioned his constituent who had simply given up reporting a pothole on her street. It may be useful to point out that councils will now have to publish how residents can report road defects, how that information is used to prioritise repairs and whether people are kept informed once a problem has been raised. Transparency really matters. It gives residents a clear view of how their roads are managed, makes councils accountable for their choices and helps to ensure that funding is used to deliver long-term improvements, not just short-term fixes.
Secondly, ratings bring that information together into a clear, accessible judgment of performance so that residents can easily see how well their council is maintaining the roads they rely on. In the most recent assessment, Nottinghamshire was rated green for highways maintenance spend, but amber for the condition of its roads and adherence to best practice, resulting in an overall amber rating. That tells us two things: funding is reaching the right places because the council is spending the money allocated to it, but there is still work to do on improving road conditions and embedding best practice.
Thirdly, incentives. A share of the funding is now linked to clear performance requirements that every authority is expected to meet. That includes spending all the Government’s highways funding on maintenance rather than devoting it elsewhere. It also requires authorities to maintain up-to-date asset management plans, which ensure that maintenance decisions are based on evidence and long-term outcomes rather than simply react to potholes once they appear.
Alongside that, we are supporting authorities to improve through highways innovation programmes such as Live Labs 2, targeted support for red-rated authorities and updating the code of practice for well-maintained highways. We are helping councils to adopt new approaches, build capacity and deliver better outcomes for residents. Earlier this year, we published the first national road safety strategy in over a decade, setting out how we will cut road deaths and serious injuries on Britain’s roads by 65% by 2035.
Let me be clear that this Government are stepping up. We are providing the funding, we are putting in place the performance framework, and we are backing regions such as the east midlands to succeed. On a national scale, we are already beginning to see the impact of that approach. In 2025, after nearly a decade-long decline, the percentage of roads receiving maintenance treatment went up again, but it is for local highway authorities, in this case Nottinghamshire county council, to get on and deliver. That means more than just filling potholes when they appear; it means investing in long-term preventive maintenance, making smarter use of materials and technology, and building a road network that is safer, smoother and more reliable for the future. Recent figures show that, while overall road fatalities have declined, far too many people are still killed or seriously injured on our roads each year. Every pothole that is left unrepaired and every surface that is allowed to deteriorate is a risk that we must take seriously.
I finish by returning to the central point made by my hon. Friend the Member for Mansfield: the people of Nottinghamshire deserve roads that are properly maintained. This Government are delivering the investment needed to make that happen, and we are putting in place clear expectations and accountability to ensure results. It is now for Nottinghamshire county council to turn that investment into results on the ground.
I thank my hon. Friend for securing this debate, and I look forward to continuing to work across the House, and with Mayor Claire Ward and local partners, to ensure that the people of Nottinghamshire see the improvements that they have every right to expect.
Question put and agreed to.
Lifelong Learning: “University of the Air” White Paper
(1 day, 4 hours ago)
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Patrick Hurley (Southport) (Lab)
I beg to move,
That this House has considered the impact of the University of the Air White Paper on lifelong learning opportunities.
It is a pleasure to serve under your chairmanship, Sir Desmond. I am grateful for the opportunity to lead this debate marking the 60th anniversary of the White Paper that led to the founding of the Open University, originally called the “University of the Air”. It is worth pausing on that phrase for a moment, because 60 years later it still sounds faintly otherworldly, even with all our electronic gizmos and gadgets and the information whizzing around us constantly. A “University of the Air” meant higher education broadcast directly into people’s homes. It meant learning being made available not just to those who had always had privilege, not just to the young or the affluent, and not only to those who followed a conventional academic route, but, crucially, to ordinary working people fitting study around jobs, families and the realities of their lives.
Sixty years on, what once sounded ambitious, perhaps even eccentric to some, instead now looks visionary. That is because it was visionary. It did not begin as some sort of administrative reform dreamt up in Whitehall; first and foremost, it was a political project. Harold Wilson first floated the idea in 1963, after seeing the potential of television and broadcasting to widen access to education in ways that had not previously seemed possible. But the person who really drove the project forward was his Minister, Jennie Lee.
There are not many White Papers that leave behind institutions that still change lives six decades later, but this one did, because Jennie Lee understood something important: there has always been a mismatch in this country—potential is spread far more widely and far more equally than opportunity. In the mid-60s, the assumption was still that higher education belonged to a relatively narrow section of society.
Mr Gregory Campbell (East Londonderry) (DUP)
I congratulate the hon. Gentleman on securing the debate. On the narrow cohort of people who normally benefit from higher education, does he agree that lifelong learning is an essential component for young people from working-class communities in particular? Many of them do not take part in traditional higher education, and they can and should be targeted so that we benefit not just now but for generations to come.
Patrick Hurley
I agree entirely, and will make similar points later in my speech. The hon. Gentleman and I are very much on the same page.
Alex Easton (North Down) (Ind)
Will the hon. Gentleman join me in recognising the Open University’s role in pioneering modules, credits and credit transfers, which turned lifelong learning into a reality for so many adults in my constituency? Does he agree that the funding changes in 2010 badly hit part-time and mature learners, and that the promise of the White Paper still depends on the choices that Governments make on funding policies?
Patrick Hurley
Funding is a huge issue here. The modular basis for the Open University has been a real boon to people who find themselves unable, for whatever reason, to study in a traditional format, but funding is still a key concern.
Back in the ’60s, university was for young people. It was thought to be for young people, usually at least middle class, studying full time and following a fairly prescribed path. The thinking went that if someone missed their opportunity at 18 or 21, that was that—they had had their chance. But Jennie Lee and the Wilson Government challenged that assumption. They believed that education ought not to be reserved for those lucky enough to travel a conventional route through life, and that people should have second chances—and third chances if they need them, and fourth chances too. Crucially, she insisted that there should be no lowering of standards and no second-class offer for those who had missed out the first time round.
Perhaps the most radical thing of all was that the Open University would be genuinely open. The White Paper made it clear that people should be able to study irrespective of their previous educational qualifications. In other words, someone would not be shut out just because they had not done their A-levels.
On all those points, the Government at the time were absolutely right, because the Open University has become one of the great success stories of modern Britain. Today, it is the largest university in the country, with around 125,000 students. Nearly a quarter of all part-time higher education students in this country study at the OU. It reaches every constituency, including my own, Southport, where around 135 people are currently studying through it. This is not some sort of niche institution sitting at the margins of education policy but one of the central pillars of lifelong learning in this country.
Fleur Anderson (Putney) (Lab)
I am grateful to my hon. Friend for celebrating such a great Labour achievement, led by a great Labour woman, Baroness Jennie Lee. Will he join me in congratulating the Open University and underlining its importance for people like me? I was looking after four children and was able to do a master’s at the Open University, spread out over three years, with some cutting-edge modules that I still rely on now. The Open University opens up education for people from all backgrounds, offering home-based and flexible learning, including for those with family responsibilities.
Patrick Hurley
I am more than happy to commend Baroness Jennie Lee, and I am more than happy to celebrate the success of my hon. Friend and of the countless thousands of others who have studied around the real lives we all lead.
One reason why the Open University works is precisely because it understands something that many higher education institutions still struggle with: life is not linear. People do not all move neatly from school to university to career to retirement in a straight line. Our lives are messier than that. People leave school without confidence, drift into jobs and later discover different ambitions. They become parents, care for relatives, lose jobs, or their health changes. Sometimes, at 35, 45 or 55, they simply decide that they want to try something new. The original White Paper understood that. It explicitly talked about flexibility, recognising that some learners would move quickly and others slowly, depending on the realities of their lives. The Open University says something very simple to people in those circumstances: “It is not too late. It is never too late.”
I should declare an interest, because I would not be standing here in Westminster Hall this afternoon without the Open University. I did not come through the conventional route into higher education. I left school without much expectation that university was really for people like me. For most of my life, I worked in fairly ordinary, fairly low-paid jobs. For instance, I sold “Magic Tree” air-fresheners to petrol stations. I spent a decade working in a call centre for an insurance company. I spent a few soul-destroying months working for a debt collector, before I could take no more and quit to go back on the dole.
Like many people, I found that without qualifications there were doors that simply remained shut, no matter how hard I tried. The Open University changed all that for me, although not in some dramatic overnight fashion like we might see in a television drama. It was hard work. It meant studying in the evenings, at weekends, on the bus to and from work—and, to be honest, probably sometimes during work if the boss was not looking. I was doing assignments when other members of the family were watching television or going out and getting on with their lives. But it made something possible for me that would otherwise not have been possible: it gave me the ability to learn around my life.
From speaking to other OU students over the years, I know that my story is far from unusual. There are hundreds of thousands of us out there who have rebuilt confidence, changed career, retrained or simply proved something to ourselves, because somebody, somewhere, 60 years ago had the foresight to build an institution flexible enough to meet people where they already are.
Something about all this is deeply embedded in the labour movement. The Open University sits in a much longer tradition of working-class people organising to educate ourselves and improve our circumstances. Long before most people had access to university, we had mechanics’ institutes, miners’ libraries, mutual improvement societies, trade union reading rooms and university extension programmes. We had the Workers’ Educational Association. Working-class people have always valued education, hard work and making something of ourselves. The nonsense about a lack of aspiration that we sometimes hear from the assembled ranks of the privileged has never been true. The problem was never aspiration; the problem was access.
In many ways, the “University of the Air” was the modern expression of that Victorian-era working-class tradition, and the belief that education should not stop, even when life gets complicated. That approach matters now more than ever. We live in a country where people are likely to work for longer. They change careers more often. They need to retrain repeatedly. We are also living through profound economic change, with automation, artificial intelligence, changing labour markets and an ageing population. We simply cannot operate on the assumption that education happens only once, in our late teens or early 20s, and then stops. Frankly, that never made sense, and it certainly does not make sense any more.
If we are serious about economic growth, improving productivity and helping people back into good work, lifelong learning has to move from being a worthy aspiration to being something much closer to the centre of how we think about our economy. Since being elected to Parliament, I have spent a lot of time working in the areas of employment, skills and economic inactivity, and I think we sometimes underestimate the role education plays in building people’s confidence as much as their competence. Often, people are not just missing qualifications; they are missing the confidence that they are capable of more. Adult education changes that. It changed it for me.
To be frank, I have forgotten quite a lot of the stuff that I was actually taught during my time at the Open University. I sometimes need a primer on the exact details of the theoretical framework underpinning the long-run Phillips curve. When I re-read my master’s thesis a few years ago, I surprised myself with how much I agreed with my conclusions on the intersection between liberty and unequal power relations. But I will never forget that moment back in December 2010, when I got my undergraduate result. It felt like validation. It was a confidence boost that has never left me.
In among the successes and the congratulations, we should be honest about the challenges—
Uma Kumaran (Stratford and Bow) (Lab)
My hon. Friend is speaking powerfully about his story and his experience of higher education. Young people from more advantaged or affluent backgrounds are still much more likely to enter higher education than their less-advantaged peers. Socioeconomic background—what we more commonly call class—is still the strongest predictor of university attendance. Does my hon. Friend agree that the mission at the heart of the 1966 White Paper, to expand access to higher education and spread opportunity, is just as relevant today as it was then?
Patrick Hurley
Definitely. If anything, it is even more important in 2026, with all the challenges we see around us.
As I said, we should be honest about the challenges. Despite the success of institutions like the Open University, adult participation in higher education has fallen over the last decade. Too often, the system still feels like it is designed around the traditional undergraduate who left school at 18, rather than the parents in their 30s or 40s, the worker retraining after redundancy or the person managing long-term ill health while trying to rebuild their future. Yet mature students are not some small minority: more than a third of undergraduate entrants are mature learners. They are already a major part of our higher education system, whether we recognise it fully or not.
That is why I welcome the broad direction of travel on lifelong learning and the more flexible provision the Government are pursuing. The principle is right—people should be able to access education throughout their lives and in a way that fits around their work and family—but it remains true that implementation and delivery matter as well. If lifelong learning is genuinely to continue to work, people need a system they can understand and easily navigate. The funding regime needs to feel straightforward and fair. Flexible provision has to be properly supported. Employers need to be part of the conversation. And, frankly, we need many more people just to know that these opportunities exist, because too many adults still assume that higher education is simply not for people like them.
I ask the Minister to reflect on the role that institutions such as the Open University can play in regions like mine. One of its great strengths is that people do not have to leave their communities to access the opportunities available to them. That matters in places that have too often watched talent drain away, like the region I am from. Somebody in Southport or St Helens, in Birkenhead or Bootle, should not necessarily have to move away from their home town to improve their prospects. The Open University allows people to build skills while remaining rooted in the places that they love and that they want to contribute to. That strikes me as important, not just educationally but economically and socially.
I am proud that this Labour Government are acting in a way that is true to the founding vision of the Open University. The lifelong learning entitlement represents a major step forward. It is transforming the student finance system to support flexible, modular learning across people’s lives. For the first time, individuals will be able to access funding both for traditional degrees and for shorter courses, as well as retraining and skills development, when they need it throughout their careers. It is fitting that this reform builds directly on the principles pioneered by the Open University almost 60 years ago.
The OU’s expertise in modular, flexible provision will be vital in making the lifelong learning entitlement a success, but we must do more. We must ensure that part-time provision is properly funded and properly supported, we must raise awareness so that more people know these opportunities exist, and we must ensure that lifelong learning is embedded across Government—yes, in education policy, but also in economic, employment and regional growth strategies as well.
As we mark 60 years since the White Paper, we should all do two things. First, we should celebrate one of the most genuinely radical and successful achievements of not just Harold Wilson’s Government but every Labour Government: an institution built on the belief that intelligence is not confined to one class, one place or one stage of life. Secondly, we should remember that the argument Jennie Lee made in 1966 is not yet finished. The central question remains exactly the same as it ever was: what do we do with potential that has not yet had its chance?
For millions of people, the Open University has represented confidence, dignity and a second opportunity. I know that, because in my case it changed the direction of my life. For that reason, if no other, I believe that the vision behind the “University of the Air” deserves not simply our admiration but our continued support.
Robin Swann (South Antrim) (UUP)
It is a pleasure to serve under your chairmanship, Sir Desmond. I thank and congratulate the hon. Member for Southport (Patrick Hurley) on securing this debate. I should also declare that I am a graduate and alumnus of the Open University, so I recognise many of those of its attributes that he mentioned. Unfortunately, I did not take the same speedy course that he did; in fact, it took me eight years to obtain my Bachelor of Science (Open), doing a 30-point level 1 to a 60-point level 3, with the odd 10-point thrown in in between—former graduates will know exactly what I am talking about.
The hon. Member talked about the changes we have seen in the Open University. I started when everything was tutor-marked assessments, which meant you had to post them to my tutor, and I finished when everything had to be submitted over the internet. There was always that panic when you pushed the send button at five minutes to midnight, hoping that your internet stayed connected until the tutor had received your full assignment. However, I do not go back to the times when members were setting video cassette recorders to record lectures on BBC Two at 2 am, as was necessary then.
The hon. Member talked about the Open University giving students the ability to learn while they were working. It also instilled deep-seated personal management skills, because students had to meet deadlines, while maintaining a work-life balance and family interaction. It is right that we recognise that on this 60th anniversary of the “University of the Air”. But we should also recognise the other things the Open University has done with regard to learning and education, including the “Green Planet” TV series, an environmental series co-produced with the BBC and narrated at that stage by Sir David Attenborough.
In terms of the opportunities offered by the Open University, I think everybody in the Chamber will recognise that there are four Northern Ireland MPs here today—that is four out of 11 or, as one of my maths courses taught me, 0.3636 recurring, as the decimalisation of the representation here from Northern Ireland. The hon. Member for Southport talked about the value of the regions, and the Open University is greatly recognised and valued in Northern Ireland, because of its ability to deliver courses across the regions and across abilities as well.
Richard Baker (Glenrothes and Mid Fife) (Lab)
In Scotland, we are very proud that Jennie Lee, the architect of the Open University, came from Lochgelly, which is in my constituency. The hon. Gentleman rightly touched on the importance of the devolved Administrations working with the Open University to create higher education opportunities for people who would not normally have them. In Scotland, 30% of students at the Open University have a disability support need. Does the hon. Gentleman agree that that is just one reason why it is important that the devolved Administrations, like the Westminster Government, work closely with the Open University to ensure that it can play its full role in lifelong learning?
Robin Swann
I fully support the Member’s contribution. In fact, one in five Northern Ireland students is registered as having a disability. So the Open University opens up not just geographical and regional abilities but all abilities to lifelong learning.
Other Members have spoken about Jennie Lee, but I would like to diverge at this point and to take the opportunity to pay tribute to another individual, John D’Arcy, who was the director of the Open University in Ireland. John served 16 years in that post and just recently retired. I was working with him and through him, and his promotion of the Open University was testament to how we were able to produce it and forward it in Northern Ireland. It was very much his skill, his interaction and his time there that shaped the Open University as a public service. He did that with ambition and innovation and, above all, by always keeping people at the centre of it. We were grateful to John for all he brought to the university and that role.
One of John’s phrases was that the Open University in Northern Ireland was one of its best kept secrets, because the Open University was in fact the third university in Northern Ireland. It was during that time—I suppose from being a graduate of it—that I recognised that ability, and we were able, when I was Health Minister, to bring the Open University together with career progression and skill shortages and to marry the two up. At that point, we had 65 Open University undergraduate nursing places; currently, more than one third of Open University students in Northern Ireland are studying science, technology, engineering and maths subjects, and nearly 600 are training as nurses. One thing that was done was to allow people working as carers, but who did not have the opportunity to go to university to become nurses, to train in their workplace. What that did was bring a loyalty to many of the hospitals and wards, because people were being built up in the place they worked in and with the people they worked with. That was then able to be expanded into social work. The Open University was working with trusts and with our Department as well.
It is right and timely that we contribute to this debate, because now is the time to invest in high-quality, flexible higher education. I also see a call there for the Northern Ireland Executive to introduce more flexible financial support for part-time students and to progress a higher education funding review to reform the higher education funding model. In that way, they can properly support lifelong learning at a time when Northern Ireland needs to grow skills, improve productivity and widen opportunity, and we can realise the full potential of the Open University and those who have not had the opportunity, as the hon. Member for Southport indicated, to access third-level education, which many employers are now looking for. It is with great pleasure that I support this motion.
Jim Shannon (Strangford) (DUP)
It is always a pleasure to serve under your chairship, Sir Desmond. I say a big thank you to the hon. Member for Southport (Patrick Hurley) for highlighting the wonderful work done by those institutions that are slightly off the beaten educational path, so to speak. Although the higher education sector has changed dramatically in the past 60 years, the Open University has continued to evolve, change and adapt while remaining true to its founding mission. From its inception, it has moved with the times. What began with television broadcasts, radio programmes and handwritten papers has now become a model of digital innovation and interactive online learning.
It is always a real pleasure to see the Minister in his place. We look forward to his answers to the questions we will ask, and I will have some in my contribution. The Open University came to the fore, if we are looking back just to the last few years, during the pandemic lockdown, when it led the way. Remote teaching was suddenly introduced in schools and universities, but the OU had already been delivering distance learning effectively for decades; it was leading the way at that time. Although many institutions were forced to rush and to improvise a remote learning model, the Open University was drawing on years of experience to support its students.
The Open University has given countless opportunities to working-class people who would otherwise never have had the chance to earn a degree. For many, the route to traditional universities had been out of reach, but the Open University offered a second, third or indeed fourth chance, producing graduates who have gone on to become nurses, teachers, engineers and community leaders, with many returning to the OU to complete their master’s degree and PhD. The hon. Member for South Antrim (Robin Swann) referred to the 65 who were on a course in his time as Health Minister and to the fact that it is now 600. That indicates just how many have been able to take advantage of this opportunity and to improve their life, improve their qualifications and improve life for others as a result.
The Open University’s commitment to inclusion was there from its inception. Long before diversity, equity and inclusion became a formal policy, the Open University had those values in place. Jennie Lee’s model has always welcomed students from every walk of life, judging them not on their past qualifications, age, sexual orientation, race or creed, but only encouraging them in their desire to learn—their motivation, their complete goal and purpose, and their desire to do more. It has been particularly transformative for women who put their ambitions on hold to raise families, meaning that they could return to education as mature students, often becoming the first in their family to graduate from university.
I can give one example. My hon. Friend the Member for East Londonderry (Mr Campbell) is away, but I know from his discussions with me that his daughter was one of those women. She wanted to have a family, so then returned to the Open University at a later stage to learn education. That mature student with a family took an Open University degree and is now head of her department. My hon. Friend’s daughter is one example that is replicated dozens or perhaps hundreds of times across Northern Ireland and thousands of times across the United Kingdom.
The Open University in Northern Ireland has delivered particularly impactful outreach in prisons and working-class communities. Those things are sometimes lost, but they should not be. I will share two examples of initiatives: the Shankill women’s centre in Belfast and the Kilcooley women’s centre, in the constituency of the hon. Member for North Down (Alex Easton). They do excellent work, not just in North Down but in Strangford, in partnership with the Open University. I have worked with them over the years as they have helped women to achieve goals they never thought they could.
The Open University has brought higher education directly into communities that have historically felt excluded from it. If we can do that—if women and men can see the opportunities, as I have witnessed over the years—that is good news. The OU’s scope is remarkable. Graduates include men and women from their 20s to their 90s; Members of the Northern Ireland Assembly; and fellow Members of this House, including the hon. Member for South Antrim. A member of my office staff, who took an Open University degree, achieved her goal with those qualifications and advanced what she is able to do. That demonstrates the depth of its impact.
In our prisons, the Open University has delivered life-changing opportunities. For many inmates, Open University courses have provided purpose and a pathway to a better future after release. At justice questions in the Chamber, we often ask, as I have done, to keep people away from the unsavoury parts of prison life and give them an opportunity to do something different when they leave. It is a wonderful opportunity for inmates to have the Open University in prisons across the land. I hope the Minister will confirm that what we have done in Northern Ireland can be done on the UK mainland as well. What is being done to encourage and enable those in prison to take courses and see a different future, one that they perhaps would never have seen if they had not been in prison? It is a golden opportunity to shape life and do better.
Today, a higher number of young people than ever are opting to enrol with the Open University after A-levels but, because it is not currently included in the UCAS system, the OU is a less visible choice than traditional brick universities. I ask the Minister to consider including the Open University in the UCAS system to ensure that it is a legitimate and visible post A-level choice for young people, alongside mainstream institutions. It should be, it must be, and perhaps the Minister will confirm that it will be.
The things that improve a society more than anything else are access to good healthcare, access to opportunities and a choice in education. The Open University continues to impact and change the lives of hundreds of thousands of students every year, who balance work, family life and life’s challenges with their studies. The OU offers no barriers to learning to anyone of any age. It is the very definition of lifelong learning, just as Jennie Lee envisaged many years ago. With the hon. Member for Southport and the hon. Member for South Antrim—and the party spokespersons and the Minister, whose speeches will follow mine—I celebrate the OU for its extraordinary and continuing contribution to people’s lives. It is lovely to see something that we Brits have done well.
Robin Swann
Reflecting on the contributions so far, it is also worth noting that the Open University supports the members of our British armed forces through its courses.
Jim Shannon
I thank the hon. Member for reminding us that many in the armed forces have taken that opportunity. The opportunity is there within their busy lives, and the opportunity is clear. We must ensure that this proud and uniquely British success story keeps opening doors for generations to come. That has to be the ambition and the goal, and that is what we are doing.
Ian Sollom (St Neots and Mid Cambridgeshire) (LD)
It is a pleasure to serve under your chairmanship, Sir Desmond. I congratulate the hon. Member for Southport (Patrick Hurley) on securing the debate. I know that he is a passionate advocate and champion of the OU. I welcome the opportunity to speak on a subject that, frankly, deserves far more attention.
Opening access to education, rewarding hard work and helping everyone to fulfil their potential are aims that sit at the heart of the Liberal Democrat vision for a free and fair society. Our predecessors were wholeheartedly supportive of the spirit behind the 1966 White Paper and we continue to be so. It is right that we mark its 60th anniversary by celebrating the work that it set in motion.
In my constituency there are currently 240 Open University students: 210 undergraduates and 30 postgraduates. Nearly half of those undergraduates started their studies under the age of 30 and over a quarter declare a disability. That tells us something about how OU study fits around life. It is not a story that is unique to my patch. Nationally, 19% of OU students live in the most economically disadvantaged areas of the country, nearly 70% are already in work when they begin studying, and three in four arrive with no previous higher education qualification at all. That is a testament to the access mission that the OU embodies.
In preparing for this debate, I enjoyed revisiting the 1966 White Paper, its proposals and the debates that led up to it. Hindsight is, of course, a wonderful thing but after reading one Member dismiss the idea as an “inflated concept” in a 1965 debate, I could not help but reflect, 60 years later, that the OU has comprehensively answered that objection, becoming a much-loved national institution.
It has also been interesting to reflect on the world of adult education at the time. The White Paper was explicit that the university would sit alongside a wider ecosystem of provision, not replace it. The Government of the day promised to make full use of
“existing agencies, such as the Extra-Mural Departments of Universities, the Workers’ Educational Association…and local education authorities.”
In fact, the White Paper returns to that point twice. The vision was plural: a national broadcasting university—at the time—working hand in hand with local night classes, adult education centres and further education colleges, each reinforcing the other.
The Open University itself has remained admirably faithful to that founding outward-facing instinct. It partners with institutions that lack their own degree-awarding powers, validating their programmes, and a high proportion of its graduates stay in their local area, contributing to the local economy. Five years after graduating, more than nine in 10 OU graduates still live in the postcode area where they studied, which I believe is precisely the kind of locally rooted impact hoped for by the authors of the White Paper.
What has perhaps not survived so well is the other half of the 1966 vision—the local ecosystem that the OU was meant to complement. Public funding for adult skills and community learning has fallen sharply since its peak in the early 2000s. Spending on classroom-based adult education specifically has fallen by about two thirds over that period, and the number of publicly funded classroom-based further education courses taken by adults in England has dropped from 5.4 million in 2004-05 to just 1.7 million last year, which is a fall of about 70%. Of course, that is not the OU’s doing, and further education colleges still do excellent work within a narrower remit, but the wider tapestry of provision that the White Paper authors assumed would sit alongside a “University of the Air” has thinned out considerably since.
Even the OU is feeling the strain of operating in that emptier landscape. Its own accounts for the last financial year show an accounting deficit of £27 million, which was brought back into a small underlying operating surplus only through a sustained programme of costs reduction, including the loss, sadly, of over 300 full-time equivalent roles last year. That should be seen less as a reflection on the OU, and more as a reflection on a much deeper structural problem. The part-time higher education market in England has been shrinking for years, and the OU, even as the strongest player in that market, cannot grow the pool of adult learners on its own. That is a job for Government policy, not for one institution’s marketing budget.
That is exactly why the choice of funding mechanism matters so much for mature and returning learners. The lifelong learning entitlement that the Government are bringing forward is a welcome step in the right direction, but the evidence consistently shows that loans are not a strong enough incentive on their own to get more people from that group into education or training. Financial anxiety is already one of the biggest barriers preventing people from returning to study. Older learners are understandably more risk averse than 18-year-olds, and asking someone to take on the very debt they are trying to avoid to access more flexible and modular learning is not necessarily the answer.
Instead, we Liberal Democrats have long called for grants of between £5,000 and £10,000 to be made available to people at key stages throughout their life to support retraining and reskilling. To ensure that that funding is well spent, we would pair it with good guidance on the options available and make sure that it is usable across a wide range of institutions, from local further education colleges to national universities and, of course, the OU.
I hope the Minister, hearing praise from across the Chamber for the OU’s success in reaching learners of all ages, will give serious thought to that proposal for the long term, because it will matter more, not less, as time goes on. The world of work is changing fast, and maintaining a highly skilled, productive economy will require us to continually invest in our most precious resource—people.
Learning cannot be a cost to be minimised once an initial education ends. The OU’s own record bears out the difference that can be made: it is ranked third nationally for graduate employability, and it has innovative schemes such as the virtual internships programme, which was built specifically for distance learners who could never have accessed an internship through conventional routes. That is what lifelong learning looks like when it works, but it cannot fall to one institution. Perhaps the most important insight from the White Paper is that no single institution, however innovative, can deliver lifelong learning alone. That responsibility sits with Government, who have their own opportunity to address that.
Last October’s “Post-16 education and skills” White Paper restated the Government’s ambitions for the lifelong learning entitlement, which is due to come into force in January 2027. However, the secondary legislation and implementation detail that will determine whether it actually reaches risk-averse adult learners, rather than just the 18-year-olds who the loan model already works for, remain outstanding. I therefore hope that the Minister can set out not just the date for that detail but whether the detail will include any role, or ambition, for grants alongside loans. It would be fitting for the anniversary that we are celebrating today to be marked by such a step forward in adult education.
Jack Rankin (Windsor) (Con)
It is a pleasure to serve under your chairmanship, Sir Desmond. I thank the hon. Member for Southport (Patrick Hurley) for securing this debate, and for sharing with us his personal journey to becoming an Open University graduate and the opportunities that higher education opened up for him. In his remarks, the passion of his political world view shone through, and though the very nature of my sitting on the Conservative Benches might mean we have some differences, I am a Lancashire man from working-class stock, and I agree with him forcibly that education should be available to all and applied with hard work—that is the most powerful action for social mobility.
I pay tribute to my honourable Unionist friends from Ulster, the hon. Members for South Antrim (Robin Swann) and for Strangford (Jim Shannon), for their contributions. They eloquently made points about skills beyond education and the wider personal growth available to people who attend the Open University, and particularly how important the Open University is in Northern Ireland. The two examples of the women’s centres made it clear that the Open University’s accessibility has been transformational to some of those young ladies’ lives. The hon. Member for Strangford also made an interesting point about UCAS, which I was not aware of, and I look forward to hearing what the Minister says in response to that.
This year marks 60 years since Harold Wilson’s Government published the “University of the Air” White Paper, which, seeking to capitalise on the advances in television and radio programme learning, set out plans for an Open University to provide higher and further education for those unable to take advantage of courses in existing colleges and universities. Envisioned as a way to tackle pressure on university and college places following the post-second world war baby boom by providing home study to university and higher technical standards, the plan for the “University of the Air” was to provide high-quality education to more adults through television and radio lectures, correspondence courses, residential courses and tutorials, and study groups at community centres. Those ideas formed the basis of what we know today as the Open University.
Like the hon. Member for Southport, I pay tribute to the late Baroness Lee of Asheridge, Jennie Lee, who was instrumental in setting up the Open University, for all her work to promote lifelong learning. When it first opened to students in 1971, the Open University offered 25,000 places. Today, it has provided courses to more than 2.3 million people. It is clear that the Open University’s flexibility helps make adult education and lifelong learning a reality for thousands who might not otherwise be able to access traditional campus-based study. Last academic year, 67% of Open University students worked full or part-time during their studies. That speaks to a culture of ambition and opportunity that lifelong learning helps to cultivate.
More than just statistics, we can see the real impact of the Open University and lifelong learning in the individual stories of those whose lives it has transformed. I know how transformative lifelong learning can be from my own early childhood memories. My first memories were of my parents going to night school—in their instance, further education—on alternate evenings; my father got his electrical qualifications, and my mother got her accountancy qualifications. They set up a small business that was transformational for mine and my brother’s life. Many others accessing the Open University, whether they be working parents, people with caring responsibilities or simply adults looking to grasp the opportunities that, for whatever reason, were not available or accessible to them when they left school, have benefited from the empowerment that comes from being able to take their education and their future into their own hands.
I also want to recognise just how hard-working and motivated many adult learners are, and the courage it must take to return to education later in life. As we heard during the debate, the ways in which learning can change lives, and the things that many people who have sought out training or upskilling go on to achieve, are truly extraordinary.
The previous Government were clear about the value of adult education. I am proud of the Conservatives’ record, which included introducing the apprenticeship levy, skills bootcamps and free courses for jobs. Together, those initiatives have helped to give adults opportunities to learn the skills that employers are looking for, which will lead them to better jobs, better wellbeing and better opportunities for the future.
The Conservatives also welcome the upcoming launch of the lifelong learning entitlement, which I understand will be available for courses from January 2027. Although the Minister may wish to take some credit for it, the LLE was put forward by the previous Government to give adults a loan entitlement of up to four years of post-18 education to use over their lifetime. Crucially, the previous Government envisaged the LLE for a whole range of adult education, including full courses at higher technical and degree level, and new modular funding. I am glad that the first of the new modular courses will be launching next year.
Raising awareness of the new overhaul of post-18 education funding will be crucial if we are to ensure that it can help unlock learning for as many adults as possible. I therefore ask the Minister how his Department is raising awareness of the new funding options that will soon be available for post-18 education. How does he plan to attract learners who might not have traditionally sought out lifelong learning and training opportunities?
The current Government say that they are committed to increasing funding for adult education. However, since entering office, they have instead cut the adult skills budget by 6%. Industry was rightly shocked, calling it a “shortsighted” move that will undermine economic growth, set back organisations and learners, and undermine trust in the Government’s vision for the country. Key sectors in our economy are calling for growth in adult education, not cutbacks.
I turn to lifelong learning in other forms, including apprenticeships. Although, as demonstrated today, we all know that a high-quality university degree can set someone on the path to success and that higher education plays an important role in lifelong learning, it would be wrong not to acknowledge that it is not the case for every course. It is frankly a scandal that too many traditional university courses do not deliver jobs in the industry that they claim to serve. Some courses will draw people in with the promise of a stable and fulfilling career but deliver nothing but mounting debt and a dead end. That is why, if we really want to support lifelong learning, we must be honest about the real issue of funnelling young people and adults into courses that do not get them the jobs that they are seeking and do not allow them to repay their loans. It is also why we must ensure that quality apprenticeships are a real choice at age 18 and beyond, and a viable, equally esteemed alternative to university.
We have a serious skills shortage. Nearly half of vacancies in the construction sector and skilled trades are the result of skills shortages. As has been discussed, the Opposition are concerned by the Government’s decision to withdraw public funding for level 7 apprenticeships, cutting support for the highest-level apprenticeships that provide vital routes for adult learners into skilled careers such as nursing. It is a major blow to social mobility for adult learners, shutting out talent from disadvantaged backgrounds and taking opportunities away from adult learners. Not only will culling level 7 apprenticeships hurt employers, but it is destabilising for university providers. It will hit institutions that have tried to open up opportunities for those who traditionally do not go to university, including, of course, the Open University. Since the announcement last year, what engagement has the Minister had with institutions, including the Open University, about the impact of axing level 7 apprenticeships?
For much of the last 30 years, our approach to higher education has hinged on the underlying assumption that successfully completing a traditional university degree is one of the best ways to boost a person’s opportunities in life. Young people and adults who pay tens of thousands of pounds to complete their degree, whether up front or through repayments, rightly and reasonably expect that it will boost their job prospects and income. If we really want to encourage lifelong learning, we must ensure that issues with low-quality and dead-end traditional degrees are addressed. A more flexible option may be part of the solution.
Lifelong learning should be for everyone. Whether that is someone taking on a new qualification to advance their career or pursuing a high-quality university degree as an adult, the empowerment and opportunity that comes from learning is truly life changing. The Open University has played an important role in opening up opportunities for millions of adults. The Government must be prepared to address the serious issues that exist with both the current welfare system and low-value university courses to ensure that those who invest in education at whatever stage in their life are rewarded with the opportunities they deserve.
The Parliamentary Under-Secretary of State for Education (Josh MacAlister)
It is a pleasure to serve under your chairmanship, Sir Desmond. I start by congratulating my hon. Friend the Member for Southport (Patrick Hurley) on securing this very timely debate and on the characteristically thoughtful case he made. I also give credit to the hon. Member for South Antrim (Robin Swann), a graduate of the Open University himself, who reminded us of the analogue age of VCRs and the magic of Sir David Attenborough.
I also thank the hon. Member for Strangford (Jim Shannon) for highlighting the genuine inclusivity of the Open University from its inception. He was also right to highlight the importance of prisoner education. Although it is not within my area of responsibility, I am very passionate about it, and I believe that the Open University and other providers have a really important role to play, given the captive nature of the audience and the chance for prison to be a place where people can genuinely turn their lives around.
I want to answer the question about UCAS before I turn to the wider debate. The Open University chooses to manage applications directly, partly because of the need for flexibility beyond the normal academic cycle, but information about OU courses, including modular courses, is available on the UCAS website.
I am keen not to get drawn too far away from the topic of the Open University, but I will respond in short to the shadow Minister, the hon. Member for Windsor (Jack Rankin), who raised issues regarding level 7 apprenticeships. This is an area simply of disagreement on policy and on where the resources that sit behind the apprenticeships levy—which is now the growth and skills levy—should rest. I am really keen, as is the Education Secretary, for those resources to be targeted very much at those who might not have taken the university path and for those entry-level apprenticeship routes to be funded to the max. That is why that policy decision was made. I stand by it and believe it was the right decision on balance for the use of those resources.
My hon. Friend the Member for Southport speaks in this debate not just as an advocate for lifelong learning but as living proof of its potential. As he spoke about movingly, his example is of someone who enrolled with the OU at the age of 30, and five years later emerged with both an undergraduate degree and a master’s degree to their name. That, for me, is the Open University’s mission in a nutshell—not a makeshift second chance, but a genuinely world-class route to opportunity for people who were not on academic pathways at the age of 18. That is why his advocacy carries such weight. In Southport, he has carried that conviction into the community at the heart of his constituency, championing the learning festival that took place in the town last year and being a strong advocate for improving educational opportunities more broadly. I have been lobbied many times about school buildings by him, so I can attest to that.
As my hon. Friend explained, it will be 60 years ago next February since another Labour Minister, Jennie Lee, published the White Paper, “A University of the Air”. She did so in the face of immense scepticism. Whitehall was snooty, the press was cynical and much of the establishment argued that the money should be spent elsewhere, but Jennie Lee was, in Harold Wilson’s words, “a tigress”. At a famous Cabinet meeting at Chequers just before the 1966 election, she argued that while the national health service was the greatest creation of the post-war Labour Government, the “University of the Air” would make
“just as much difference to the country.”
The White Paper made a radical argument that higher education should be open to all, regardless of background or prior qualifications, that learning should be flexible, rigorous and lifelong, and that new technology would carry academic excellence far beyond the walls of traditional institutions. Jennie Lee won that argument, and 60 years on, every part of that vision—open access, flexibility and technology in service of excellence—reads less like history and more like a description of the task that sits in front of us today.
The Open University, the institution founded as a consequence of that White Paper, is today the largest academic institution in the UK, with students in all 650 parliamentary constituencies. Since 1969, it has taught more than 2.5 million students worldwide. Three quarters of its undergraduates arrive with no previous higher education qualifications. The open door that Jennie Lee promised is still open.
In the last five years alone, more than 15,000 people who began studying without any A-levels have earned higher education qualifications through the Open University. Two thirds of its students are working while they study. It is learning that fits around life—not the other way around. The OU was never second best: at the last assessment, 82% of its research impact was rated world leading or internationally excellent, and last year it was awarded gold—the highest ranking—in the teaching excellence framework.
Jim Shannon
We all, including the Minister, recognise that the Open University reaches out to those who are perhaps isolated and lonely. It gives them an opportunity to focus their attention on a degree, thereby giving them hope for the future. That is sometimes underestimated, but it is critical.
Josh MacAlister
I completely agree. I will turn now to the Government’s actions, which will take the Open University to its next chapter, so that those opportunities are spread even more across our great country.
Last October, we published the “Post-16 education and skills” White Paper. There is a powerful alignment between the Open University’s mission to widen access and our own vision, set out in that White Paper, for a world-leading skills system that breaks down barriers to opportunity. The strategy in the White Paper is the blueprint for delivering our new target for two thirds of young people to be participating in higher-level learning—academic, technical or apprenticeships. We are determined to break the damaging link between background and success, and we want more people from all backgrounds to be able to access higher education as part of that.
As part of our reforms, the lifelong learning entitlement —a policy from the previous Government that I am very pleased we are continuing, with cross-party support—represents one of the most significant student finance reforms in a generation. For the first time, it establishes a single, flexible funding system covering levels 4 to 6 across further and higher education, enabling people to learn, upskill and retrain throughout their working lives.
The rationale for the entitlement is clear. More than a third of vacancies go unfilled due to skills shortages, and around 80% of the 2030 workforce are already in employment. However, the current system was largely designed for younger, full-time students and lacks the flexibility that adults in work need. The LLE will expand access to higher-quality, flexible education and training, promote learner mobility and ensure that providers can respond to the needs of learners, employers and the wider economy.
Sixty years ago, a White Paper of just a few pages was dismissed as vague, insubstantial and impractical. Today, the institution it created has taught more than 2 million people, with my hon. Friend the Member for Southport among them. That is the test that Jennie Lee set us: not whether an idea is convenient, but whether it changes lives. She insisted that there could be no question of offering students a makeshift project, inferior in quality to other universities. Sixty years on, that standard still binds us.
From January next year funding will, for the first time, follow the learner, module by module, at any stage of life. Our ambition that two thirds of young people reach higher-level learning is matched by an entitlement that lasts to 60, because opportunity should not have a closing date. Jennie Lee’s revolution was to say that the door to education should never close behind someone. The task of the next 60 years is to hold that door open wider still, in Southport and in every community like it. When our learners thrive, our country thrives.
Sir Desmond Swayne (in the Chair)
Patrick Hurley, you have two minutes to wind up.
Patrick Hurley
First, I pay tribute to you, Sir Desmond, for your exemplary chairmanship, Sir Desmond. I also thank Members from across the House for their valued contributions.
With your indulgence, Sir Desmond, I will touch on funding, a topic raised by several Members, through an anecdote about how I paid my Open University fees. When I studied at the OU, modules were around £700 each. Even that was too expensive for me. It was not until I realised that I could pay for my modules using Tesco Clubcard vouchers that I finally took the plunge and enrolled.
The choice was this: every few months, a booklet from Tesco would come through the post, and I would have the option of getting 50% off a Pizza Express bill, or free cinema tickets, or potentially transforming my life through higher education. Given the context, it was no choice at all—it was obvious what I should do.
Funding is never easy, but we need to redouble our efforts to ensure that the principle the OU was founded on—that education should be affordable and accessible to all—holds true not just for the last 60 years, but for the next 60 years.
Question put and agreed to.
Resolved,
That this House has considered the impact of the University of the Air White Paper on lifelong learning opportunities.
West Midlands Police: Government Support
(1 day, 4 hours ago)
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Ayoub Khan (Birmingham Perry Barr) (Ind)
I beg to move,
That this House has considered Government support for West Midlands Police.
It is an honour to serve under your chairmanship, Sir Desmond. As elected representatives we hold various obligations to our constituents, but I suspect that few are of greater importance than giving residents the right to feel safe in the places they call home. For that reason, we must do all we can to support the brave men and women of our police forces.
This debate is more than about visible patrols that reassure parents taking their children to school, or swift responses to reports of crime. It is also about giving people the confidence that when something goes wrong, the police will deliver justice in a fair and proportionate way. In the west midlands, that basic promise has been undermined by years of budget cuts and neglect.
Across the communities of Birmingham Perry Barr, where knife crime, antisocial behaviour and gang violence are constant concerns, residents are not seeing enough police on their streets. The figures tell a grim story: compared with 2010, West Midlands police has 520 fewer officers on duty, on top of the 520 fewer police community support officers.
Jim Shannon (Strangford) (DUP)
I commend the hon. Member for securing the debate. He is making a reputation for himself in the House when it comes to such subjects, and I wish him well. Does he agree that to have an effective police force, there must be community buy-in? To have community buy-in, people need to see the police on the streets each and every day, which obviously requires more finance. Does the hon. Member agree that the Minister needs to ensure that the Government make community funding the cornerstone of policing once again? Does he agree that community policing is the way forward?
Ayoub Khan
The hon. Member is far more learned than I am in this House, and he makes a very important point. Community policing is of course the optimum type of policing, and I will deal with that point later in my speech.
To make matters worse, when we adjust for population growth, as we must, our area actually needs 640 additional officers compared with 2010. In real terms, then, we are not just 520 police officers and 520 police community support officers down; we are down by about 1,700 officers.
Paulette Hamilton (Birmingham Erdington) (Lab)
I thank the hon. Member for securing this vital debate. I represent the constituency next door to his, and I agree with much of what he has said. People are saying they need to feel safe on the streets. My constituency has had Operation Fearless, which has now expanded to the hon. Member’s area. It has been absolutely brilliant, because we have had extra police, but unfortunately it is only short term. Does the hon. Member agree that any future Government support for West Midlands police must guarantee targeted resources to support the work that is so desperately needed in local communities?
Ayoub Khan
The hon. Lady is an amazing advocate for her constituency. She mentioned Operation Fearless, which produced amazing results in her constituency, and, as she rightly points out, I am fortunate that it is now being conducted in my Perry Barr constituency, where it has already had an amazing impact. But this should not be a postcode lottery; it should be spread across the whole region and across the country.
I want to give some figures, because it is very important for the Minister to understand the level of deprivation and decline. In real terms, the west midlands region is short of 1,700 officers: 1,200 police officers and 500 police and community support officers. I suppose one could ask for additional police and community support officers, because we have not adjusted that figure for population growth.
For far too long, the West Midlands police has been set up for failure by the Government’s funding allocation, which leaves the force around £43 million short every year. That shortfall risks a further loss of another 80 police officers, with the situation becoming so dire that the residents of Birmingham are being asked for an additional contribution through their council tax. They have already seen their council tax increase by 24% over the last three years, and now they are being invited to make good the shortfall by paying more, which simply is not acceptable.
What makes this failure all the more disappointing is that few areas are seeing their police presence eroded at the same scale as ours. While the vast majority of forces have as many personnel, if not more, West Midlands police continues to be left far behind. For years, successive Governments have known the challenge we face. They know that the system needs reforming, and to date they have done nothing about it. The Public Accounts Committee, the Home Affairs Committee, the National Police Chiefs’ Council, the Institute for Fiscal Studies, the chief inspector and even the previous Government all recognised that the formula is outdated and no longer fit for purpose, yet it remains in place.
The Government’s new police reform White Paper was an opportunity to address the injustice; instead, it has become another missed opportunity. Although we welcome the steps to fix local government funding, the White Paper puts police funding reform—the single biggest obstacle to tackling crime in our area—on the back burner, with reports that change will not start until 2034. Police funding needs to be fixed, and it needs to be fixed now.
Because many forms of crime, including violence against women and girls, are on the rise, the need for visible policing is becoming ever clearer. Since day one of being elected, I have been campaigning to put more police officers on our streets and make our communities safer. I am proud to say that after almost two years of hard work with West Midlands police, local organisations and residents, we have finally brought Operation Fearless to the Soho Road and Handsworth triangle area. That means more police officers on patrol, more arrests and a restored sense of safety for residents.
Operation Fearless is about more than just numbers. It matters because it puts officers where people can see them. It shows what can be achieved when the police work with communities, listen to local concerns and act on the priorities that residents themselves identify. Most of all, it works because people notice the difference. If we want to know how well we are tackling crime, we need to know whether people feel safe. I am afraid that if people have become so desensitised to seeing antisocial behaviour, fly-tipping and any other crime that they no longer feel reporting achieves a result, that leaves them feeling vulnerable. That is not acceptable, and we must not let that happen.
Operation Fearless must not be the exception. It needs to be part of a wider approach across the constituency in places such as Aston, Lozells, Kingstanding and Perry Barr, and, in fact, across the west midlands. People should not have to campaign for more than a year to secure the basic police presence that every community deserves. But we can have that only when the people of the west midlands finally receive their fair share, and it is on the Government to deliver change.
At the same time, we must be clear that support for visible policing is not the same as support for prejudice in policing. The majority of my constituents have welcomed Operation Fearless, but that does not mean they accept draconian stop-and-search powers, racial profiling or predictive policing. I am glad to say that we have had discussions with our police officers about such issues, and they are very alert and receptive to our history, including the Handsworth riots. Our communities know what happens when policing is done to people rather than with them. Public safety depends on public trust, and if that trust is broken, everyone stands to lose. The Government must not only help the police to reduce crime, but tackle corruption in the force and prevent any miscarriage of justice.
Many of my constituents have expressed concerns about the case of the Birmingham Four. In 2017, Ali, Hussain, Rahman and Aziz were convicted of terrorism-related charges after an operation conducted by the police. The police created a courier business and enticed the four men into working as drivers, using vans supplied by the police that were pre-fitted with surveillance equipment. I understand that even though little evidence of criminal activity was found after months of surveillance, the four men were nevertheless convicted and sentenced to life in prison.
One concern raised by a member of one of the men’s families was that the entire case hinged on a bag containing incriminating items that was mysteriously found in Ali’s car on the first day he went to work, just an hour after he had given undercover officers access to the vehicle, and it is said that several more concerning revelations emerged during the trial. The undercover officers openly admitted to being accused of planting evidence in other cases, and later bragged about their “Oscar performance” while delivering evidence in court. Despite it being readily available, we understand that CCTV footage taken while an undercover officer was left alone with Ali’s car was withheld from the jury.
There was no conclusive DNA evidence, no proof that the men had bought the items in the bag, and no sighting of the men ever having had the bag, yet each of them was sentenced to between 15 and 20 years—
Sir Desmond Swayne (in the Chair)
Order. The sitting is suspended for 45 minutes.
Ayoub Khan
Before the suspension, I was referring to the injustice felt in respect of the Birmingham Four. I did not do that lightly, but because of the demands of vigilance required. We all know about the Birmingham Six, who were wrongly convicted on the basis of police lies and spent 16 years in prison before being exonerated. The families of the victims and the wrongly accused are still demanding an inquiry into police failings and evidence suppression that occurred; to this day, that wait continues.
Of course we need more police on our streets, but we also need policing that is accountable, transparent and significantly worthy of public trust. The people of Birmingham Perry Barr are not asking for any special treatment; rather, they are asking for fairness and the police officers they were promised when Labour came to power. As I have said before, delivering on promises of safer streets, faster responses and support for victims must not become a postcode lottery. In practice, the message from my constituents is very simple: fix the funding formula, restore the officers we have lost, expand visible community policing, confront corruption, and rebuild the public trust on which all effective policing depends. The west midlands must not be treated as an afterthought. My constituents deserve so much more, and I urge the Government to deliver now.
Before I finish, I will just say this: we have an amazing West Midlands police and crime commissioner, who works with grassroots communities. I know that the Government have plans to get rid of police and crime commissioners, but I am certain that, in my area, the Mayor of the West Midlands cannot simply do two jobs. I encourage the Government to reflect on whether PCCs being left in post should be considered on a case-by-case basis.
The Minister for Policing and Crime (Sarah Jones)
It is a pleasure to serve under your chairmanship, Sir Desmond, and a pleasure to talk about policing, which is one of the most important aspects of any Government’s function—it is certainly the priority of this Government. When we came to power in 2024, we committed to reform policing because at the moment it is not fit for purpose. Our constituents feel, rightly, that they need a proper response to the epidemic of everyday crime in our communities. They know, and the police tell us, that we need to be better equipped to tackle the serious organised crime and sophisticated online crime increasing at regional, national and global levels.
The police, who are some of the most brilliant people in our country and do an incredible job, tell us that the technology they have is creaking at the seams. They cannot work as effectively as they want to because they do not have the necessary infrastructure or systems around them. Everything is complicated by layers of bureaucracy because databases are so out of date. I want to help our police officers and to be held accountable by our communities to improve policing. I am delighted that we have the support of most elements of policing for our police reform agenda, including the senior police to whom we speak every day. All the different organisations involved in policing agree that the structure is not right and we need to change it, so we are bringing in legislation soon to do that.
At the heart of everything we do is a commitment to improving the local policing offer. Above all else, we have to fulfil that commitment. We must establish local policing areas that are enabled to drive down crime, as the public rightly expect them to do. We will also have a regional structure that brings together some of the more sophisticated elements of our criminal investigations and has the manpower to do such investigations. At the top, we will have a national police service that brings together counter-terrorism, serious organised crime and many other functions of policing, so that it can set the standard for what policing should be.
Alongside that, we will make policing more accountable —the hon. Member for Birmingham Perry Barr (Ayoub Khan) talked about accountability in policing—through a new structure for inspection and performance assessment, so that we have our eyes wide open to the challenges in each force area and we have the levers to improve performance where needed. He talked about his local police force. To reassure him on a few issues, he and I, and all hon. Members in this Chamber, would agree that we must ensure that our local police have the resources they need. This year, West Midlands police has £883 million in funding, which is a significant increase of £36.9 million on last year.
The hon. Gentleman quoted police numbers going back to 2010. I hope he appreciates that we cannot transform the numbers overnight, given the picture that he painted, and hope that he will be pleased that our priority is to make sure that we have more police in our neighbourhoods. Since last year there are, I think, 309 more full-time officers in west midlands neighbourhoods than there were before. There has been a small overall increase in the number of police officers but a bigger increase in the number of officers who are in our communities, where we believe they should be.
Through the funding formula and direct money from Government, we are trying to incentivise more neighbourhood police. That is what our populations want, so that is where we are putting our resources. The 3,000 additional police officers and police and community support officers in our communities will begin to make a difference, but I am not for one minute suggesting that is enough. Our ambition is to have 13,000 extra police in our neighbourhoods by the end of this Parliament. I hope that the hon. Gentleman and other hon. Members will hold us to account on that ambition. Achieving it will be no easy feat, but we believe that it will transform how we do policing at local level because the police will be visible locally, able to gather intelligence about problems that are emerging, and able to tackle the epidemic of everyday crime.
Like other parts of the country, the west midlands has particular challenges, which we are responding to with the funding we provide. The serious violence programmes that we fund amount to £5 million for West Midlands police. The knife crime concentrations fund, which is the continuation of the funding that the hon. Gentleman mentioned, is a targeted fund aimed at tackling the very serious epidemic of knife crime that we know we must tackle in the communities where knife crime happens. There is a significant challenge in the west midlands, as there is in other parts of the country, and £2.8 million from the knife crime concentrations fund is going to the West Midlands police to enable targeted policing. There is also £5.4 million from the county lines programme, which enables us to join up across forces to understand the patterns of the lines that people are being coerced into running. On the one hand we do investigations to stop the criminals, and on the other hand we try to safeguard the kids being coerced into carrying drugs across county lines.
I know the hon. Gentleman will expect the Government to provide the support for the police that he rightly demands, but taken together, we have by some measure put extra money into funding the West Midlands police this year. Over and above that, we are using the resources we have to target the serious crime that we know is a problem in the west midlands, as in other parts of the country. I am focused on outcomes, rather than on the number of officers—although we are bringing a lot more officers into the neighbourhoods—and there are some quite good crime outcomes in the west midlands, not least the reduction in knife crime, which I hope the hon. Gentleman will join me in welcoming.
Question put and agreed to.
Resolved,
That this House has considered Government support for West Midlands Police.
Access to Dental Services: West Sussex
(1 day, 4 hours ago)
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Jess Brown-Fuller (Chichester) (LD)
I beg to move,
That this House has considered access to dental services in West Sussex.
It is a pleasure to serve under your chairmanship, Sir Desmond, to have secured this debate—on Sussex Day, no less; I am confident that the Minister will have some excellent responses on behalf of all constituents in Sussex—and to have the opportunity to lay out the impact of the historic failings within the dental contract before the Minister.
The state of access to NHS dental services across the country is utterly disgraceful. In Sussex, 63% of adults had not seen a dentist in the two years prior to June 2025. Similarly, four in 10 children had not seen a dentist during that time. Fourteen million people were unable to access NHS dental care in early 2025 across the UK. The result of people locked out of NHS dental services has been a rise in cases of DIY dentistry, with a survey earlier this year suggesting that 7% of UK adults had attempted some form of DIY dentistry.
All that contributes to an alarming increase in hospital admissions for tooth-related issues. Tooth decay is now the most common reason for hospital admission among children aged between six and 10, with more than 100,000 children admitted to hospital with rotting teeth between 2018 and 2024. Those figures outline a dire situation that is only getting worse. Improvements in oral health are being wiped out, and tooth decay rates are at levels not seen since the 1990s.
Jim Shannon (Strangford) (DUP)
I commend the hon. Lady on bringing this forward. She is absolutely right that there is a dental crisis not just in West Sussex, but across the whole United Kingdom. Some 14 million people cannot get an NHS dentist. Whenever I look back—and I am old enough to look back, at my age—I think that perhaps we should move back to the situation I can well remember in the past, when there were full-time NHS dental surgeries in community hospitals. They never let us down. Those positions must pay enough for dentists to be comfortable. Is that perhaps where we are going?
Jess Brown-Fuller
I thank the hon. Gentleman for his passionate advocacy for NHS dentistry in West Sussex. I am grateful to him for caring about access to NHS dentistry across the whole country. He is a fierce advocate for Strangford and makes the important point that the situation we are in is a damning indictment of the failure of the previous Government—a failure that the Prime Minister himself referred to regularly in the run-up to the general election. It was a stick that he used to beat the Conservative Government with in every televised debate, when he spoke about rotting teeth falling out of children’s mouths.
We are still going backwards, dealing with problems on a scale not seen for generations, all at a time when the British Dental Association has warned that NHS dentistry is facing an existential threat. Parliament often hears the term “postcode lottery”, but I cannot think of a more applicable example than NHS dental services for residents in Chichester and West Sussex.
Last week I had the opportunity to conduct a little bit of research with a staff member who has recently moved to London and needs to register with an NHS dentist. Within two miles of his new postcode in London, 10 surgeries were accepting NHS patients. Entering the postcode of my constituency office in Chichester into the NHS search tool produced a very different result: zero surgeries accepting new adult NHS patients within a 12-mile radius. There were none within the city itself, and only one surgery was accepting new patients under the age of 17. That means that residents not registered locally have to travel to other towns and cities. At the time of looking, the closest surgery was in Littlehampton in the constituency of the hon. Member for Bognor Regis and Littlehampton (Alison Griffiths). That is not close to the city of Chichester.
I ask the Minister what his solution would be for people attempting to register locally, people living in the area already and people moving to it after years of increased mandated development in my constituency. I would like to share with the Minister a few examples of what this means for my constituents in Chichester, who very kindly got in touch with me to share their stories. Kathryn moved with her family to the area four years ago. She still travels to Three Bridges for dental care. Christine still returns to the Isle of Wight for treatment. Marina and Denise moved to Bracklesham in 2011—15 years ago—and have never been able to register for an NHS dentist locally. Jim contacted me to say that he undertakes a 140-mile round trip just to receive routine dental care.
Ben Maguire (North Cornwall) (LD)
I commend my hon. Friend on an excellent speech. Some of my residents still travel to their NHS dentist clinic in Nottinghamshire, which is a more than 500-mile round trip from Cornwall. Does my hon. Friend agree that Cornwall integrated care board needs to sort out its underspend? This year, there was a £1.2 million underspend that could have been invested in vital NHS dental services. I understand that West Sussex is a good example: it has managed to reinvest any underspend money on the services that my hon. Friend is talking about, which are so desperately needed in West Sussex and in Cornwall.
Jess Brown-Fuller
My hon. Friend makes an excellent point about his local ICB. The underspend issue has plagued the dentistry contract over many years. The ICB for Sussex did manage to commission more urgent dental care using its underspend, meaning that it had very little to give back to the Treasury. That was absolutely the right thing to do; I commend my hon. Friend for recognising that that is an opportunity that Cornwall ICB could take. However, the Sussex ICB invested in urgent dental care while not addressing the problem that we have in routine dental care.
Residents in Chichester cannot access routine dental care in their own city and are forced to travel considerable distances. That takes time out of people’s lives, costs money, and creates additional risks. Imagine someone making that 140-mile round trip for a routine appointment, only to discover that they require an emergency procedure. They would be miles away from their home and family, and might not be capable of driving themselves home afterwards. That is completely unacceptable in today’s society.
To make matters worse, a number of individuals told me that they had been removed from their surgery’s patient list, particularly during the pandemic when they did not want to be in close contact with others. They had no notification that that was happening. Others were informed out of the blue that their surgery was switching to private care and that, unless they paid, they would need to seek treatment elsewhere. Given the costs involved, as reflected in the national figures, many simply choose to go without care altogether.
On top of that, individuals who have been lucky enough to secure an NHS place often face enormous waiting times for treatment. Jade shared her experience of being placed on a waiting list for routine root canal treatment and then being ignored for months. At 28-weeks pregnant, she suddenly found herself in excruciating pain and required emergency surgery. As we know, that costs the taxpayer a lot more than if the issue is addressed before it becomes an emergency. Another mother contacted me to say that three years ago her son developed an abscess over Christmas. They were unable to secure emergency treatment so they joined a waiting list at three separate practices. They still have not secured an appointment.
Those examples all point to a broken system in Chichester and across the country—one that is failing my constituents and worsening health outcomes. In the long run, it is also making the country poorer: the failure to invest in preventive care means that individuals require more serious and expensive treatment further down the line. This has to end. That view is shared by the dentists I spoke to ahead of today’s debate. A key issue raised by them and many across the profession is the state of the NHS dental contract. The British Dental Association identified it as a major factor driving NHS dentists into the private sector. The current settlement has been widely criticised since its inception back in 2006. The Health and Social Care Committee published a report in 2023 calling for an urgent overhaul of the system, and the Labour party promised to renegotiate the contract in its manifesto.
One former dental nurse who contacted me described the contracts as being like
“tying dentists’ hands behind their backs.”
That is hardly practical if they are trying to perform a root canal procedure. The contracts are failing patients because the number of patients a dentist can see on the NHS is limited according to the units of dental activity that they have been commissioned to deliver. The nurse I spoke to suggested patients are being referred to hospitals for routine procedures because contractual arrangements prevent practices from carrying them out themselves and being renumerated.
The Government promised to reform the contracts, but they have been slow to address problems that are widely recognised across the sector. The consultation that the Government announced in April must lead to a contract that is genuinely patient-focused, with greater flexibility in commissioning. When it was announced, the Government committed to bringing out the consultation before the summer, but the official line has changed slightly to “in due course”. I share the concern raised by campaigners that any further delay will mean that a new system will not be implemented before the end of this Parliament. Will the Minister commit to bringing out the consultation before the summer and to a firm deadline for when formal contract renegotiations will begin? Frankly, we cannot afford any further delays.
Another issue is costs. Lab costs went up 9% last year, but NHS contract holders got just a 3.55% uplift—add to that the hikes in national insurance contributions, which have exacerbated an already dismal situation. The British Dental Association believes that an average NHS dentist is losing £25 per routine dental check. Without support and changes to the contracts, many practices will continue to be pushed into the private sector, as we have already seen happen to many. In West Sussex, the number of dentists with NHS activity has dropped by 13% since 2019. I imagine that that figure is actually an underestimation, because a practice can offer just one NHS appointment a year and still feature on the list of NHS providers.
Local dentists are also concerned that the merger of the Surrey and Sussex ICBs, alongside a 50% reduction in ICB running costs, could undermine the local commissioning expertise and local relationships with providers. Can the Minister today provide any reassurance that, at a time of significant change within our ICBs, they will be given the resource to maintain and improve relationships with contract providers?
The Government talk a good game on dentistry, but they are tinkering around the edges and leaving major issues such as the contracts so far unresolved. They quietly dropped their manifesto pledge of delivering 700,000 more dental appointments, under the guise of broadening the definition of urgent dental appointments for clinical reasons. That is a sticking plaster that addresses the requirement for more urgent dental appointments, but does not address those who cannot get routine care, which in many cases would prevent them from needing the emergency care.
The Liberal Democrats have long called for reforms that will address the root of the crisis. Our £750 million plan would begin to undo years of underfunding, guarantee urgent and emergency dental care for everyone who needed it, and hopefully bring an end to DIY dentistry. That would be needed to address the backlogs in emergency care. I have heard of wait times of up to 18 months at St Richard’s in Chichester for complex dental treatment such as difficult extractions.
It is clear that the system is broken. Nobody is naive enough to believe that it can be addressed overnight, but the Government have had two years. All the while, residents in Chichester continue to have a lack of access to basic dental services. Dentists want to help patients, but it is not currently financially viable for many to stay in the NHS. That has to change, and I urge the Government to listen carefully to contributions from all Members in today’s debate, and take the steps that they promised in their manifesto.
John Milne (Horsham) (LD)
It is a pleasure to serve under your chairmanship, Sir Desmond. I thank my hon. Friend the Member for Chichester (Jess Brown-Fuller) for shining a light on this important subject, which causes such distress for residents of West Sussex.
The Department for Health, like many Government Departments, has promised a consultation, as well as extensive reform of the dental contract. I appreciate that the Minister wants to get this right. He has said that the dental system is complex. He has also made it clear in the past that these changes will not be rushed. Speaking to dentists across my constituency and beyond, very few people would say that taking two years just to start a consultation could be called rushing.
The Government need to be clear with both dentists and patients. Dentists were told that the consultation would come last year; then they were told that it would come before the start of summer—but summer is more or less upon us, and we are still waiting. At this rate, the Government risk making no meaningful reforms to dentistry within this Parliament. This sense of political inertia is, of course, not confined to one Department, and we do not have to look far to imagine the reason for that.
Alongside those delays sits an equally serious issue: funding. The Government have been clear that no new funding is available for dental reform; I imagine that the Minister himself finds that deeply frustrating. Only about 40% of adults are effectively provided for within the current NHS dental budget, and even that is propped up by an estimated £1 billion cross-subsidy from private provision. The Public Accounts Committee was clear in its assessment: without frontloaded investment, meaningful reform has no chance of success.
What does this mean for residents in my constituency of Horsham? The honest answer is that we do not fully know, which is frustrating to say the least. Under the previous Conservative administration, West Sussex county council had not carried out a comprehensive oral health survey since before 2019. I have written to the new Lib Dem-led council asking it to ensure that West Sussex is included in the next survey, because without reliable data, we simply cannot design effective or targeted reforms.
The data that we do have is deeply concerning. A quarter of children in West Sussex are at high risk of tooth decay compared with a national average of roughly half that level. From an early age, we are sending out the message that oral health is not a priority. At the same time, we are seeing a growing reliance on urgent dental care, but as a substitute for routine check-ups. Preventive dentistry—the very foundation of a sustainable system—simply cannot function under those conditions. We risk raising a generation that engages with dental services only at a moment of crisis, and that will have profound long-term health consequences.
I am very much seeing the impact of this in my Horsham casework. One of my constituents, Gail, was recently removed, along with her daughter, from the dental register. It was not from any fault of her own, but simply because there are not enough dentists left who are willing to operate on NHS contracts. That is distressing enough for patients, but it is also deeply frustrating for dental professionals, who find themselves forced to turn away patients who they can see are in urgent need.
Another constituent, Medi, does have access to a dentist, but not locally, and we have heard the same from other Members. She has to travel three hours for her appointments in another part of the country completely. She suffers from arthritis, so the journey is not just inconvenient, but very painful. However, she cannot find anyone closer, and even the waiting lists are vague about when a place may eventually be available.
I have also heard directly from dentists in Horsham. One practitioner, who has worked in the NHS for over 15 years and has trained NHS dental graduates, told me that, each year, funding has become more constrained and the administrative burden continues to grow. Without proper support for preventive care, he warned, dentists simply “don’t stand a chance”.
Carla Lockhart (Upper Bann) (DUP)
The hon. Member is making a powerful point for his constituents. Similarly, in Northern Ireland only 50% of adults are registered with NHS dentists. Almost 400,000 registrations have been lost since 2023, and ultimately practices are leaving NHS dentistry because it is financially unsustainable. Would he agree with me that there needs to be a UK-wide look at this? While health is a devolved issue in Northern Ireland, there needs to be learning from the UK, because this is not just about waiting times, but about people finding a dentist who will actually take them on. Does he agree with me that we need a UK-wide resolution?
John Milne
I very much agree that this is a national crisis. Some local authorities or local ICBs are better than others, but this is basically a national problem and needs national action.
The dentist I mentioned has told me that many of his peers have already stopped offering NHS services, and the ones left are increasingly considering doing exactly the same. That tells us that the entire dental system is slipping into freefall. The broader figures reinforce the local picture. Only 40% of adults in West Sussex have seen a dentist in the past two years, which is a fall of 7%. Among children, the figure has dropped from 63% to 58%. Over the past five years, the number of residents per dentist in West Sussex has increased by a fifth. That is a huge jump, and further evidence that the system is heading for collapse.
From my conversations with the chief executive officer of the newly merged Surrey and Sussex ICB, I know that dentistry is a priority area for her and that the team are doing their best to introduce flexibility where possible. However, they face cuts of up 50% in budgets and staffing, which are enormous challenges not just for the leadership, but for the NHS teams on the ground. There is real concern that, unless we change now, dentistry risks becoming an expensive luxury, rather than a universally accessible service.
To conclude, the combination of delayed reforms and reduced funding is leaving patients without access to care and professionals without the support they need to provide it. Oral health inequalities continue to widen. I appreciate that this Government are once again picking up the pieces from their Conservative predecessors, but the obligation now falls on today’s Ministers. Unless we see a change in trajectory, we will be left with exactly what the Public Accounts Committee warned us about—no money, no reform, no teeth.
Alison Griffiths (Bognor Regis and Littlehampton) (Con)
It is a pleasure to serve under your chairmanship, Sir Desmond. I congratulate the hon. Member for Chichester (Jess Brown-Fuller), my constituency neighbour, on securing this very important debate. Access to NHS dentistry is one of the issues that my constituents raise with me most often, and when they do, they are not talking about contract reform, commissioning arrangements or NHS structures. They are talking about pain, cost, worry and ringing practice after practice but still not being able to get an appointment.
Anthony in Littlehampton contacted me after being told that he needed a crown. He is on personal independence payment and employment and support allowance. The treatment that he needs would cost hundreds of pounds. His question was simple: how is he meant to afford that? Clare in Bognor Regis did everything that patients are told to do. She remained with her NHS dentist and kept up with her appointments. Yet she was then told that NHS provision at her practice was being reduced and that she would be placed on a waiting list. Jill in Middleton-on-Sea is a pensioner who has spent years trying to navigate a system in which practices close, go private or stop taking NHS patients altogether. She is still trying to find care that she can afford.
Those are not isolated cases. They show what happens when NHS dentistry becomes too difficult to access. People wait, put treatment off and make compromises that they should not have to make, and then routine problems become urgent ones. We too often talk about dental care as though it sits separately from the rest of the NHS. It does not. Poor oral health affects confidence, nutrition, wellbeing and wider health outcomes, including in respect of heart disease and septicaemia.
One constituent who contacted me, Andrew from Bognor Regis, was undergoing treatment for two separate cancers. Through no fault of his own, regular dental appointments had—understandably—fallen by the wayside while he focused on fighting those illnesses. When he later tried to access NHS dental care again, he found himself in effect locked out of the system—abandoned at precisely the moment he needed support the most. What struck me was not simply his concern about finding dental care, but the wider impact that poor access can have on a patient’s healthcare journey. A patient battling cancer should not also be worrying about whether they can access a dentist.
However, there has been some local progress and I would like to recognise it. In Bognor Regis, mydentist is now delivering additional NHS dental activity and offering about 56 urgent appointments each week. That matters. Urgent appointments help people to get treatment when they need it the most, and stop problems becoming even more serious. The local ICB has also confirmed that new NHS dental contracts have been awarded for both Bognor Regis and Littlehampton, with services expected to open next year. That is welcome. But let us be honest: we are not where we need to be. My constituents should not have to become dental detectives simply to find treatment. They should not have to wait until pain becomes an emergency before the system responds. Urgent care is important, but must not become a substitute for routine access.
We also need to get much more serious about prevention. That starts with children. It starts in the early years with good habits, education and helping families to understand the importance of looking after their oral health. Prevention is better for patients, and it is also better for taxpayers.
Finally, we need to make every appointment count. I recently met Katie Cook, the practice manager at the new mydentist in Bognor Regis, and she told me that around 5% of appointments each week are lost because patients simply do not attend. This is not about blaming people—life happens—but a cancelled appointment can often be reused; a missed appointment cannot. When so many residents are desperate to be seen, that lost time matters. The national dental contract still needs reform, access needs to improve and patients need clearer routes to care when they cannot find an NHS dentist.
I will finish by asking the Minister three questions. First, what further steps will the Government take to improve access to routine NHS dentistry so that people are not forced to wait until a problem becomes an emergency before they can be seen? Secondly, what more can be done to support prevention, particularly among children and young people, so that we stop problems from developing in the first place? Thirdly, what assurances can the Minister give that areas such as West Sussex will receive the additional capacity needed to bring down waiting lists and improve access to NHS appointments?
My constituents do not expect miracles—they understand the pressures facing the NHS—but they do expect to be able to see a dentist when they need one. They expect a system that prevents problems rather than simply responding to crises, and they expect access to NHS dentistry to be determined by need, not by whether they can afford to go private. That is the standard my constituents deserve, and it is the standard they expect this Government to deliver.
Alison Bennett (Mid Sussex) (LD)
It is a pleasure to serve under your chairmanship on Sussex Day, Sir Desmond. I start by congratulating my hon. Friend the Member for Chichester (Jess Brown-Fuller) on securing this important debate on access to dentistry services in West Sussex. I also thank my fellow West Sussex MPs, my hon. Friend the Member for Horsham (John Milne) and the hon. Member for Bognor Regis and Littlehampton (Alison Griffiths), for taking part in the debate. Of course, I particularly thank the hon. Members for Strangford (Jim Shannon) and for Upper Bann (Carla Lockhart), and my hon. Friend the Member for North Cornwall (Ben Maguire), for their interest in the debate and for making links between our experience in West Sussex and their experiences in their constituencies.
My constituents in Mid Sussex know all too well about the challenge of accessing dental services both for them and their children. An incredible 133,560 children covered by the NHS Sussex integrated care board did not see a dentist last year. That is 41% of them. The figure was even worse in 2024, with more than 140,000 children not seeing a dentist. Dozens of my constituents have contacted me to say that their local dentists are no longer taking NHS patients, leaving them and their children without the vital preventive dental care that they need and that we know saves the NHS a fortune down the line.
Recently, a constituent contacted me after spending months trying to find an NHS dentist. Practice after practice told her the same thing—that no NHS places were available. Faced with either a long wait or private fees she simply could not afford, she was left with nowhere to turn. Sadly, as we have heard during the debate, that story is anything but unique.
Carla Lockhart
I apologise for intervening again, but I want to make a point about cancer patients, similar to the one made by the hon. Member for Bognor Regis and Littlehampton (Alison Griffiths). The teeth of cancer patients are heavily impacted by the strength of the drugs, so does the hon. Lady agree that the Government need specifically to consider how they can support cancer patients post-treatment and that cancer patients should be able to access free dental care quickly and efficiently?
Alison Bennett
The hon. Lady makes a really good point. We know that cancer treatment is a real priority for this Government and it certainly makes sense that her suggestion is considered.
I hear from parents who are worried about finding appointments for their children; I hear from pensioners who are living with pain while waiting for treatment; and I hear from families who are forced to choose between paying for private dental care and paying for other essentials. There is currently only one dental practice in Burgess Hill accepting under-17s and the same is true in Haywards Heath; they are the two main towns in my constituency. For too many people in Mid Sussex, access to an NHS dentist feels less like a right and more like a lottery.
When discussing this crisis, we often hear the phrase “DIY dentistry”. Its use has become so commonplace that we risk forgetting what it actually means. It means people pulling out their own teeth with pliers, or gluing crowns back into place. It means people attempting to treat serious dental problems themselves, because they cannot access professional care. A recent survey found that around 7% of UK adults had attempted some form of DIY dentistry. Over a third of those had tried to extract a painful tooth themselves; others had attempted to drain abscesses or repair fillings at home. People are doing these things because they are in pain and because they feel that they simply have no alternative.
The scale of the challenge to turn that situation around is enormous. As my hon. Friend the Member for Chichester noted, recent NHS figures show that around 60% of adults have not seen a dentist in the last two years, and over 5 million children did not see a dentist at all in the year to June 2025. Tooth decay remains the most common reason for hospital admission among children aged six to 10. That is truly shameful.
The previous Conservative Government left NHS dentistry in a deeply fragile state. Years of neglect and a fundamentally flawed dental contract drove dentists away from NHS provision, leaving patients to pay the price. Although the current Government inherited this crisis, they simply cannot inherit the excuses. The public were promised 700,000 additional urgent dental appointments, yet only around 100,000 have been delivered so far. Ministers might point to commissioning figures, but patients judge success by whether they can get an appointment when they need one. Far too many people across West Sussex still cannot do so.
I welcome any increase in dental places, and the Government have made moves in that respect. However, I am sure that we all accept that there will be a long pipeline before the trainees of today become the fully fledged dentists who are able to carry out work doing NHS contracts.
More importantly, training more dentists alone will not solve the problem. The dental contract remains broken, as we have already heard today. Dentists continue to tell us that the current system discourages them from doing NHS work and fails to reflect the complexity of the treatment that they provide. Unless the Government are prepared to commission and fund more NHS dentistry, increasing the number of dentists will not automatically increase access for patients. That is why contract change is so important.
In April, Ministers announced a consultation on changing the contract, with proposals expected before the summer. Midsummer’s day is next week. Patients waiting in pain cannot afford further delays, and dentists who are considering their future in the NHS cannot afford further uncertainty. The Government must set out a clear timetable for reform and ensure that implementation is not kicked into the long grass.
The Liberal Democrats believe that there is a better way forward. We have proposed a £750 million dental rescue package to end dental deserts and restore access to NHS dentistry. We would guarantee access to an NHS dentist for everyone requiring urgent or emergency care. We would fix the broken dental contract, expand training places, continue recognition of EU-qualified dentists and put proper workforce planning into law. We would also guarantee free dental check-ups for children, pregnant women, new mothers and those on low incomes while investing in prevention and oral public health, because if we are serious about solving this crisis, we must stop treating dentistry as an afterthought.
This debate is about real people in Mid Sussex and across West Sussex and the country. It is about the parent in Haywards Heath who cannot find an NHS dentist for their child, and the older resident in Burgess Hill who is living with pain while waiting for treatment. It is about families who are doing everything right, but finding that accessing basic NHS dental care is increasingly impossible. No one in Mid Sussex should ever be forced into DIY dentistry, and no child should end up in hospital because routine dental care was unavailable.
I would be grateful if the Minister could address three points. First, when will the Government publish and implement proposals for dental contract changes? Secondly, how will Ministers ensure that additional training places result in greater NHS capacity, rather than simply increasing the number of dentists working outside the NHS? Thirdly, what specific action is being taken to tackle unmet dental need and dental deserts in areas such as West Sussex? People in Mid Sussex and across our region deserve access to timely, affordable NHS dental care. I hope the Government will respond to this crisis with the urgency it demands.
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship, Sir Desmond. I thank the hon. Member for Chichester (Jess Brown-Fuller) for securing this important debate, and for outlining the issues that her constituents—and, indeed, many constituents across the country—are facing. It is something of an irony that I find myself speaking on NHS dentistry for the second time in as many days, having co-sponsored yesterday’s Backbench Business debate on precisely this issue, but if anything, that underlines the scale of the issue we are dealing with.
The hon. Member for Chichester will know that West Sussex borders my constituency, which spans Surrey and Hampshire. Many of my constituents in Haslemere and the surrounding villages routinely access services across that boundary, and would regard West Sussex as part of their natural health economy. I am sure the same is true vice versa, because dentistry does not respect administrative lines, and access to care either exists or it does not.
Let us be clear about the scale of the problem. Oral health is not a luxury issue; as my hon. Friend the Member for Bognor Regis and Littlehampton (Alison Griffiths) set out so clearly and passionately, it is fundamental to dignity, confidence, employability and overall health, yet access to NHS dentistry has become a postcode lottery. Nearly 14 million people are struggling to access care, and in many areas more than 70% of practices are not accepting new NHS patients, including children. As far as I can tell, not a single dentist in my constituency of Farnham and Bordon is accepting new NHS patients.
It is often suggested that we simply have a workforce shortage, but the issue is not that we do not have enough dentists; it is that, understandably, too few are willing to work within a contract that no longer makes sense. The 2006 NHS dental contract, introduced under the last Labour Government, is based on units of dental activity. It pays the same whether a dentist carries out one filling or six, rewards volume rather than complexity, and actively discourages preventive care. That contract is central to why the system is struggling.
The Government came into office promising a dental rescue plan, including urgent appointments, contract reform, workforce expansion and a greater focus on prevention. Those commitments were clear and repeated, yet delivery has not matched the rhetoric. In practice, the additional appointments that have been rolled out amount in many cases to only a small increase in urgent capacity. According to the British Dental Association, they are equivalent to a couple of extra slots per dentist per month. At the same time, the long-promised NHS workforce plan has still not been published and, without it, there is no credible road map for how capacity will be met. Warm words about recruitment are no substitute for a clear and funded strategy that tells practices and patients what the future looks like.
We also need to recognise inefficiencies within the current system. In some practices, around one in seven NHS appointments is missed, costing individual surgeries tens of thousands of pounds a year. That is not just a frustration for clinicians—it is lost capacity in a system that is already under extreme pressure. However, rather than addressing the structural incentives that contribute to this, the Government’s response has been piecemeal. The consequences of all this are not evenly distributed; rural and coastal communities are particularly badly affected, with some having as few as 10 NHS dental practices per 100,000 people. These so-called dental deserts are not accidental, but the predictable outcome of a system that does not align funding, workforce planning and local need.
There is a striking example of underused capacity in my local area. In Haslemere, the hospital contains a fully equipped dental suite that remains unused despite clear local demand. That facility could serve patients across the West Sussex border, given the natural geography of where people access care. Instead, it sits idle.
I think everyone in this Chamber agrees with prevention in principle, and with the need to move away from a purely treatment-based model. The challenge is delivery. Likewise, workforce expansion is essential, but announcements without a credible plan do not translate into appointments. Ultimately, what is required is straightforward in principle, but urgent in practice: a properly funded and credible workforce plan, contract reform that rewards prevention and complexity rather than volume, and a serious strategy to address dental deserts that reflects real geography and need.
We should also acknowledge the previous efforts of the Conservative Government, including the dental recovery plan, which did attempt to address these issues through recruitment incentives, training expansion and support of overseas qualified dentists. I accept that some measures had limited uptake, but they were at least an attempt to respond to a growing crisis. The question now is whether this Government build on what works or continue to drift without clear direction. Patients do not care which Government designed which contract or which plan; they care about seeing a dentist when they need one.
I end with three straightforward questions that I asked the Minister in yesterday’s debate, but to which I did not get an answer. When will we see a fully funded and credible NHS dental workforce plan? How many additional dentists, hygienists and therapists are required to meet demand? What is the plan to ensure that dental deserts do not become a permanent feature of our healthcare system? Patients deserve these answers not in the future, but today.
The Minister for Care (Stephen Kinnock)
It is a real pleasure to serve under your chairmanship, Sir Desmond. I thank the hon. Member for Chichester (Jess Brown-Fuller) for securing this important debate and I am delighted to wish her a happy Sussex Day. We may come from different political traditions, but she occupies Gillian Keegan’s former parliamentary seat, and I occupy Gillian’s former office in the Department of Health and Social Care, so we at least have that in common.
This is the second debate that I have responded to on dentistry in as many days—I was in the Chamber yesterday, and I am here in Westminster Hall today. That shows what a critical matter this is to our constituents, which is why this Government are taking clear action. On access to NHS dentistry, I point to 1.8 million extra treatments in the first seven months of the last financial year. In fact, taking the last full year into consideration, we are on track to deliver more than 2.5 million more dental treatments than in the year leading up to the general election.
Alison Griffiths
As this is a debate on dentistry in West Sussex, I invite the Minister to share the numbers that relate specifically to West Sussex rather than to the country.
Stephen Kinnock
I am so delighted that the hon. Lady intervened, as I was about to come to that. We have reduced the underspend—one of the many utterly shocking things I found across my portfolio when we came into office in July 2024 was a £392 million underspend on NHS dentistry. We had an absurd situation where demand for NHS dentistry was going through the roof, but because of utter incompetence, the previous Government were underspending by £392 million. We were hands-on on that. We have the ICBs commissioning; we have micromanaged this. I am delighted to say that we have got the underspend down to just £36 million in 2024-25. That is how we have managed to massively boost the number of treatments.
According to the most recent data available, the Sussex integrated care board, which serves the constituency of the hon. Member for Chichester, has delivered over 67,200 more NHS dental treatments. That is 11% more treatments between April and October last year compared with the same period before the general election. I hope that answered the question from the hon. Member for Bognor Regis and Littlehampton (Alison Griffiths).
While we have made significant progress, I do not downplay for a second the issues faced by the constituents of the hon. Member for Chichester. Whenever I reel off these statistics in a debate or on the morning media round, I can hear people saying, “Okay, you say that, but where is my dentist appointment?” I understand that there are pockets of progress and areas where we are not at all where we need to be. But it is important to be realistic: 14 years of neglect cannot be put right overnight. The result of that neglect has been people doing DIY dentistry, and the No. 1 reason why children aged five to nine are going to hospital is tooth decay. It is a shocking and Dickensian state of affairs, frankly, and the Government take it very seriously.
As I said in the main Chamber yesterday, the solution is not to bring out sticking plasters and press releases, and to tinker around the edges. The sector needs long-term reform, and the Government have laid the groundwork for a recovery that is based on solid foundations, not the sort of gimmicks that we saw under the previous Government. For example, the patient premium cost £126 million and we did not see any increase in new patients. We had to scrap that because it was a waste of time and money.
The most important thing we can do to end dental deserts is train the next generation of dentists in the relevant areas. We are taking steps to increase the supply of dentists across the country. Earlier this month, I announced the first sustained expansion of dental school places since 2007. Let that sink in for a minute. It is 20 years since we had any increase at all in dental school places, apart from a one-off increase after covid. Backed by £11 million, a total of 50 dental school places per year have been allocated equally to the University of Portsmouth and the University of East Anglia.
Alison Griffiths
In Bognor Regis and Littlehampton, and in significant parts of Chichester, we have coastal areas. In our manifesto, the Conservative party pledged golden handshakes to attract dentists to coastal constituencies, because we know that is one of the issues. Could you tell please me what specific proposals you have to attract dentists to coastal constituencies?
Stephen Kinnock
We will be publishing the data on the golden hellos in August, along with all the other data. There is a time lag from the end of the financial year to when we have collated all the data—it takes a few months—so there will be data in August on a number of issues we have discussed today. The challenge of golden hellos is that we run into problems around the contract, incentivising people to do NHS dentistry, and getting people to live and work in certain parts of the country when they might be more attracted to a big city. We are aware of the challenges for coastal areas.
On the Portsmouth announcement, I have never driven from Portsmouth to Chichester, but I understand it is about a 20-minute drive, depending on the traffic—
Stephen Kinnock
Yes, but before the hon. Lady intervenes, I will say that I am fully aware that Portsmouth is in Hampshire, so I ask her not to give me a deluge of letters from her constituents.
Jess Brown-Fuller
I promise that I will not give the Minister a lesson in geography, although what he said suggests that he may not have frequented the A27. If somebody can get to a dentist in Portsmouth in 20 minutes, they are setting off at 3 am to do so, because that is the only time it can be done in about 20 minutes.
Stephen Kinnock
We clearly need to check our GPS on that one. I understand that there are challenges, but the point is that, for the first time in decades, Chichester has a school in its vicinity that is training dentists who will be within striking distance. Who knows where all the dentists will end up living when they have done the training? But our data suggests a strong correlation and causation between where somebody goes to dental school and where they end up putting down roots and working, living and settling. That is very much our hope for the 25 places that are, for the first time in 20 years, going to the University of Portsmouth, which I was pleased to visit just a few weeks ago.
Jess Brown-Fuller
I am sure the Minister will join me in congratulating Chichester college, which is creating a programme to train up the next generation of dental assistants and nurses. Staff there are excited to be able to contribute to addressing the recruitment issues in the Chichester area.
Stephen Kinnock
I strongly echo the hon. Lady’s congratulations to Chichester college. Of course, technicians, nurses and therapists play a crucial role; dentists’ practices function not just because of the dentist but because of the whole team.
It was, frankly, a travesty that the hon. Lady’s local area did not have a dental school, and it was a problem that Governments ignored for far too long. I am delighted that we have put that right, and hope she will recognise what a game changer it is. Whereas before, people had to train elsewhere and make an active decision to move to Chichester to practice dentistry, we hope that local people can now train up in the area and stay there if they wish to. That is a real incentive for people in Chichester to choose a career in dentistry, and to stay and serve in Sussex among the people they grew up with. It will also attract young people from across the country, who may choose to continue their careers, make their homes and put down roots in the area.
Similarly, the most important thing we can do for the long-term dental health of the hon. Lady’s constituents is to make the shift from treatment to prevention. In 2024, more than one in 10 children aged five years old in Sussex ICB had experience of tooth decay, despite it being largely preventable. We are backing supervised toothbrushing through a national programme that will reach up to 600,000 children in the most deprived areas of England, backed by £21.5 million. Over £290,000 has been invested across West Sussex, East Sussex and Brighton and Hove, and over 45,000 free toothbrushes and toothpastes have been delivered through our innovative partnership with Colgate-Palmolive. We are beefing up the soft drinks industry levy to remove more sugar from children’s diets and updating standards so that there is healthier food and drink in schools.
This year, we are undertaking vital reforms in dentistry. Two months ago, we embedded urgent dental care into NHS practices, making it easier for patients to get support where they need it most. The problem we heard time and again from the sector was that dentists were not incentivised to undertake NHS work, so we brought forward a package of reforms, from which I will highlight two measures. First, dentists are set to receive higher payments for treating patients who need urgent care, taking the payment for a unit of dental activity from approximately £42 to approximately £75. Dentists now have the extra incentive to provide urgent care for issues such as severe pain, infections or dental trauma on the NHS.
Secondly, from this month, those receiving complex care, such as treatments for severe gum disease or decay in multiple teeth, will be able to schedule a single planned package of treatment and pay one patient charge for it, rather than having several courses of treatment and paying a patient charge for each. That could save people more than £200 per year—money going straight back into the pockets of working people. We are also paying dentists more fairly for this work, to incentivise them. The appointments also mean that we are easing some of the pressures on St Richard’s hospital in the hon. Lady’s constituency, because we are preventing more painful conditions from spiralling into avoidable hospital admissions.
In a nutshell, our 2026 reforms are putting patients first and supporting those with the greatest need while backing our NHS dentists, making the contract more attractive and effective, and giving them the resources to deliver more.
The Government remain committed to rebuilding NHS dentistry after years of neglect. We have made a start with reforms to the dental contract that prioritise patients with the greatest need, support better access to urgent care and deliver a better deal for dentists. Alongside that, we are taking targeted steps to support areas where access is most challenging, including through workforce incentives, new school places and reforms to the exams process for overseas-qualified dentists, which will deliver an additional 2,000 dentists per year by 2028. And we are just getting started: as I have said previously at the Dispatch Box, I remain firmly committed to delivering fundamental reform of the dental contract before the end of this Parliament.
However, meaningful reform requires careful consideration. The challenges facing NHS dentistry are complex, and there is no single universally agreed solution or perfect payment model. That is why it is important that we take the time necessary to develop reforms that are effective and sustainable, and that work for patients and the profession. I will continue to engage closely with dentists, representative bodies and patients to ensure that the reforms we bring forward address long-standing concerns and support the long-term future of NHS dentistry.
Jess Brown-Fuller
I thank all the Members who took part in the debate. This will not be something the Minister has not heard before, but I ask him to take this away: when constituents write to me saying that they are unable to register with an NHS dentist, if I send an email back to them saying, “But the Minister told me there were 67,000 more NHS dentist appointments in Sussex,” I am not getting an email back saying, “Bloody brilliant—I’ll forget it then. Don’t worry.” People are still frustrated and waiting. I am really glad that the Minister has committed to reforming the system, because it desperately needs it, and I look forward to holding his feet to the fire as he does so.
Question put and agreed to.
Resolved,
That this House has considered access to dental services in West Sussex.
Written Statements
Plug-in Solar: Consultation
(1 day, 4 hours ago)
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The Parliamentary Under-Secretary of State for Energy Security and Net Zero (Martin McCluskey)
Today I am announcing the publication of a consultation on proposals to enable the safe deployment of plug-in solar across the United Kingdom.
Plug-in solar brings the benefits of clean power directly to consumers across the country. Enabling more households than ever before to generate their own cheap, clean electricity from the sun could save households up to £110 per annum. Plug-in solar is already widely used by households across Europe, with Germany seeing around half a million new devices plugged in per year. However, existing regulatory frameworks were not designed with these technologies in mind. We are changing this, with safety at the forefront of our minds.
This consultation seeks views on proposed amendments to the Plugs and Sockets etc. (Safety) Regulations 1994 and a draft UK plug-in solar interim product specification, both of which will facilitate the introduction of plug-in solar products in a safe and proportionate way. The draft product specification has been drawn from established approaches in Germany, where plug-in solar is already widely deployed, demonstrating that these systems can be used safely when appropriate standards are in place, and adapted to ensure it reflects UK regulatory requirements, building practices and safety expectations.
The interim standard, together with the development of a long-term product standard, which we are developing in parallel, will ensure that plug-in solar is safely available and ensures a seamless transition while a full product standard is developed and fully consulted on.
We are seeking evidence on key issues including minimum product specification, consumer protection and market issues and implementation and timing. This will ensure that any regulatory changes are informed by a robust evidence base and reflect the views of industry, consumer groups, and other interested parties.
In the context of recent developments in Iran and wider energy pressures, we are making every effort to accelerate deployment of plug-in solar, ensuring that where it is safe and appropriate to do so products can reach the market and retail as quickly as possible.
The Government are committed to the development of a well-functioning and safe market. We will carry out targeted engagement and expert workshops while the consultation is running.
I am committed to making plug-in solar available within months, giving consumers a practical option to increase their energy independence, reduce their energy bills and benefit from this country’s vast clean power resources.
[HCWS118]
Thames Water
(1 day, 4 hours ago)
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The Secretary of State for Environment, Food and Rural Affairs (Emma Reynolds)
I wsill be making an oral statement on this subject later today.
[HCWS116]
Group-based Child Sexual Exploitation and Abuse
(1 day, 4 hours ago)
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The Secretary of State for the Home Department (Shabana Mahmood)
Today marks one year since the publication of Baroness Casey’s national audit on group-based child sexual exploitation and abuse, and one year since this Government accepted all 12 recommendations.
This was a landmark report, exposing more than a decade of inaction in the face of these appalling crimes, and it is right that these findings continue to command the highest level of attention.
Time after time, victims and survivors were let down by the very institutions responsible for keeping them safe, despite repeated warnings and long-standing recommendations for action. This Government have been clear that we will not lose any more time in pursuing truth and justice for victims and survivors, who deserve so much better. I remain determined that we confront these failings directly and decisively. We must be clear-eyed about what went wrong, ensure full accountability, and drive the lasting change that is so urgently needed.
I want to take this opportunity to update the House on the Government’s progress in delivering all 12 of Baroness Casey’s recommendations, and driving the change that victims and survivors deserve.
In response to recommendation 1, we have legislated in the Crime and Policing Act 2026 to create new offences in England and Wales covering rape and other penetrative sexual activity with a child under 16 by an adult regardless of apparent consent, where that adult did not reasonably believe that the child was aged 16 or over, as long as they are at least 13. We will conduct a post-implementation review of the new offences to test what impact they are having, including looking at how the element of “reasonable belief in age” works in practice. We will also launch a public consultation on how to treat close-in-age relationships.
In response to recommendation 2, we have established a national police operation into group-based child sexual exploitation and abuse, Operation Beaconport, overseen by the National Crime Agency and delivered in partnership with policing, backed by £37.7 million this year. This is a tenfold increase from last year—financial year 2025-26—and is part of a £100 million funding package to drive a crackdown on child sexual abuse. This investment will support the collaborative work of Operation Beaconport to reset the way in which policing responds to group-based child sexual exploitation and abuse including by reviewing closed cases, building capability, embedding trauma-informed practice and approaching child sexual exploitation like serious and organised crime. We have also established the statutory independent inquiry into grooming gangs, backed by a £65 million commitment, with a chair and panel who are committed to getting the answers that victims and survivors have so long fought for.
In response to recommendation 3, we have legislated through the Crime and Policing Act 2026 to disregard convictions and cautions for loitering or soliciting for the purpose of prostitution—contrary to section 1 of the Street Offences Act 1959—where the offender was under 18 at the time of the offence. The section 1 offence was amended by the Serious Crime Act 2015 so that it no longer applied to persons under 18. Section 68 of the 2015 Act removed from the Sexual Offences Act 2003 anachronistic references to “child prostitution”, instead recognising such children as victims of child sexual exploitation.
For cases not covered by the disregard scheme, the appropriate route is to apply to the Criminal Cases Review Commission. Last month, the Criminal Cases Review Commission referred its first conviction of a grooming gang victim to the courts since Baroness Casey’s audit.
In response to recommendation 4, we continue to work with police forces to improve collection of ethnicity data for suspects of these crimes, and we have committed—through the police reform White Paper—to legislate through the police reform Bill to ensure we have the necessary powers to mandate the collection of this and other forms of data. In the meantime, we will hold police forces to account for improving performance in the collection of this data as a priority.
In response to recommendation 5, we have secured the new information-sharing duty through the Children’s Wellbeing and Schools Act 2026, to ensure it is unequivocally clear that information must be shared where it is necessary to safeguard and promote the welfare of children.
Parliamentary progress to pass this vital piece of legislation was slower than the Government would have liked. However, since Royal Assent, the Department for Education has worked swiftly to develop draft statutory guidance that is now out for consultation. This pace will enable the information-sharing duty to be commenced in September 2026. In parallel, the Government response to the consultation on the child protection authority will be published this summer. Updates to children’s services inspections and the regulations for the relevant workforces will reflect these changes in legislation.
In response to recommendation 6, the passing of the Children’s Wellbeing and Schools Act 2026 means that there is legislative provision for a single unique identifier that will improve information sharing. In April 2025, the Department initiated a series of test and learn pilots, starting with Wigan local authority, to establish how a single unique identifier can be implemented effectively. Initial pilots explored access to the NHS number for local authorities and matching rates between school census data, data held by children’s social care, and the NHS personal demographics system, which holds all NHS numbers. Building on this learning, work is now progressing in close partnership with the Department of Health and Social Care and NHS England to design and deliver the next phase of implementation.
We have been explicit in our ambition to move at pace, with a clear intention to bring forward regulations at the earliest opportunity and by the end of this Parliament.
In response to recommendation 7, the Department for Education and the Home Office have undertaken a deep dive, looking at policing systems to help inform the work done in recommendation 6 and to establish how an identifier for children would work in policing systems. Work is also under way to improve national data integration and data sharing by developing and establishing a national data integration and exploitation service, which will link key policing datasets and improve data sharing.
The Home Office has also invested record amounts in the tackling organised exploitation programme, including £10.8 million this year, which brings high-end technological capabilities, including AI, to bear in order to enable policing to better exploit large datasets to identify potential victims and suspects.
In response to recommendation 8, we have made it a core requirement of Operation Beaconport to ensure an enduring legacy across policing, so that forces approach child sexual exploitation investigations like serious and organised crime, and we are investing in the capabilities to enable this at all levels.
In response to recommendation 9, in December 2025 the Department for Education completed this action and published “Children in need: A focus on sexual abuse and exploitation”, followed in March 2026 by the publication of qualitative research. We are disseminating this widely and harnessing opportunities to improve identification, practice and data.
Tackling child sexual exploitation and abuse is a top priority for the Department for Education. This includes improving its identification by children’s services, as well as work under way to improve the quality of serious incident notifications. This activity is being personally driven by the Secretary of State for Education.
We are looking to change the data we collect on children in the children’s social care system to better understand the abuse they suffer. We have strengthened the statutory guidance, “Working together to safeguard children”, in order to ensure that child sexual exploitation and abuse is strongly reflected throughout. The 2026 update included changes to areas of the guidance about submitting serious incident notifications.
We are rolling out child sexual exploitation and abuse training to child protection practitioners, and embedding child sexual exploitation and abuse in new standards for lead child protection practitioners.
Joint targeted area inspections are currently assessing how effectively local areas identify and respond to child sexual abuse. Findings from these inspections, alongside new practice guides, will strengthen the evidence around what works to improve the identification and response to child sexual exploitation and abuse.
In response to recommendation 10, the Home Office has commissioned UK Research and Innovation to deliver independent research into the drivers of group-based child sexual exploitation and abuse, including cultural factors, group dynamics and the role of online technologies. This will strengthen the national evidence base, enabling a more detailed understanding of the factors at play, and will support the development of more targeted and effective interventions. Calls for applications will launch soon.
In response to recommendation 11, the English Devolution and Community Empowerment Act 2026 includes provisions to set national standards for taxi and private hire vehicle licensing in order to ensure that high safeguarding standards are applied across the country. The Department for Transport will consult on these standards later this year. Through the Act, the Government also have powers to allow all licensing authorities to take immediate action where there is an urgent risk to public safety, wherever a taxi or private hire vehicle is licensed or operating. The King’s Speech announced the development of a proposed draft taxis and private hire vehicles Bill for pre-legislative scrutiny during this parliamentary session, which will go further still. This will include reforming regulation of taxis and private hire vehicles, stronger enforcement powers for regulators, mandating a national database of all licensees, and taking action so that operators and drivers are licensed where they intend to work.
Finally, in response to recommendation 12, the Government are fully committed to the implementation of these recommendations, and the Home Office continues to track progress across them.
We have made good progress against the mandate for change set out by Baroness Casey, but our job is far from complete. Among other things, we have committed to a post-implementation review to assess how the changes to the criminal law are operating in practice, and the new independent inquiry will shortly announce which local areas will face specific local investigations. We need to do—and are doing—more to improve the collection of suspect ethnicity data in the short term. We need to ensure that the changes to information-sharing policy and practice work effectively so that the safety of children is prioritised. As set out in the police reform White Paper, we need to do more to ensure that policing data that is siloed in local systems can be effectively shared, which is why we have announced a new national data integration and exploitation service.
The Government response to Baroness Casey’s recommendations is just one part of a comprehensive approach to tackling all forms of child sexual exploitation and abuse—backed up by investment of over £100 million to help tackle offending, protect children, and support victims and survivors of these heinous crimes wherever they occur, including within the family home, institutions, in the community or online.
Following recommendations from the independent inquiry into child sexual abuse, we have taken action, including by recently introducing measures in the Crime and Policing Act on the new mandatory reporting duty, reforms to Disclosure and Barring, and the removal of the civil limitation period. The Home Office is working with the Department of Health and Social Care to roll out the Child House model of support for child victims, and with the Department for Education to establish a child protection authority to strengthen national oversight and improve child protection.
We are also acting on our commitment in the violence against women and girls strategy to make it impossible for children to take, share or view nude images. This measure supports and goes beyond IICSA’s recommendations on protecting children online, and reflects Baroness Casey’s finding that grooming is now as likely to begin online.
One year ago, Baroness Casey set out in stark terms the repeated inaction and failures faced by the victims and survivors of these horrific crimes, and she called for action. We are acting: to rectify the failures of the past, to bring perpetrators to justice, to ensure victims and survivors can count on us to support them, and to do everything possible to prevent these offences from ever happening in the first place.
I recognise the long-standing and deeply held interest of parliamentarians in this issue, and I am grateful for their continued scrutiny and engagement. I also pay tribute to Baroness Casey for her formidable work, and to the victims and survivors whose courage in coming forward has been instrumental in driving forward this agenda. They will remain at the heart of our response.
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Neighbourhoods and Public Services
(1 day, 4 hours ago)
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The Secretary of State for Housing, Communities and Local Government (Steve Reed)
This Government are determined to build a new relationship of respect, trust and shared responsibility between the state and its citizens. On 21 May, I announced this Government’s ambitious new programme to reform local services, building more integrated, place-based and user-centred models of delivery, and restoring people’s pride in their areas and communities. I can now set out further details of this agenda and new reforms to put communities first.
Building on the measures announced in May, I can today confirm:
Our new programme of community power pilots, designed to support councils to work with community groups and residents to deliver community-led and locally responsive services in areas such as youth provision, community safety, housing and green spaces. The pilots will cover 25 places in England to accelerate change and will be backed by £15 million of new funding.
We are determined to drive out profiteering from public services. In May, I made it clear that the Government would not flinch from using new powers to cap the profits of private providers in children’s social care if our assessment and consultation showed this to be necessary. But we recognise that profiteering is not limited to children’s social care. Therefore, we are also working with the Home Office and with London councils signed up to the London accommodation management agreement to bring consistency and value for money to the procurement of temporary accommodation and to prevent profiteering.
In addition to the new powers for mayors, I announced under the new right-to-request process in the English Devolution and Community Empowerment Act 2026 that we will establish a task and finish group to jointly define the role of mayors and strategic authorities in public service reform more widely. This will include specific consideration of how strategic authorities could play a role in driving better procurement, commissioning and delivery of local public services. We believe local authorities should retain autonomy in their procurement of the services they are accountable for and should remain responsive to local need and community concerns. However, we want to build a system where they can benefit from increased market power and the knowledge that pooling resources at regional level can provide, in order to crack down on profiteering.
We have concluded our review of the right to manage and will be taking forward a series of reforms to the regulatory and policy framework to make it as easy as possible for more social housing residents to come together to take control of their own homes and estates, and to make housing managers directly accountable to the people who live in them. Currently, the majority of social housing residents live in homes run by housing associations and are excluded from the right to manage. We will explore whether there is a case for extending the statutory right to these tenants, and will consult with residents and social housing providers on the detail ahead of any change. We will make sure there is better support and oversight built into the right-to-manage system, including stronger enforcement action in the event of serious mismanagement where residents’ safety is put at risk. We want social landlords to do more to support tenants to take up right to manage, in line with existing regulatory requirements.
In addition, I can also announce the following new measures:
We will introduce a new Pride in Place community right-to-buy fund, backed by £61 million—focusing on the most deprived areas—to empower communities to take ownership of valued local assets such as pubs, clubs and community centres, reversing the decline in shared public spaces and supporting social connection. This funding is part of the £301 million earmarked to support our high streets and community spaces. It will directly support communities in taking advantage of community right to buy created by our English Devolution and Community Empowerment Act, and will support efforts to revitalise local high streets, building on the new powers for councils that I announced last month.
Alongside this, I can announce a £10 million test, learn and grow capability fund, led and funded by the Cabinet Office. The test, learn and grow programme is central to how this Government are delivering services differently, putting people at the centre, starting small and building on what works, and empowering frontline staff and local places to respond to what users need. The new fund will support up to 20 places to try out new ways of delivering public services. It will first be targeted at those areas already involved in the programme, with a specific focus on extending learning beyond individual local authorities and across sub-regions, through mayoral strategic authorities and clusters of local authorities working together. It will then expand to new locations later in the autumn. We will announce further detail in due course.
To address the barriers that hold back local authorities and other partners’ ability to integrate services, target prevention, and provide a more seamless user experience, we will be taking action on local government data sharing. The Government strategic data road map will support local public service reform through a range of data products and services designed to facilitate greater collaboration on data sharing and interoperability. We will also develop standardised data sharing agreements for central Government and the wider public sector, including local government, to use, reducing administrative burdens and speeding up processes. This will complement work already in train at the Department for Education that is focused on improving multi-agency information sharing for the purposes of safeguarding and the welfare of children, including the introduction of a single unique identifier for children.
Finally, in recognition of the importance of place to outcomes for citizens and to the delivery of public services, I can announce that this Government have established a new place unit, based in my Department. This unit will act as convenors across Departments, local stakeholders, and community and place experts. They will provide an advisory function to other departments, ensuring that place and community are considered in policy development and helping to bring local voices into central Government decision making.
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Defined Benefit Pensions Regulation: Flexible Apportionment Arrangements
(1 day, 4 hours ago)
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The Parliamentary Secretary to the Treasury (Torsten Bell)
We are taking action to ensure the strong regulatory framework for defined benefit pensions remains effective as innovation develops, to manage future risks and protect member benefits.
On 4 December 2025, a novel use of existing legislation led to an asset manager assuming responsibility for the liabilities and the assets of another employer’s defined benefit pension scheme.
This Government have since delivered the landmark Pension Schemes Act 2026, introducing major reforms to UK occupational pensions, consolidating our fragmented pensions system into larger, better run, more secure schemes.
We want to encourage innovation that has the potential to benefit scheme members throughout the pension system and need to ensure the right legislative guard rails are in place for this to happen safely.
Flexible apportionment arrangements, the legislative mechanism used in this transaction, were introduced in 2012. They were designed to ensure that corporate restructurings, mergers and sales do not cause employer insolvency events when there is an appropriate sponsor who can support the scheme. Whilst this transaction complied with the existing FAA mechanism it did so in a way not anticipated when the mechanism was introduced.
We therefore intend to review this area of legislation to ensure the regulatory standards and safeguards evolve and keep pace with the innovation we are seeing in the pension market. This is to protect members and the Pension Protection Fund, which is there to protect people’s pensions in the event of an employer insolvency.
The DB superfunds framework set out in the Act reflects the fact that superfunds operate schemes on a commercial basis and is designed to ensure that the interests of commercial providers are appropriately aligned with those of scheme members. This contrast highlights the importance of considering whether additional safeguards are required where other mechanisms, such as FAAs, are used in ways that similarly involve the commercial operation of DB pension schemes. We will therefore consult in due course on whether and how existing FAA regulations could be strengthened.
Where providers are looking to run schemes for profit, this can work in scheme members’ interests but regulatory standards and safeguards must evolve to match the new risks this creates.
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