Health Bill (Fourteenth sitting)
Thursday 9th July 2026
(1 month, 1 week ago)
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The Chair
Before we begin, I remind hon. Members to switch electronic devices to silent. Tea and coffee are not allowed during the sitting, but there is loads of water—silver is fizzy, blue is flat. I am happy to give a blanket permission for people to take off their jackets. Officially, you are meant to ask me individually, but given the heatwave, take them off if you like.
New Clause 6
Health Data Charter
“(1) The Secretary of State must, within six months of the passing of this Act, establish an independent body (to be known as the "Sovereign Health Data Trust”) for the purpose of creating a Health Data Charter.
(2) The membership of the Trust should include—
(a) people with a diverse range of backgrounds; and
(b) health data experts, clinicians and patient representatives.
(3) The Charter must—
(a) set out the fundamental principles and responsibilities for assessing whether a data sharing partnership is in the interest of the public and the NHS;
(b) include the primary goal of protecting people’s privacy and their data from exploitation, while promoting trust in data systems and the handling of health data;
(c) ensure patients have control of their data, including providing relevant opt-outs;
(d) provide that all health data is held anonymously and accessed through a trusted research environment;
(e) set out ways to retain and protect the value of health data in England, including providing measures to invest a share of the income generated from new medicines or treatments developed with that health data to be invested back into the NHS;
(f) be designed in such a way as to render it interoperable with the European Health Data Space in technical terms, including through the promotion of Findable, Accessible, Interoperable and Reusable (FAIR) data principles within the NHS.
(4) The Sovereign Health Data Trust will—
(a) hold continuous oversight of all health data and oversee the trusted research environment;
(b) have power to recall or restrict an organisation’s access to data if it has reason to believe that the data is not being used for public or patient benefit;
(c) ensure that all data sharing arrangements with a non-NHS organisation are transparent, with all health data contracts entered into by a public body made publicly available;
(d) publish detailed minutes of all meetings discussing potential uses of health data; and
(e) ensure all health data collection and sharing initiatives are preceded by public consultation, involvement and awareness.”—(Helen Morgan.)
Brought up, and read the First time.
Helen Morgan (North Shropshire) (LD)
I beg to move, That the clause be read a Second time.
It is a pleasure to serve with you in the Chair, Dr Huq. The new clause would require the creation of a health data charter, and includes measures to protect data so as to ensure privacy and reasonable usage.
Patients should be in control of their data. As we have discussed in previous sittings, we do not think that the Bill goes far enough to provide reassurances in that regard. Everyone agrees with the need for the single patient record, but there is genuine risk—one that I do not think anyone in this room wants—that it could be derailed over very understandable and reasonable data privacy concerns. Sufficient guardrails and transparency are key, especially for secondary uses of health data. As we have discussed on many occasions, trust is essential for the system to succeed.
That is why we have tabled this new clause on a health data charter that would set out guiding principles for data sharing across the national health service, including for the single patient record. It would be led by data experts, as well as, importantly, clinicians and patient representatives. Ensuring that the voices of doctors and patients are heard is central to building trust and the widespread use of any data-sharing systems or technologies.
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship again, Dr Huq.
New clause 6 raises an important question on how we govern health data, which one of the greatest assets of the NHS. The development of the single patient record platform and database, and the wider use of the linked NHS data, present enormous opportunities.
When used responsibly, healthcare data can support much more personalised care, improve NHS planning, accelerate medical research, enable earlier diagnoses and help develop new medicines and treatments. It can also improve efficiency and strengthen the evidence base for healthcare decisions. However, those benefits can be realised only if the public have the confidence that their data will be used safely, ethically and transparently. Public trust must be the foundation of any successful health data policy.
NHS health data is currently overseen by NHS England, following the merger of NHS Digital into that organisation. With the Government proceeding with the abolition of NHS England and the transfer of its functions elsewhere, it is right that we consider future governance arrangements. In principle, I agree that an independent body may be needed to ensure and maintain the security, integrity and responsible stewardship of NHS data. There is definitely scope for an independent body to oversee the management and regulation of the public’s health data. That proposal places patient privacy at its heart, and would strengthen safeguards against misuse, give patients greater control over how their information is used, and provide meaningful mechanisms to opt out of certain forms of data sharing. It also promotes the use of anonymisation and trusted research environments, allowing valuable research to take place while reducing the risk of inappropriate disclosure. We have discussed inappropriate disclosure by a malign actor, or even inadvertent disclosure, during debate on other clauses.
The Liberal Democrat new clause also seeks to address a concern that has attracted significant public attention: where commercial organisations derive substantial value from NHS data, the NHS itself should share in that benefit. Although we did not support a number of Liberal Democrat proposals because of the inadvertent implications of their drafting, I still have sympathy with the overall thrust of what they were trying to achieve. There is a strong argument that the value generated from the data contributed by NHS patients should help to support future patient care and research.
Transparency is another important feature. Publishing data-sharing agreements, increasing openness around decision making and consulting the public on significant new data initiatives would help to strengthen public confidence. The proposed trust would bring those principles together by overseeing data use, monitoring compliance with governance standards, ensuring transparency and, where necessary, suspending access for organisations that misuse their data.
Of course, any new governance framework must avoid creating unnecessary bureaucracy or delaying important research. To reassure the Committee that the framework would not create a block or dampener, or insert inertia into the system, will the hon. Member for North Shropshire tell us what evidence she found when drafting the new clause? If we are going to do something like this, the oversight should be proportionate, and it should complement, rather than duplicate or frustrate, any existing regulatory responsibilities.
Ultimately, the new clause has potential benefits. It would establish a clear social contract for NHS health data, which would hopefully protect privacy, support research and innovation, maintain public trust and ensure that patients and the NHS share in the benefits arising from the responsible use of a very valuable national asset. In terms of what it could be used for, that data is probably second to none in the world, but I am concerned about adding extra bureaucracy and inertia to the system, when we want a vibrant life-sciences industry that is able to use the data for the benefit of British citizens and patients. What does the hon. Member for North Shropshire think would happen in that case?
Joe Robertson (Isle of Wight East) (Con)
It is a pleasure to serve with you in the Chair, Dr Huq.
My hon. Friend the Member for Farnham and Bordon has set out the arguments clearly; I will just add some of my own views. As he stated, the single patient record provides a unique and special opportunity to improve efficiency across the whole health and social care space and to empower patients, but it faces significant challenges. As I said in an earlier sitting, perhaps one of the biggest challenges is ensuring that it means something in practice. In a previous debate, the Minister helpfully clarified that the data currently held on a great variety of databases and electronic record-keeping systems in the NHS will remain on those wide and disparate recording systems. It seems that the advantages will be realised only if those systems are able to speak together and are fully interoperable.
I know from a previous time in my career that, in reality, many such systems are not interoperable or are only part-interoperable, and that, even where they do speak to one another, the data is collected and recorded in different ways. Simple things—someone’s name, their age or the principal field of the issue for which they are presenting to a clinician—are recorded, but because the systems are not standardised, that data cannot be transferred between them easily.
The advantages of the single patient record will be realised only when all those systems are unified in some form, but the Bill does not address that directly. I am not necessarily suggesting that it should, but I do not see the Government acknowledging anywhere that systems are contracted and provided by private providers through procurement processes at a local level, and asking, “How do we knit that all together?” It seems that somebody somewhere will have to produce some gateway software or system to allow the single patient record to be accessed. If every other existing system needs to be able to feed into that, the public sector will have a huge role, and the private sector will sit behind it to try to deliver that. It seems a huge project that could be fraught with difficulty, it could take many years before the single patient record is established, regardless of when the Bill is passed—although I am sure it will be passed fairly soon.
New clause 6 seeks to address another significant issue with the single patient record: security and the control of data. The single patient record, if fully realised, will make it easier for data to be accessed and shared. Its very purpose is to ensure that systems and services are more integrated and data flows more freely, to avoid the ridiculous situations in which a GP fills out a patient note but cannot share it with a secondary care provider, so must print it out for the patient, or attach a PDF to an email, so that somebody at the other end can input it to their database.
One issue with making it easier to share data—including personal data of the most intimate kind—is that once it has been accessed by bad-faith operators, it is easier for them to run riot and cause an awful lot of damage. It is also much easier for wider access to be shared accidentally, because the whole system is lubricated by the single patient record. I therefore understand the reason for the health data charter as a cure for potential ills.
New clause 6(3)(b) states that the charter must
“include the primary goal of protecting people’s privacy and their data from exploitation”.
That is a fantastic goal that we all support, but I do not necessarily agree that the measure will achieve that. It is an added layer of bureaucracy. My hon. Friend the Member for Farnham and Bordon asked a rhetorical question about the bureaucracy and effectiveness. I endorse that question and hope that the hon. Member for North Shropshire will answer it.
I am minded not to support the proposal, though I agree with what it tries to achieve. If the Minister does not support the new clause, will she explain how its aim of protecting people’s privacy will be delivered by the Bill? There seems to be great scope for the undermining and abuse of privacy, not just deliberately by bad faith actors, but inadvertently.
A second issue aim of the charter is the balance between the security of personal data and the recognition of the value of anonymised data gathered by the NHS for research and development. Fully anonymised data that cannot be unpicked through reverse engineering is of huge value, both commercially and for the public good. Commercial value and the public good are not necessarily opposed to each other; in fact, they often come together. The NHS should be able to exploit the value of that anonymised data—“exploit” is probably seen as a negative word—for the public good. How do we balance that with people’s right to privacy?
Again, there is the possibility of inadvertently using for a wider public good data that was intended to be anonymised but in which people can be identified. The charter tries to get to the heart of that issue as well, which I welcome. Indeed, new clause 6(4)(a) states that the sovereign health data trust will
“hold continuous oversight of all health data and oversee the trusted research environment”.
The Minister may not agree with the new clause, but how will the Government’s proposals balance the security of an individual’s personal data while exploiting, for the public good, the value of the huge depth of anonymised data that the NHS holds and will hold? It could be used to drive so much innovative research and development, for the benefit of health delivery not only in this country, but across the world. Such a valuable commodity has commercial value that could deliver financial benefit to the NHS. I think we all agree that we have not yet exploited that area to the fullest. There is an opportunity to do so with the single patient record—if it is done properly, with all the necessary safeguards.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
As my hon. Friend the Member for Isle of Wight East just said, new clause 6 seeks in essence to ensure that we have good data security and control, with which I agree. Trust is important, data security is important and supporting research with anonymised data is a good thing to do.
What would the new clause do? First, it would establish an independent body known as a sovereign health data trust. In essence, that is a group of people who have been put together. The new clause does not say how big the group would be—I do not know whether the hon. Member for North Shropshire had its size in mind—but it describes a group of people with
“a diverse range of backgrounds…and…health data experts, clinicians and patient representatives.”
Are the first group intended to be laypeople, rather than experts? What does the hon. Lady mean by a “diverse range of backgrounds”? Does that relate to protected characteristics, or is she looking for a farmer from Northumberland and a lawyer from Islington, because they have different backgrounds? It is not entirely clear what she means, so I would be grateful if she clarified that. Additionally, however big that group is, who would decide how it is composed and by what criteria? Who would be responsible?
The sovereign health data trust would be charged with creating a health data charter. That leads me to my second question: what is a health data charter? In essence, a health data charter—as defined in the new clause—must
“set out the fundamental principles and responsibilities for assessing whether a data sharing partnership is in the interest of the public and the NHS”,
and, as my hon. Friend the for Isle of Wight East said,
“include the primary goal of protecting people’s privacy and their data from exploitation, while promoting trust in data systems and the handling of health data”.
That is important, because we have heard in the media several examples of data being put up for sale or leaked, and the problems caused by that.
The charter must also
“ensure patients have control of their data, including providing relevant opt-outs”.
I am glad to see that bit about relevant opt-outs. We have talked about the importance of the record being shared not as a whole, but in pieces. Things such as obstetric or sexual health ought perhaps to be consented to separately. Patient control of the data is important. How would the hon. Member for North Shropshire deal with safeguarding issues in the control of data, particularly in relation to children?
The new clause sets out that the charter must
“provide that all health data is held anonymously and accessed through a trusted research environment”—
which seems reasonable—and must
“set out ways to retain and protect the value of health data in England, including providing measures to invest a share of the income generated from new medicines or treatments developed with that health data to be invested back into the NHS”.
Earlier this week, the hon. Member for Lichfield and I discussed the important value of the NHS data—I think he said that it was the most valuable dataset in the world, and he might well be right. I was a bit confused by that part of the new clause, because we talked earlier this week about the Health Services Safety Investigations Body being able to sell time and training and share expertise, including with private sector organisations overseas. The Government changed that in the Bill, so that they would only be able to retain costs and not make any money for the Treasury. When we put amendment 56 to a vote, the Liberal Democrats abstained. I do not know what the difference is between using NHS data for research and the HSSIB using their expertise for training overseas organisations. I would be grateful to understand that.
The charter must be
“designed in such a way to render it interoperable with the European Health Data Space”.
The European Health Data Space regulations were introduced in March 2025. We are in a transition period, and they will be implemented in 2027 and 2029. It should be interoperable in technical terms
“through the promotion of Findable, Accessible, Interoperable and Reusable (FAIR) data principles”.
What is the European Health Data Space? Essentially, it is a single patient record for Europe. Its instructions say member states may—I underline the word may—offer
“an opt-out option for the cross-border exchange of electronic health data under EHDS.”
I do not understand the Liberal Democrats’ argument for that, because they have made a strong argument throughout Committee stage that data needs to be shared carefully. They advanced some clauses that will ensure that data is held in the United Kingdom and that we use British tech where possible. New clause 6 would make us interoperable with the European system and presumably move us towards European systems.
Gregory Stafford
I do not mean this as a cheeky point, but is it not the case that clearly, as with everything, the Liberal Democrats think that the European Union can do no wrong? They do not see the same problems of data that they have expressed in other clauses because they want to rejoin the European Union. Therefore, they conceive that it can have no possible harm to British subjects.
Dr Johnson
Indeed. When reading it, it is ironic to me that they seem comfortable with data being shared across the EU but not across our own country. It did not make complete sense to me, but the hon. Lady for North Shropshire may be able to tell us more about that in her summing up.
What else will the sovereign health data trust group do? It will have
“continuous oversight of all health data and oversee the trusted research environment”.
Having oversight over “all health data” is quite a big job. Again, what sort of resources does the hon. Lady think that will entail, and what does she have in mind in terms of the cost and bureaucracy of that? It would also
“have power to recall or restrict an organisation’s access to data if it has reason to believe that the data is not being used for public or patient benefit.”
What is the threshold for that? A lot of these organisations will be working in a commercial environment; if they receive a letter, potentially from a competitor, saying there is a concern, does that meet the threshold? What would the threshold be?
Having decided that the data might not be used for public benefit, what investigatory powers does the hon. Lady envisage the trust having to establish whether that is the case or not? What if it does receive some concerning correspondence, it does the investigation under the investigatory powers that it has been given, it decides that it does not think it is being used for public or patient benefit, and it restricts the organisation’s ability to access data? That will potentially have a significant financial penalty and it may affect patients’ access to healthcare, too. What right of appeal would the organisation have? Who would they appeal to and how would it work? On the wording, commercial activity may well benefit patients, which is sometimes forgotten.
The next thing the data trust will have to do is
“ensure that all data sharing arrangements with a non-NHS organisation are transparent, with all health data contracts entered into by a public body made publicly available”.
I would like some more detail about that. Would that include anonymously provided data? What effect would that have on the research environment and the integrity of research done under commercial arrangements? What about the costs? Would any costs be shared and what effect would that have on future commercial negotiations when the Government are trying to get the next organisation to look at the data? What level of detail made publicly available in the contract would need to be provided?
The trust would need to publish minutes of their meetings, which seems reasonable. It would need to
“ensure all health data collection and sharing initiatives are preceded by public consultation, involvement and awareness.”
Do the Liberal Democrats really intend for all data collection to go through public consultation? If, as we talked about regarding corridor care, the Government wanted to know how many people are waiting more than 24 hours in A&E, would they have to do a public consultation to collect that data? It seems overly bureaucratic.
Gregory Stafford
Is that not part of the problem with the wording of the new clause? It is not clear, from the new clause, what is NHS data and what is the patient’s data, and who owns which bit of it. The problem with the drafting of the new clause is that it appears to cover every single piece of data held by the NHS, whether it directly relates to a patient or not. Additionally, if the Government were to collect any other sort of data, even if on an aggregate basis, it would come under this. That would be totally unworkable and put an enormous burden of bureaucracy on the health service.
Dr Johnson
My hon. Friend is, as ever, correct. I would be interested in whether the hon. Member for North Shropshire has made any estimates of personnel time or cost that the proposal would entail.
In summary, the new clause would create an unelected committee removing democratic control. Essentially, it is asking a committee of unelected individuals to write and implement policy, which is the job of the Minister. That should be under ministerial control.
Joe Robertson
Does my hon. Friend agree that there is an overarching issue here of public confidence in the safety of their data? That is not about one company or another; it is about ensuring that robust safeguards are in place for everyone and for every provider of a data and record-keeping system. If the public do not have confidence, they will understandably withdraw consent for their data being held. That will undermine the single patient record and the whole way in which health can be delivered efficiently in the best interests of patients.
Dr Johnson
I agree. I am sure that the purpose behind the new clause is to ensure that data is safe, but it removes democratic accountability from the process of developing the policy, which may reduce the public’s confidence in it. I agree with its underlying principles, but much of it is cumbersome and, as yet, undefined, so it is important that we get more detail and specificity.
The Minister for Secondary Care (Karin Smyth)
It is good to see you in the Chair, Dr Huq. I am grateful to the hon. Member for North Shropshire for tabling this new clause. I am sympathetic to its intentions: the security of data, the transparency of use and even realising the value of data. Its principles are in the interests of the public and the NHS, but we do not consider it necessary to achieve our aims. It would impose onerous operational requirements and could have a damaging impact on the ability of the NHS to function.
There is also a significant overlap with the role of the independent national guardian and potentially that of the information commissioner. Once the functions of NHS England have transferred to the Secretary of State, the Secretary of State must have regard to the need to respect and promote the privacy of recipients of health services and of adult social care in England, which is in addition to the requirements already set out in UK GDPR. The Secretary of State will be able to issue guidance to the health and care sector relating to the processing of information to which NHS bodies must have regard. The Secretary of State will be under a duty to have regard to guidance given by the Health Research Authority on the disclosure of confidential information.
The proposed trust functions would also encroach significantly on the operational role intended for the health data research service, and would place cumbersome constraints on vital data collecting and sharing within the NHS. The new clause would mean that all health data collections and data-sharing initiatives would have to be preceded by public consultation. That would capture any of the essential collections that NHS England undertakes, and indeed any collection by NHS organisations, not to mention the use of that data. The burden would be considerable, with very real consequences for the ability of the NHS to use that data to improve outcomes for patients.
Likewise, I cannot see how requiring all health data to be held anonymously and accessed only through a trusted, secure research environment would be compatible with delivering direct care to a patient or using confidential patient information for planning and commissioning services or research. It seems that the new clause would prevent such uses. For those reasons, I ask the hon. Member to withdraw the motion.
Helen Morgan
Hon. and right hon. Members on the Committee will understand that we are talking about a single patient record that we do not understand much about yet, because most of the detail will come later. This new clause is attempting to establish what guardrails we would like to see for the protection of patient data when the single patient record is brought into existence
There are very genuine concerns about people’s health conditions becoming individually identifiable. If there is an individual in a single postcode with a rare condition, anonymising the data can essentially never happen. That is a genuine concern that people have. I hope that, when we get to Report stage, the Government will be able to give us a little more detail on what safeguards they intend to put in place over the use of that data. To that end, I do not intend to press this new clause to a vote, but I hope that the Government will take into account the concerns we have expressed about building trust and protecting data privacy, and will give us further reassurance at a later stage. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 11
Directors of public health
“After section 7B of the National Health Service Act 2006 insert—
‘7BA Directors of public health
Each integrated care board must, for the purposes of exercising any public health functions directed by the Secretary of State, appoint a lead director of public health.’”—(Dr Caroline Johnson.)
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss new clause 24—Directors of public health: requirements and functions—
“After section (73C) of the National Health Service Act 2006 insert—
‘73D Directors of public health: requirements and functions
Directors of public health must—
(a) be an officer of the local authority and shall have responsibility for its public health functions,
(b) be an NHS consultant in public health responsible for giving independent professional public health advice and for promoting public debate on health matters,
(c) be a corporation sole and NHS body for working with others to initiate measures to improve the health of the people,
(d) be an officer of the Crown responsible for such functions as the Secretary of State may specify,
(e) as an officer of the Crown have power to draw the attention of the Chief Medical Officer and the Attorney General to events within the area of the local authority creating circumstances in which it might be appropriate to bring proceedings in the name of the Crown for public health purposes,
(f) be an officer of the National Health Service responsible for promoting the provision of services which are outcome-focused, are provided following a proper needs assessment and pay attention to the promotion of health and the prevention of illness,
(g) as an officer of the NHS, have power either personally (in the case of a body which primarily serves the population of the local authority which appointed the DPH) or through joint arrangements with other Directors of Public Health (in the case of a body which primarily serves the population of several local authorities) or through a collective arrangement established by the Chief Medical Officer (in the case of a body with a national remit) to appoint, or approve arrangements for the body to appoint, a consultant in public health to serve on the governing body of any NHS body (other than an NHS body which is a local authority), any NHS Foundation Trust, any of the bodies established under this Act or any of the bodies established under the Health & Social Care Act 2012 or any other legislation relating to the governance of the NHS (for the avoidance of doubt the consultant so appointed may be, but need not be, the Director of Public Health personally).
(h) as an officer of the NHS and of the local authority, have power either personally (in the case of a body which primarily serves all or part of the population of the local authority which appointed the DPH) or through joint arrangements with other Directors of Public Health (in the case of a body such as a joint board or combined authority which primarily serves the population of several local authorities) to appoint a consultant in public health to attend any local authority meeting and to advise the meeting whilst it is in session on matters affecting the health of the people (for the avoidance of doubt the consultant so appointed may be, but need not be, the Director of Public Health personally and a different consultant may be appointed for different meetings).
(i) be contractually required, subject to law, to carry out the functions in subsections (b) to (h) herewith as an independent health professional treating a population as a patient and pursuing the improvement of its health and to be contractually entitled not to be subject to any detriment by the local authority or by the Crown for so doing.’”
Dr Johnson
I want to briefly discuss these new clauses because I think that they are important, particularly because they were tabled by the hon. Member for Worthing West (Dr Cooper), who is an expert in the field. New clauses 11 and 24 relate to directors of public health. We know from the Government that prevention, and therefore public health, is extremely important. New clause 11 says:
“Each integrated care board must, for the purposes of exercising any public health functions directed by the Secretary of State, appoint a lead director of public health.”
New clause 24 sets out the requirements and functions of directors of public health—what such an individual will do.
Currently, every local authority must have a director of public health, which is set out in statute. They focus on three areas: health protection, health improvement and healthcare public health. They take the evidence in relation to their population, produce a vision, develop aims, deliver those aims and then produce a report annually to say how they are getting on with that process. The National Health Service Act 2006 says that that must be done across an upper tier or unitary local authority area, and that directors of public health must provide advice about public health to any ICBs that overlap with their area. ICBs also have a legal duty to seek advice on protecting public health when they are exercising their functions.
I think that we all agree across the Committee that public health is important, but I do have some questions. Unfortunately, the hon. Member for Worthing West is not a member of the Committee, so she is not able to respond to any questions today. We have talked in this Committee about the representation of local authorities on ICBs and the fact that Government cuts of 50% have led to a merging of ICBs in a somewhat haphazard fashion, which means that there can be a clash between different areas.
I guess that my question for the Minister would be this: if this clause were to come into force and the ICBs that are no longer coterminous with the local authority upper-tier or unitary authority areas, would there be a duplication of work? My other concern would be that it would lead to a situation where there might be one director of public health with a vision to go one way, and another with a direction to go the other way. If that happened, how would the negotiation process work? I think this measure was brought in with good intent by a lady who is an expert in the field, but I have more questions than answers about how the clause will work in practice.
Gregory Stafford
It is very important that we consider these new clauses and amendments carefully, not least because, as my hon. Friend has just outlined, the hon. Member for Worthing West, who tabled them, has considerable expertise, being a public health consultant herself. I have the pleasure of sitting with the hon. Member on the Health and Social Care Committee and she brings her expertise to every single sitting. I am sure that the Minister has welcomed her questioning when she has appeared before that Committee.
It is really clear that, if we are going to make a success of the Bill, public health in all its guises needs to be at the forefront of our thinking about how we achieve better patient outcomes, better health and, more specifically, the Government’s stated aims in the 10-year plan to, first, shift care closer to home and, secondly, focus more on prevention rather than treatment. I am sure that across the House we agree with that ambition and therefore I can totally understand why the hon. Member for Worthing West has tabled these new clauses.
I suspect that the new clauses are also a reaction to something that we have already discussed in this Committee, which is the dislocation and now the separation of local authorities from ICBs, with the removal of their statutory functions on those boards, to be given to strategic mayoral authorities. Some of those strategic mayoral authorities exist but, as we have discussed at some length in the Committee, many of them do not exist and might never exist. I can see why the hon. Member for Worthing West is trying to ensure that the vital work of directors of public health in local authorities for their population areas is somehow safeguarded and included in the Bill.
That being said, I have some reservations about how these new clauses are currently drafted. My hon. Friend the Member for Sleaford and North Hykeham has already outlined many of them. Although strengthening public health leadership is an essential objective, new clause 24 defines the statutory role and legal status of directors of public health in this context without providing sufficient clarity about accountability or governance, or about how these new powers would interact with existing NHS and local authority structures. Potentially, there is a risk of creating overlapping responsibilities, blurred lines of accountability and additional bureaucracy at a time when integrated working should be simplified rather than made more complex.
Obviously, the hon. Member for Worthing West is not here to answer my questions. I ask the Minister this: if these new clauses are not pressed to a vote, or if they are but are not accepted by this Committee, how can she reassure me and the hon. Member for Worthing West that public health will still be at the forefront of the Bill, and that the removal of local authorities from ICBs will not have the impact that I think the hon. Member, who tabled these new clauses, is concerned about?
Karin Smyth
Further to that point, I absolutely want to assure my hon. Friend the Member for Worthing West, who is not a member of this Committee, and indeed the members of this Committee that the Government fully appreciate the important role of public health professionals. They bring critical expertise in population health intelligence, epidemiology and community co-design, and those capabilities are integral to the role of ICBs as strategic commissioners.
On new clause 11, there is already a statutory duty on ICBs to seek advice, and a statutory duty on local authorities to provide public health advice to ICBs. However, that does not mean that ICBs should be required to employ a director of public health directly. Local authorities already employ a director of public health and we expect ICBs to work collaboratively with their local authority partners and not to duplicate their work.
NHS England recently published the strategic commissioning framework and guidance for ICBs on strengthening the public health advice, both of which are clear that ICBs should work with local public health teams and stakeholders to draw upon their expertise to ensure a strong evidence base for commissioning decisions.
As the responsibilities of ICBs for commissioning NHS public health services grow, we expect them to continue to draw on the skills and expertise of local authority directors of public health, as well as other specialist public health expertise, including screening and immunisation leads, and the UK Health Security Agency. I absolutely agree that public health expertise is essential for ICBs to commission effectively and we have set out how they will access that; the basis for all this is of course the joint strategic needs assessment. However, I do not believe that it is necessary to require an ICB to appoint a lead director for public health in order to have access to such advice.
On new clause 24, as the Committee is aware, local authority directors of public health are advocates for the health of their population. They have a professional leadership role across the three domains of public health: health improvement, health protection and healthcare public health. Their work spans organisational boundaries. Although they are employed by local authorities and appointed jointly with the Secretary of State, their role is designed to bridge local government and the NHS. They are also required to provide objective, evidence-based advice, without political interference, and they are expected to be suitably qualified and regulated public health specialists who take a population-wide perspective to health outcomes and health inequalities.
At the heart of their role is their statutory responsibility to prepare an annual report on the health of their local population. That crucial document underpins the plans of health and wellbeing boards and, through them, the ICBs. Directors of public health are also required to be members of health and wellbeing boards, which will be the central mechanism for partnership working between local authorities and ICBs in the new neighbourhood health system. As such, directors of public health will be well placed to help to shape ICB system-wide plans and strategies on public health issues going forward, something that we discussed earlier in the Committee.
There is a statutory duty on ICBs to obtain appropriate and expert public health advice, and a legal duty on local authorities in turn, carried out by the director of public health and their team, to provide public health advice to ICBs. Beyond those requirements, the NHS, including ICBs, is of course free to employ its own senior public health professionals.
The proposed new clause risks creating some significant ambiguity around accountability and risk, constraining rather than enhancing the independence of directors of public health, which I am sure is not the intention of the hon. Member for Sleaford and North Hykeham or of the Committee. I hope I can offer reassurance to the hon. Member and indeed to the Committee that we are proud of our strong and coherent public health system, that this Bill does not alter its importance and that we will continue to champion the role of directors of public health and ensure clarity in the new architecture. I ask that the new clause be withdrawn.
Dr Johnson
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 12
Corridor Care Accountability
“(1) Six months after the passage of this Act, and every 12 months thereafter, the Secretary of State must produce and lay before Parliament a report on the prevalence of corridor care in NHS hospitals.
(2) A report under subsection (1) must include—
(a) an analysis of data on the number of corridor incidents at the national, integrated care board, trust, and hospital level,
(b) the steps the Secretary of State has taken that year to reduce the number of corridor care incidents,
(c) the Secretary of State’s plans to reduce the number of corridor care incidents in the coming year, and
(d) information regarding the amount of funding directed toward reducing the number of corridor care incidents that year and funding allocated for such efforts in the future.
(3) Following the publication of a report under subsection (1) the Secretary of State must give evidence in front of a panel (to be called the “Corridor Care Tribunal”) including—
(a) patients,
(b) bereaved or affected families, and
(c) frontline NHS staff who have been impacted by corridor care.
(4) Panel members for a Corridor Care Tribunal under subsection (3) shall be identified by local Healthwatch organisations and NHS Royal Colleges.”
This new clause requires the Secretary of State to publish an annual report about corridor care and give evidence before a panel of affected patients and staff.—(Helen Morgan.)
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss the following:
New clause 56—Accident and Emergency: waiting times—
“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision relating to Accident and Emergency Department admission.
(2) Provision under subsection (1) must include the requirement for every patient to be admitted into an Accident and Emergency Department within 12 hours of approval of their admission being made.
(3) The Secretary of State must establish and implement an Accident and Emergency Scheme (“the Scheme”) to support NHS hospital trusts to achieve the requirement set out in subsection (2).
(4) The Scheme must consider—
(a) creating safety-net social care beds,
(b) increasing step-down care,
(c) publishing a dedicated accident and emergency care workforce plan, and
(d) mandating a qualified clinician is present in every Accident and Emergency waiting room.
(5) The Secretary of State must have due regard to the final report of the Independent Commission on Adult Social Care in establishing the scheme.”
This new clause gives patients a legal right to be admitted into A&E within 12 hours from decision to admit and requires the Secretary of State to introduce a scheme to achieve this.
New clause 84—Publication of data on avoidable deaths—
“(1) The Secretary of State must publish every quarter the number of avoidable deaths where waits of more than 12 hours in accident and emergency departments was a contributory factor.
(2) The Secretary of State must make the data under subsection (1) available by integrated care board area.”
This new clause would require the Secretary of State to publish data on avoidable deaths caused by waits over 12 hours in A&E departments.
Helen Morgan
New clause 12 would require the Secretary of State to publish an annual report about corridor care and to give evidence before a panel of affected patients and staff.
In the main Chamber yesterday, we had a Backbench Business debate on corridor care, introduced by the hon. Member for Tooting (Dr Allin-Khan). There was a great deal of consensus across the House about the harm that corridor care causes to both patients and staff, and the requirement for urgency in dealing with that issue.
I am not going to remake the same speech that I made yesterday on corridor care for the Minister’s benefit, because she heard it yesterday and there is little value in repeating it. What I will say is that it is important that there is an understanding at a ministerial level of the personal impact that corridor care has on patients and their families.
That is the purpose of this new clause: to ensure that the Secretary of State is taking the concerns of patients and staff very seriously, hearing them at first hand and then reporting back progress to the House on dealing with the issue. At the moment, it feels as if every year we acknowledge the problem in the House, every winter there are statements on winter crisis and corridor care, and we never really seem to take any steps forward. The new clause aims to ensure that is no longer the case.
New clause 56 is intended to give patients a right to be admitted to accident and emergency
“within 12 hours from decision to admit”,
and would require the Secretary of State
“to introduce a scheme to achieve this.”
We have discussed the legal right to admit and the legal right of patients on a number of occasions. I just want to clarify our intention, because it always raises some questions. The NHS constitution enshrines legal rights for certain things: for example, the two-week wait for a cancer referral to a specialist and the right to receive elective care within, I think, 18 weeks, if so referred. The other targets in the NHS are pledges; there is an aspiration for the Secretary of State to meet them, but it is not a right of the patient that the Secretary of State meets them. We think that 12-hour waits on corridors in hospitals merit the same urgency as cancer referrals, because they lead to awful outcomes.
Edward Argar (Melton and Syston) (Con)
I agree with the broad thrust of the points made by the hon. Member for North Shropshire in highlighting the impact of corridor care on patients, on families and on those seeking to provide the care for those patients. I suspect that pretty much all of us, in our own lives or as constituency MPs, will have come across examples of that and the impact that it has on our constituents, or on our friends and family members, so it is a very important point.
Before I turn to new clauses 12 and 56, I will briefly address new clause 84, tabled by my hon. Friend the Member for Sleaford and North Hykeham. It is a very moderate and reasonable proposal, in that it seeks simply for data to be made available and published on where 12-hour-plus waits in A&E have contributed to avoidable deaths. That should not be a challenge; I suspect that that data is already extant in some part of the system. She is proposing a very moderate measure, which would pull all that together in one place, and allow it to be focused on and looked at in the round, rather than in disparate little penny packets of data. That is a very reasonable proposition.
The only challenge that I see is, sadly, in proposing it for integrated care board areas. Were the ICBs still what the Conservatives had conceived them to be—a number of geographical areas mapping on to an upper-tier authority social care provider—that data would have been even more meaningful, because it would have been more granular. The risk with the mergers and acquisitions—for want of a better phrase—among ICBs to form ever-larger areas is that that granularity is increasingly diluted. I fear that the genuinely positive benefits of what my hon. Friend is proposing might be somewhat diluted by virtue of what the Government are doing.
Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
On the publication of data on avoidable deaths, new clause 84 states
“where waits of more than 12 hours in accident and emergency departments was a contributory factor.”
Does the right hon. Member consider it likely that there is any great accuracy in the assessment of whether a death was avoidable?
Edward Argar
The hon. Gentleman makes a valid point, and I suspect that he has seen this issue in his professional career. Often, when a death occurs in a clinical setting, multiple factors are contributory. I think that that is why my hon. Friend the Member for Sleaford and North Hykeham framed this as she has, as “a contributory factor”—not the sole factor or the individual most significant factor, but that it could reasonably be deemed by a clinician or by those collecting the data that the long wait contributed to the death, because had that patient been seen, for example, in two hours rather than 12 hours, better clinical outcomes might have been achievable.
I take the hon. Gentleman’s point, however, that with many of these things—both clinicians and coroners grapple with this—it is often complex to determine the actual most significant contributory factor. My hon. Friend the Member for Sleaford and North Hykeham may correct me, but I think that is why she framed new clause 84 as she did, to allow for that degree of a lack of total certainty in such contexts. Nevertheless, the hon. Gentleman makes a reasonable point.
I can see what the hon. Member for North Shropshire is seeking to do in new clauses 12 and 56: not unreasonably, she seeks to cast light on the impact of corridor care on patients, families and those caring for people. My only challenge would be—I will enlarge on this in a little more detail—that a narrow focus on corridor care, while understandable, slightly loses the bigger picture. Corridor care is, for want of a better way of putting it, a subset, a consequence, of a much broader systemic challenge.
The Minister will probably know this as well; when I was first appointed to her job, one of the first conversations I had in the context of secondary care was about the importance of flow through our acute hospital systems, from a patient either presenting at A&E or arriving by blue light at A&E, to being treated, and the ability of A&E to function through those patients being seen, treated, and discharged or put into a hospital bed to become an in-patient. The ability to achieve the latter is dependent on the ability to discharge.
Helen Morgan
New clause 56 speaks about the importance of creating capacity across the system, including social care, and about having regard to the outcome of Baroness Casey’s commission on social care to deal with the issue of capacity and flow through the hospital. We have discussed at length in Committee other amendments that would deal with the front door, in terms of GP access and trying to ensure that people are treated at first in the community, rather than ending up in A&E as a last resort. I wonder if the right hon. Gentleman would just acknowledge those points.
Edward Argar
The hon. Lady pre-empts me— I am afraid I have rather a few more remarks to come to. I planned to through the subsections and paragraphs of her new clauses to acknowledge exactly that. For example, in proposed new clause 56(4), she highlights capacity, and in proposed new subsection (5) she mentions Baroness Casey’s independent commission and the need to pay heed to it. All that is important, but my slight fear relates to the drafting. While the new clauses note such factors, they do not necessarily reflect the overall interdependency of all parts of the system. I believe that what the hon. Lady seeks to achieve is perfectly reasonable, but I am not convinced by how the new clauses are drafted.
The hon. Lady was right to highlight in her remarks the importance of timely discharge from hospital as a key element of whether we can achieve that flow into hospital beds and have hospital bed capacity to allow an A&E department or emergency department to function. I looked at this issue four years ago, so the situation may well be very different today, but post the pandemic I inherited about 13,000 acute beds across the system occupied by patients who were medically fit for discharge, but whose discharge had been delayed due to a variety of factors. Some were because hospital pharmacies were not open through the night to provide the drugs when patients were signed off to go home; some were because of the unavailability of patient transport; some were because all the necessary clinicians were not present to sign in the appropriate order.
The single biggest factor, as the hon. Member for North Shropshire has alluded to, was the availability of step-down or social care provision, so that patients could safely go home or to another NHS or care facility and be looked after. We managed to get the delayed discharge total down from 13,000 at a given time to about 10,000—possibly just a bit under. I would be interested to hear from the Minister what the current total is for beds occupied by those medically fit for discharge at a given time.
I see where the hon. Member for North Shropshire is coming from with her suggestion of a tribunal comprised of a mixture of people to interrogate the figures and interrogate the Secretary of State. I can see that she is seeking to make the experiences of those undergoing corridor care and their families real to Ministers, who will be accountable. I gently say that I suspect that the Minister and her boss, the Secretary of State, are only too aware of the consequences of corridor care. Such patient experiences very much weigh on them as Ministers, as they did on me and others, day in, day out. We were always very cognisant of them.
I can see the hon. Member for North Shropshire’s intention with new clause 12(4), where she suggests that Healthwatch should be involved in helping put such a tribunal together. I fear that the Government’s direction of travel may have rendered subsection (4) redundant, but I do not disagree with the intention, because I think she and I both share a view on the importance of healthwatch groups and the value that they bring locally to our healthcare system.
While I can see the point about waiting 12 hours from arriving at the hospital to being taken into A&E, but the new clause does not reflect how the system might seek to manage that. It does not explicitly reference ambulance handover times and waiting times. A challenge we have seen in the past is that, in a desire to avoid hospital corridor care, some trusts have not admitted patients from ambulances until they feel that they could manage them in the hospital.
Arguably, that is less safe than corridor care, for two reasons: first, because the ambulance is not able to offload and be available in the community again and, secondly, because although corridor care has negative consequences, none the less in a hospital corridor there is a consultant or clinician very nearby, should a medical crisis occur. That is better than someone being in an ambulance in the car park—or waiting at home, having called an ambulance that is not coming, and not having their condition assessed because the ambulance is still holding a patient that a trust does not want to admit, in order to avoid congestion and corridor care.
I worry that, although the new clause has the best of intentions, the way the system might react and the impact on ambulance handovers and the ability of ambulances to pick up patients might have been overlooked. That is not a reason not to try to solve the problem of corridor care, but we must acknowledge the ambulance part of the challenge in A&E and emergency care, and encourage and incentivise the system to work as a whole to solve the problem, rather than focusing purely on the ED. In saying that, I acknowledge that the hon. Lady has referenced social care, step-down beds and community care, which are all hugely important, and I listened to her speech with interest, as I always do her contributions.
I would be grateful if the Minister could update the Committee on the latest daily figure for how many patients who are medically fit for discharge are still in an acute hospital bed. Perhaps, when the hon. Member for North Shropshire winds up on this group, she might be able to address the ambulance point—she addressed the social care point, but I would be grateful for her thoughts on ambulances.
Gregory Stafford
I rise to support a lot of what my right hon. Friend the Member for Melton and Syston said. Across the Committee, I think we all agree that corridor care and care in other inappropriate settings should have no place in the NHS. No patient should be assessed, treated or left waiting in a corridor, in a cupboard or anywhere else because there is nowhere for them to go.
We owe it to patients and our constituents to be honest about the scale of the problem and be serious about ending it. That starts with measuring it properly, because if we do not collect the data, publish the evidence and track progress, inappropriate care settings risk becoming normalised. In May, nearly 3,000 patients were in corridor care, which was a 2.5% increase from the same time last year. In the same month, 50,000 patients waited in A&E for more than 12 hours, which was a 17% increase from the same period last year.
The Government continually miss their target on the 12-hour wait. I am not making a political point; this is a serious problem, and successive Governments are still struggling to ensure that it does not happen. We all know from our casework and our inboxes, and some of us know through personal experience or from loved ones, that too many patients are experiencing unacceptably long waits in A&E after a decision has been taken to admit them. That is bad for patients, bad for staff and bad for the wider functioning of our hospitals.
New clause 56 in the name of the hon. Member for North Shropshire acknowledges that the causes of delays extend far beyond the emergency department itself, and I will touch on that in a moment. Challenges in social care, discharge processes, step-down provision and workforce capacity all contribute to bottlenecks that leave patients waiting longer than they should. Although there might be legitimate questions about the precise mechanisms proposed in the new clause, I do not think there is any disagreement among the Committee about the principle that patients deserve timely access to a hospital bed and that excessive admission delays should not be accepted as the norm.
That is why I fully support new clause 84 in the name of my hon. Friend the Member for Sleaford and North Hykeham. Publishing data on avoidable deaths associated with waits of more than 12 hours would help to ensure that we, as a Parliament and as policymakers, remain focused on outcomes for patients, not just performance indicators. I am particularly persuaded by the proposal to publish that information at ICB level, notwithstanding the concerns raised by my right hon. Friend the Member for Melton and Syston, which I agree with entirely. It would at least give some allowance for those making decisions to look at the local variation and ensure that it is identified, however less local that will become.
Hopefully, good practice will be able to be shared between different areas, and the areas that face the greatest challenges will be able to receive both appropriate scrutiny and appropriate support. Of course, collecting and publishing data will not by itself reduce waiting times, but we cannot effectively tackle a problem that we do not properly measure. Sunlight is often the best disinfectant in these cases, and greater transparency can be a powerful driver of improvement.
At the heart, new clause 84 recognises the simple truth that every statistic represents a person, a family and a life, and if avoidable deaths are occurring as a consequence of prolonged A&E waits, we should have the courage to measure them, publish them and learn from them. That is why I support the new clause. As has been touched on in other speeches, and as I mentioned earlier, the issue of corridor care does not sit in isolation. In fact, it is not a cause of the problem; it is the symptom of many other problems within our health and social care network.
Dr Prinsley
When I was a young doctor—a registrar—in the 1980s, we had 300,000 beds in our health service. By the time I was a senior doctor in the 2020s, we had 140,00 beds—less than half the number of beds we had before. When I was a young doctor, corridor care did not exist; I had never heard the term. The hospitals were simply big enough. Does the hon. Member agree that the many years of decline in the total number of beds in our hospitals is an extremely important factor in the fact that we do not have enough beds for the patients sitting in the A&E departments?
Gregory Stafford
I respect immensely the hon. Gentleman’s experience. He described being a young doctor, but he is still a very young doctor/politician now. Of course, capacity is an essential part of this. He is a clinician, so I will not lecture him on this, but my suggestion would be that it is not about just capacity within hospitals. The Government’s shift is to try to get people out of hospitals and into community settings as much as possible, so it is capacity within the whole system that needs to be looked at. Going back and putting loads more beds into hospitals would not somehow solve this problem or create a healthcare system that is aligned with what the Government want, which is hopefully treating more people at home. On his general point, I accept that the more capacity there in the system as a whole, the more likely we are to solve some of the problem.
That neatly moves me on to my next point, which is about the whole-system approach to this. As hon. Members have mentioned, we have a potential problem with ambulances waiting in carparks, and unfortunately, trusts gamify the system when targets are put in place—they do not admit people through the door because it will hit their targets. As my right hon. Friend the Member for Melton and Syston mentioned, that has a knock-on effect for the people sitting in the ambulances and those who are potentially not receiving an ambulance because the capacity is not there. Likewise, at the other end of the system—though I suppose it is both ends of the system—social care needs to improve significantly. I am deeply disappointed that the Government have pushed another social care review that is probably not going to report until 2028, which is kicking the can down the road. I think it is essential that we get social care correct.
Liz Twist (Blaydon and Consett) (Lab)
Some excellent points have been made about corridor care; I know that all of us want to see that improved. It is a serious issue for all of our residents, and the Minister and others will be working hard to do all they can to address it. May I gently point out the irony of colleagues on the official Opposition side raising all these issues now as if they have had a Damascene conversion, when they had 14 years to try and address them? I remember raising these issues in the House when my party was in Opposition. We are not undermining in any way the concerns about corridor care, because we all care deeply about it. [Interruption.]
Gregory Stafford
I am grateful to the hon. Member; she makes an interesting point. She talks about irony, and I respond in the same manner as that which she intervened on me with a gentle response, which is to ask why, if everything was going so swimmingly well, she and the rest of her colleagues got rid of the Prime Minister?
Joe Robertson
I am grateful to my hon. Friend for giving me an opportunity not to chunter from a sedentary position and to remark that this tedious rhetoric about the last 14 years—when all the public want to do is hear about plans for the future and how they will work—is the reason why we are in the state that we are. Will my hon. Friend continue and address the points that the public want, which he had already begun to do?
Gregory Stafford
My hon. Friend is absolutely right. The public do not want to hear about the last 14 years or the rhetoric around them.
Gregory Stafford
I will give way to the hon. Lady after I finish my sentence, if I may. The public want to know what the solutions are. I think we could look back through history at successive Governments since prehistory and say, “They got some things right, and they got some things wrong.” What the public want to know now is what the current Government will do.
On the point about social care, I was not a member of the last Government, but I stood on an election manifesto commitment, as the Labour party certainly did and I think most political parties did, that essentially said that the Dilnot review had decided how we were going to deal with social care, and we were going to get on with it. It strikes me as very strange that the last Secretary of State, the right hon. Member for Ilford North (Wes Streeting), decided to have another review; he has said himself in interviews since he resigned that it looks like the stalling on social care means that we will not get any movement on it before another general election. I do not think the public should put up with that.
Karin Smyth
As the hon. Member was not here at the time, perhaps it eludes his memory, I remind him that it was a coalition Government agreement to move forward with Dilnot, which had cross-party support. As soon as the coalition finished in 2015 and the Conservative party had dumped their friends in the Liberal Democrats, almost immediately after that election, it also dumped all pretence around the Care Act 2014 provisions at the time. We are where we are. I just wanted to help his memory.
The Chair
Order. I think we are moving a little out of scope here. Could we bring it back to the contents of the Bill?
Gregory Stafford
I will do that. As I have already said, no party has necessarily covered itself in glory with this issue. It might have taken us four years to dump it; it took the Chancellor of the Exchequer less than two weeks.
Liz Twist
I want to touch on the point made by the hon. Member for Isle of Wight East in his intervention. We absolutely agree that the public are concerned with what we do for the future. We are talking about a specific Bill here. There is a huge concentration of effort in getting those figures down. We absolutely agree that people want to look to the future and whether this is the way to do it.
Gregory Stafford
I look forward to the new Prime Minister coming in and, I hope, providing a position where the hon. Member is able to achieve some of that. [Interruption.] I note for Hansard that that received acclamation across the Committee Room.
Getting back to the Bill, as you have suggested I do, Dr Huq—I take your suggestions very seriously—the social care element is extraordinarily important. It is important to ensure that people do not enter the secondary care system if at all possible, especially through attending A&E. When I worked on the Getting It Right First Time programme, our accident and emergency reports put forward some interesting methods that could potentially help with that. Some of that has been implemented and some has not, but I recommend all hon. Members look at that report, because it contains a number of interesting proposals.
This is not only about stopping people entering the system, but about ensuring that people come out of the system in a timely manner, freeing up the capacity we have just talked about. In my constituency, Haslemere hospital had 16 step-down inpatient rehabilitation beds. Unfortunately, last year, that service was “temporarily paused”—that is how it was described, but it has been over a year now, so it has essentially stopped. That service is not happening in my constituency, which is down to the fact that it was a GP-run service and the trust could no longer get a GP who was willing to run that service.
Haslemere hospital and the Royal Surrey NHS Foundation Trust that runs the hospital have some really fantastic ideas, very much in keeping with the Government’s push towards neighbourhood health, and I fully support those proposals, but it is a shame that we have had 16 beds sitting empty for more than a year, which could have been used for rehabilitation. We as a body politic should be looking at how we can improve and expand our step-down/step-up capacity, so that people do not have to go into acute settings.
I turn briefly to the specifics of new clause 12. I am concerned about subsections (3) and (4), which talk about a tribunal system. I do not quite understand how that would work. The way it is set out almost gives it an adversarial, inquiry-type, case-by-case element. It would include patients, bereaved or affected families, and frontline NHS staff. I can see how that kind of body might work if one was investigating a failure around a single patient or at a single trust, but I would be grateful if the hon. Member for North Shropshire could expand on how she sees the national report coming forward and then a group of people being selected to interrogate it. It is also not clear what would be the consequences of the interrogation, or otherwise, once it has happened.
Dr Johnson
New clauses 12, 56 and 84 are about care in our accident and emergency departments and care in corridors. I do not want to rerun the debate on corridor care that we had in the Chamber last night, but corridor care does not provide safety, privacy and dignity, and it is unpleasant for the patient, their family and staff. If someone is in a corridor, how can they get changed, or use a commode or a bed pan? How can they be examined privately, and give information about their medical history without being overheard by a person walking down the corridor or the person in the bed next to them? Corridor care also has safety issues; for example, a patient may not be proximal to as much equipment, such as oxygen supplies and other equipment that might be required in the event of a collapse or arrest. It is not right and should not be the case that patients are cared for in corridors.
The hon. Member for Blaydon and Consett talked about the history, but I agree with my hon. Friend the Member for Isle of Wight East that the current situation and the future are what is important. A&E services are under pressure. Attendances went up by 2.5% last year, but in March 2025, 46,766 people waited more than 12 hours in A&E following a decision to admit before being moved to a more appropriate bed. That figure is up 8.8% on the previous year. The Government’s urgent and emergency care plan sought to improve that poor performance, but things have got worse. The latest NHS figures, from May 2026, show that more than 50,000 patients waited more than 12 hours following a decision to admit—17.1% higher than the May 2025 figure. The narrative that there was a problem but now things are getting better is not necessarily accurate. We keep being told that waiting lists are coming down, but they are higher than they were a month ago, and for those waiting for an admission or procedure, they are than they were a month ago and higher than they were a year ago.
Dr Prinsley
I wonder whether the hon. Member remembers that in 2010, when I believe there was an election—[Interruption.] Yes. The point I wish to make is that at the end of the previous Conservative Government, before Labour came back into office, waiting lists had reached an absolute record. Under the previous Labour Administration, waiting lists came down to almost nothing, but after 2010 they crept up and up, and by the time of the election in 2024 they had reached a record. I think she will recognise that Labour Governments have had strong records of reducing waiting lists, which is what we are doing now. We are only getting started, but it would be good to have some words of encouragement.
Dr Johnson
I am always happy to encourage the hon. Gentleman; I hope that in the impending reshuffle, he is given the opportunity to put his experience into practice. I have one word for him: pandemic. The pandemic made a huge difference to the numbers on waiting lists, and there is no current pandemic. It is possible to make arguments about whether the Government at the time—I was not in the Government at the time—were too harsh in their policies around elective care, whether patients would have come into hospitals for elective operations during covid or whether they would have preferred not to, and whether the waiting lists grew more than they may have done in other circumstances, but to try to say that the pandemic had no effect is going a stretch too far.
Karin Smyth
To correct the shadow Minister, I do not think my hon. Friend the Member for Bury St Edmunds and Stowmarket said that; he said the waiting lists have gone up. To be clear, in case her memory eludes her again, they were at 4 million before the pandemic and the Conservative party—her party, whose manifesto she stood on—did not meet a single target since before 2015. That is important for people to remember: 4 million people were on waiting lists before the pandemic started. The NHS went into crisis under the Conservatives’ leadership. Even if the hon. Member for Isle of Wight East thinks it is tedious to remind them of their record, no member of the public thinks it is tedious; they will never be forgiven for that record.
Dr Johnson
I think what members of the public want is the people who are in government now to do something to improve their lives. I am in danger of repeating myself, which could present an extra concern when so many people are questioning my memory, but there has been a 2.5% increase in the number of A&E attendances, but a 17.1% increase in the number of people waiting more than 12 hours after a decision to admit. That suggests that the Government are not going in the right direction. The public may enjoy a history lesson from time to time, but what they really want to know is what is happening now to make their lives better. I am sure the Minister will give us the answer to that in her summing up, but at the moment the Government are not bringing down the long waits in A&E.
Let me return to the new clauses. Corridor care needs a whole-pathway approach. In last night’s debate we talked about the importance of preventing admissions—I know that is one of the Government’s shifts—in order to increase hospital capacity. The hon. Gentleman for Bury St Edmunds and Stowmarket talked about capacity and the number of beds having reduced over a long period—another history lesson—but when my mum had me, a good few years ago, it was common for women to stay in hospital for quite a long time after having their child, and it was quite common for people to stay in bed for many days after having an operation. We now know that it is better for people to be up and about, and people leave hospital more quickly. That is a good thing. The reason for bed numbers coming down over successive Governments of different parties is clinical as well as managerial. I think that is worth saying.
Will the Minister answer a question that I asked in last night’s debate but, unless I missed it, she did not answer in her summing up? Does the NHS have more beds now than it did when Labour came to power in July 2024, or fewer? I believe the answer is fewer.
Edward Argar
Does my hon. Friend recognise the statistic that between 1997 and 2007, the then Government closed 32,000 hospital beds—more than double the number closed between 2010 and 2022? That is when the big reductions took place, and they failed to put in place an expansion of community beds to match that.
Dr Johnson
I will come to the hon. Gentleman in a minute, but I need to answer my right hon. Friend’s question first. My right hon. Friend has a much better memory than me—I was much younger then—so I am sure his statistics will be accurate.
Dr Prinsley
I think the principal reduction that the right hon. Member for Melton and Syston described was a result of the change of practice in the way that psychiatry was managed. During that period, we closed the asylums—large hospitals on the outskirts of almost every town and city. That was the result of a change in clinical practice—the idea that patients should be managed within the community. However, we continued to close acute beds, and it is the acute beds in the district general hospitals that are the problem we are talking about.
Dr Johnson
I think we are going back full circle to the hon. Gentleman’s intervention on my hon. Friend the Member for Farnham and Bordon, when he suggested that the problem was that beds had historically been closed. Now he is making the point that there were clinical reasons why that happened, not just managerial reasons. I think that is an important thing to note.
Moving on from capacity, we also need to look at the workforce. I would be grateful if the Minister could tell us how soon “imminent” is in terms of the workforce plan. There was also a point picked up earlier—I cannot remember who picked it up; it might have been the hon. Member for North Shropshire—about discharge from hospital and pharmacies. One of the challenges that I find as a clinician is that hospital pharmacies often close relatively early, which means that it is more difficult to discharge patients in the evening. That is something for the Minister to look at. There is also, of course, the importance of social care, and ensuring the provision of social care beds both to prevent admission and to get people out of hospital as quickly as is safely possible.
That is the background to this group of new clauses. New clause 12, in the name of the hon. Member for North Shropshire, would require a report on corridor care to be produced six months after the passage of the Act, and then every 12 months, containing data at the hospital, trust and ICB level on the number of individuals receiving care in an inappropriate place. That seems sensible data to collect, but I believe the Government may already to be collecting it; the Minister may be able to enlighten us on that. The report would also set out the steps taken in that year to reduce the number of patients in inappropriate care spaces, the plans for the coming year to reduce that number further—as I said, it is going up at the moment—and the funding allocated to that. There is some sense to that. Then the Secretary of State would have to give evidence in front of a panel, called the “corridor care tribunal”, which would include patients, affected families and impacted NHS staff, who would be selected by Healthwatch and NHS royal colleges.
I have just a couple of points on that. One is that Healthwatch will be abolished by the Bill, which would make that challenging—perhaps the new clause would need to be redrafted. Also, I am a member of the Royal College of Paediatrics and Child Health and an NHS consultant paediatrician and, as far as I am aware, the royal colleges are independent of the national health service. They are separate; they are connected in terms of training, standards and advice, but I believe that they are organisationally independent. I am sure that the Minister will correct me if I have got that wrong.
I wonder whether the hon. Member for North Shropshire has considered whether the Health and Social Care Committee, which is elected and politically balanced, might be the right body to scrutinise those Government plans. My hon. Friend the Member for Isle of Wight East, who is a member of the Select Committee, is not here now, but—
Dr Johnson
Sorry; I forgot. I am sure that my hon. Friend the Member for Farnham and Bordon will tell me if I am wrong, but that is an elected Select Committee, with political balance, that is set up specifically to scrutinise the work of the Department of Health and Social Care. If the Department is working to try to reduce the number of patients receiving corridor care, and to measure it, it seems to me that the right organisation to scrutinise that work is already in place: the Health and Social Care Committee. I therefore think this measure would be a duplication. However, I understand the need to get patient voice into the picture; that is why it is unfortunate that the Government are choosing to abolish Healthwatch, which I think would do that very effectively.
New clause 56, also in the name of the Member for North Shropshire, talks about A&E waiting times. I will start by saying that we all want A&E waiting times to be shorter—we all want people to be seen quickly and do not want patients to suffer—so the intent behind this proposal, to get people seen more quickly, is obviously a good one.
However, the new clause would require, within six months, provision to be made requiring
“every patient to be admitted into an Accident and Emergency Department within 12 hours of approval of their admission being made.”
I have a question about the wording of that, because my understanding is that someone is admitted to A&E when the decision is made to admit them to A&E and they become an A&E patient. I wonder whether the hon. Lady intends it to mean admission to an appropriate bed, whether in the trust or elsewhere. Usually, people waiting in corridors or in A&E are waiting for admission to the ward, rather than for someone to make a decision.
New clause 56 would also require the Secretary of State to establish and implement an A&E scheme to help trusts to achieve that requirement, and provides that the scheme must consider creating safety nets, step-down beds and a dedicated workforce plan for A&E—it will be nice to see the workforce plan, which the Government are supposed to have written—and mandating the presence of a “qualified clinician” in the waiting room. Will the hon. Member for North Shropshire tell the Committee what she means by a qualified clinician? Does she mean a consultant, a senior nurse or a healthcare assistant? What sort of qualifications does she think that they must have? The Secretary of State must also have regard to Baroness Casey’s report, but that is not due to be written in time for the new clause, which creates a little tension. However, again, I agree with the principle that social care is important in this context.
In summary, the principle of new clause 56 is good and important, but I think that there are some issues with the drafting of it. New clause 84 in my name, which has been well covered by my colleagues, would just require the publication of data. In her speech earlier, the hon. Member for North Shropshire gave a figure of 15,000, but I looked back at Hansard and last night she said that the Royal College of Emergency Medicine reported that long waits caused 15,860 deaths. That figure tells us what a serious problem this is. Being able to measure that figure and, I hope, see it falling would be a helpful step.
Ordered, That the debate be now adjourned.—(Emma Foody.)
Health Bill (Fifteenth sitting)
Thursday 9th July 2026
(1 month, 1 week ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 9 July 2026 - (9 Jul 2026)
The Committee divided: - Ayes: 1 / Noes: 7 - Question accordingly negatived.
The Chair
I remind the Committee that with this we are discussing the following:
New clause 56—Accident and Emergency: waiting times—
“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision relating to Accident and Emergency Department admission.
(2) Provision under subsection (1) must include the requirement for every patient to be admitted into an Accident and Emergency Department within 12 hours of approval of their admission being made.
(3) The Secretary of State must establish and implement an Accident and Emergency Scheme (‘the Scheme’) to support NHS hospital trusts to achieve the requirement set out in subsection (2).
(4) The Scheme must consider—
(a) creating safety-net social care beds,
(b) increasing step-down care,
(c) publishing a dedicated accident and emergency care workforce plan, and
(d) mandating a qualified clinician is present in every Accident and Emergency waiting room.
(5) The Secretary of State must have due regard to the final report of the Independent Commission on Adult Social Care in establishing the scheme.”
This new clause gives patients a legal right to be admitted into A&E within 12 hours from decision to admit and requires the Secretary of State to introduce a scheme to achieve this.
New clause 84—Publication of data on avoidable deaths—
“(1) The Secretary of State must publish every quarter the number of avoidable deaths where waits of more than 12 hours in accident and emergency departments was a contributory factor.
(2) The Secretary of State must make the data under subsection (1) available by integrated care board area.”
This new clause would require the Secretary of State to publish data on avoidable deaths caused by waits over 12 hours in A&E departments.
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to see you in the Chair, Ms Lewell. I will speak first to new clause 84, tabled by the hon. Member for Sleaford and North Hykeham. I reconfirm the Government’s focus on reducing long waits by improving patient flow, increasing productivity and delivering better emergency care for patients. Last night in the Chamber, we had a good discussion about corridor care in particular; all our comments are on the record, so I will not delay the Committee by repeating everything, but I will take some time to answer the questions raised in Committee this morning.
We are clear that the Government will end corridor care in this Parliament. It is completely unacceptable. Longer waits for emergency care can be associated with poorer patient outcomes. That is why, through the urgent and emergency care plan in 2025-26, we are investing more than £450 million to expand urgent and emergency care capacity, including new same-day emergency care services, urgent treatment centres, additional mental health crisis provision and nearly 1,000 replacement ambulances. Alongside that, we are implementing new clinical standards and improving patient flow across hospitals, all to reduce the number of patients waiting more than 12 hours.
Sojan Joseph (Ashford) (Lab)
I was pleased to take part in the debate in the Chamber yesterday. I raised some examples from my local hospital, which is expanding its same-day emergency care because of the funding that we received from the Labour Government. We also have a safe haven for mental health patients who do not need to go into accident and emergency. Lots of work is happening in my local hospital area, which will make a big improvement to corridor care and wider emergency care pressures. Does the Minister agree that that is what we need to do, and that the Labour Government are doing it?
Karin Smyth
My hon. Friend has been a strong campaigner. His health community has a lot of problems, as he well knows, but he is always there first, challenging me about the challenges in his healthcare system. He ensures that the people of Ashford are duly represented. He is absolutely right that what will make a difference to patients is improvement on the ground. I do not minimise how far there is to go, but I think patients are already starting to feel that improvement.
In the debate last night, we heard about some great work that is happening. We heard from, among others, my hon. Friend the Member for Ashford; from my hon. Friend the Member for Rossendale and Darwen (Andy MacNae), who talked about the challenged system and the challenged hospital in Blackburn, and the real improvements there; from my hon. Friend the Member for Watford (Matt Turmaine); and from my hon. Friend the Member for Bury St Edmunds and Stowmarket, who talked about progress in West Suffolk. That is really encouraging to see.
Earlier in the debate, statistics in the public domain were raised by, I think, the hon. Member for North Shropshire and others on deaths due to long waits and so on. That is a completely unacceptable situation, but I want to put it on the record that those statistics are not Government statistics. We had a bit of a debate about that. My hon. Friend the Member for Bury St Edmunds and Stowmarket highlighted how one can attribute cause of death to certain provisions. It is a really important measure. We do not want anyone waiting, full stop, but the statistics are not verified as Government statistics. I want to be clear about that.
On new clause 84, I assure the Committee that trusts are already held to account on the number of patients waiting 12 hours from arrival in A&E to admission, discharge or transfer. The medium-term planning framework published in October 2025 sets out the expectation that trusts will reduce the percentage of patients waiting 12 hours or more, year on year until 2028-29, as part of our overall ambitions to return to meeting the NHS constitutional standards.
The Government already produce comprehensive data on urgent emergency care performance, including on waiting times and on 12-hour waits. Those data provide transparency, support the oversight of the NHS’s performance and enable independent analysis of patient outcomes. We have been very keen to ensure that those statistics are published.
Another issue raised this morning was bed numbers. We had a bit of a historical throwback to the 1990s; I will not detain the Committee further by doing that again. My hon. Friend the Member for Bury St Edmunds and Stowmarket talked about changes in clinical practice, mental health beds and so on. I could talk for many hours about that. As a junior manager coming into the health services, one of my first tasks was to define what a bed is. That is not an easy thing to do. Most people think they know what a bed is but, as we discussed earlier, a trolley without wheels could be a bed. Counting beds and defining what they are and what they are used for is a complicated business in the health service. I know you will tell me not to deviate from the new clause, Ms Lewell, but this is important. Practice changes, and it is important that we make the most effective and efficient use of NHS resources. That means making changes to bed numbers, where they are and how we count them.
In June 2026, an average of 13,618 adult patients in acute hospitals per day were waiting for delayed discharge. We have improved data collection, so we have a better sense of the scale of the problem and, crucially, where it is; it is different in different places. We are seeking to improve that data. I gently remind the Committee that the NHS England website produces an awful lot of really good data so that Members of Parliament and our constituents are able to keep track. As my hon. Friend the Member for Bury St Edmunds and Stowmarket made clear, we need to keep up with best clinical practice, as well as the best use of resources. We are very happy to share that information and keep it transparent.
New clauses 12 and 56 were tabled by the hon. Member for North Shropshire, who is right to raise the unacceptable waits for care that some patients experience in A&E after the decision has been made to admit them. That includes patients being treated and cared for in corridors at times because of hospitals’ lack of capacity to admit them. As we discussed last night, the Government are clear that corridor care is not an acceptable standard of care and must not be normalised. We inherited an NHS under severe pressure with long waits and increasing numbers of patients receiving care in non-designated clinical areas. It is unacceptable, but I am afraid it was allowed to happen under the Conservatives. We are committed to eradicating corridor care, and we have a plan to do so.
To improve transparency, we have already established a clear national definition of corridor care. Again, the Conservatives could have done so in the past 14 years but chose not to. We have introduced daily reporting arrangements and strengthened the data quality processes. We are working hand in hand with stakeholders, including the royal college. In addition, we have published national guidance to support safe care where such situations cannot be avoided.
We are working hard to tackle the causes of corridor care; we are not just reporting on the consequences. That is why we want to improve patient flow. We have had good discussions about patient flow, both pre-admission and post-discharge, involving social care and primary and community care to support people who need care homes. We do not want people—particularly frail, elderly people—turning up at hospitals if it is better for them clinically to be treated where they are. We are improving patient flow, strengthening the discharge arrangement and investing £215.5 million in new and expanded urgent care services across England. We are also providing targeted support to the trusts facing the greatest challenges in relation to corridor care so that improvements can be delivered where they are needed most.
I gently remind the hon. Member for North Shropshire—and the hon. Member for Sleaford and North Hykeham, as a clinician, will be clear on this information about admissions—that when a patient presents at A&E, a clinician decides whether to admit them to the hospital, provide treatment, transfer their care to another location or discharge them. Under the current reporting rules, the clock starts running on a patient’s arrival in A&E and stops when one of those actions is taken. As a result, no decision is made to admit to A&E itself. Instead, if someone requires admission, it should be to somewhere elsewhere in the hospital.
Although I fully recognise the concerns that underpin these new clauses, I do not believe that further statutory requirements are the right approach. In the debate last night, we outlined in full the Government’s absolute commitment to addressing the issues and improving the situation for all our constituents. I hope that I have suitably reassured hon. Members that these new clauses are not required, and that they will not press them.
Helen Morgan (North Shropshire) (LD)
I will speak briefly to new clauses 12 and 56, about which we had quite a long debate this morning. Let me respond to a couple of questions. The shadow Minister asked about the role of Healthwatch in selecting the panel that would interrogate the Secretary of State, as we envisage in new clause 12, given that Healthwatch will be abolished by the Bill. She also asked about new clause 56, which would require the Secretary of State to have due regard to Baroness Casey’s final report. The shadow Minister said that those things are essentially inconsistent, but, considered as a suite of amendments, the provisions we have tabled are consistent. We oppose the abolition of Healthwatch; had that been successful, Healthwatch would still be there. We have also tabled new clause 60, which we will get to later and which would require Baroness Casey’s commission to report much more quickly. That is why that apparent inconsistency exists; I hope I have sorted that out for the shadow Minister.
The right hon. Member for Melton and Syston, a former Minister, talked about capacity in the system as a whole and its impact on corridor care. His concern was that if we focus on corridor care, we will end up with more people being treated in ambulances, have longer ambulance handover times and very long ambulance wait times. He will know, having been the responding Minister to my first Adjournment debate, that ambulance wait times have been a significant problem where I live. I am pleased to say that they are becoming less of a problem, because the new management of the hospital have focused relentlessly on the A&E department and on ensuring that ambulance patients can be taken into it very quickly, or certainly much more quickly than they used to be. I recognise his concern, but I think it is a manageable one.
Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
Although it is true that hospital management could concentrate on dealing with the waits in A&E, surely it needs to concentrate on the flow through the entire hospital. Every department and everybody involved in the hospital has to be thinking all the time about the flow through the entire hospital. That involves having a pharmacy that is open at night and ensuring that social workers are there when they need to be—it involves all manner of things. Simply concentrating on a particular statistic in an A&E department will not actually deal with the problem.
Helen Morgan
I think our new clause addresses that point. As I mentioned, my own hospital trust, Shrewsbury and Telford, has improved ambulance wait times simply by improving the flow through the hospital and addressing some of the issues. I recognise that our new clause does not deal with pharmacy availability at weekends and overnight, which I know is a critical issue in many hospitals; on Report, we will certainly tidy it up to ensure that it does, but I take the hon. Member’s point.
My new clause would address the system-wide capacity issue that the hon. Member highlighted so carefully, both in last night’s debate and here today. We need more capacity across the whole system. Otherwise, we are just trying to push a lump in the carpet to a different place, but there will always be a lump somewhere. The new clause seeks to provide 6,000 more beds across the whole system, to allow flow through the system and to ensure that waits do not back up in the ambulance service, on corridors in A&E or outside wards, as they do currently.
Critically, we should address the point about NHS pledges and rights. The constitution is broadly agnostic about the time people wait on corridors, but is not agnostic about the time it will take for them to get cancer treatment. That is an inconsistency and we should sort it out, because I think our constituents consider the two things equally important.
I take the Minister’s point about new clause 12. I will not push it to a vote, but although trusts are held to account on their A&E performance, the missing piece is that the Secretary of State is not. That is what new clause 12 seeks to address, and I hope that the Minister will consider that on Report. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 14
Healthy life expectancy target
“(1) Within six months of the passage of this Act, the Secretary of State must—
(a) make regulations to set a statutory target for improving overall healthy life expectancy for the population of Great Britain, and
(b) publish a cross-governmental strategy, renewed every 24 months, to set out how the target set by regulations under subsection (1)(a) will be achieved.
(2) The strategy under subsection (1)(b) must be laid before both Houses of Parliament.
(3) Upon publication of a strategy under subsection (1)(b) the Secretary of State must make a statement before the House of Commons regarding progress made towards the target set by subsection (1)(a).”—(Dr Chambers.)
This new clause would require the Secretary of State to make regulations to establish a statutory target for healthy life expectancy in Great Britain and publish a strategy every two years setting out how this target will be achieved.
Brought up, and read the First time.
Dr Danny Chambers (Winchester) (LD)
I beg to move, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss the following:
New clause 79—Public Health Committee—
“(1) The Secretary of State must establish a Public Health Committee within six months of the passage of this Act to ensure a cross-governmental focus and consideration of the promotion of public health in government policy and address national health inequalities.
(2) The Public Health Committee under subsection (1) must—
(a) include at least one minister from each government Department in its membership,
(b) include all cabinet ministers in its membership,
(c) be chaired by the Prime Minister, and
(d) meet once in each annual quarter.
(3) Under subsection 2(b), cabinet members must attend at least three quarters of the Public Health Committee's meetings each year.
(4) Each government Department must publish an annual report on their department's consideration of public health in its policy and the extent of joint policy formulation with other government Departments.
(5) The Secretary of State must establish a Health Creation Unit to support the Public Health Committee.
(6) The Health Creation Unit must submit an annual report on its activities, decision-making and cross-government progress to the Liaison Committee.”
This new clause would establish a Public Health Committee and Health Creation Unit to promote public health and cross-government policy making.
New clause 80—Duty to promote public health—
“All Ministers of the Crown have a duty to consider health outcomes and the promotion and protection of public health when exercising their duties.”
This new clause will place a duty on all ministers to consider health outcomes and the promotion of public health when exercising their duties.
Dr Chambers
New clause 14 is about healthy life expectancy. It would require the Secretary of State to make regulations to establish a statutory target for healthy life expectancy in Great Britain and publish a strategy every two years, setting out how the target would be achieved. New clause 79 would establish a public health committee and health creation unit to promote public health and cross-Government policymaking. New clause 80 would place a duty on all Ministers to consider health outcomes and the promotion of public health when exercising their duties. All three new clauses are closely related.
Over the last 100 years, life expectancy in the UK has been increasing for a variety of reasons, including vaccination, improved hygiene and medical advances, but worryingly, between 2022 and 2024, it decreased by 1.8 years for men and 2.5 years for women. That is the first time it has decreased in a while. There is an 11.1-year gap between the highest and lowest life expectancies, which is partly due to demographics and different socioeconomic situations. Socioeconomic disparity is causing a very significant difference in life expectancy.
We need wider whole-of-Government working to address the root cause of and contributing factors to ill health. DHSC, the NHS and social care deal with too much in silos, which is a problem across the whole of Government. There is too much siloed working. All Departments should be working with at least one eye on the health of the nation. That is what our new clauses seek to foster. A healthy life expectancy target would provide the basic metric for that aspiration, forcing wider thinking on prevention and ill health, rather than on waiting lists and hospital performance, as important as they are.
New clause 80 would place a duty on all Ministers to consider health outcomes and the promotion of public health when exercising their duties. That should aim to focus the minds of non-DHSC Government Departments that have a central role to play in the promotion of good health and longevity, whether that be housing standards or environmental regulations. We included health protection—areas such as clean water, for instance—as well as health promotion, which includes areas such as active travel.
New clause 79 would create a public health committee and a health creation unit to support its work, especially between Departments. This is an idea originally introduced under the coalition Government, designed to tackle obesity, alcohol abuse and other public health problems. Although we recognise that it was not perfect, given the Tories’ lack of engagement and spotty attendance, the desire to foster cross-Government thinking was definitely right.
Dr Prinsley
Would the hon. Member comment on what I consider to be almost the most successful and important Bill that our new Government have passed, on the effective abolition of cigarette smoking? As time goes by, that will save more lives than anything else we could possibly think of. I recognise that it was the initiative of the previous Government, but the fact that the new Government have managed to get it over the line is a massive achievement. That is very much underappreciated and certainly not spoken about anything like enough. We will never do anything as important as the abolition of cigarette smoking.
Dr Chambers
Yes, I sat on the Tobacco and Vapes Bill Committee for six weeks, going through the legislation line by line. One of the most interesting things about that Bill is not only that it will improve public health and life expectancy, but that it is probably one of the single most impactful pieces of legislation in terms of improving inequality and especially socioeconomic health outcomes. So many of the disparities in life expectancy between wealthy people and those living in relative poverty are due to levels of smoking—it is not just smoking, but that is a significant factor. It is good of the hon. Gentleman to highlight that.
During the coalition, the Tories recognised that the approach I described would send a powerful message that public health is the responsibility of all Government Departments. When it was scrapped, the then shadow Health Secretary, the right hon. Member for Makerfield (Andy Burnham), said that we could tackle Britain’s looming obesity crisis only if all Government Departments pulled together. We completely agree with that statement.
New clause 79 tries to address some of the issues that occurred back then, including by placing requirements on ministerial attendance and giving the Liaison Committee oversight to drive accountability. I am sure the Minister will agree that greater cross-Government working is needed. What are the Department’s plans to support that? If we want to tackle the various public health crises facing our country, we cannot do so without proper cross-Government working.
In my professional life, I was made an honorary lecturer at Bristol University veterinary school in the area of One Health, recognising that animal health, human health and environmental health are completely interlinked. It is difficult to improve one without looking at the factors that improve the others, and we need that kind of approach throughout all Government Departments.
Sojan Joseph
It is good to see you in the Chair, Ms Lewell. I strongly believe that public health is very important to our health system because it focuses on prevention, so that people do not end up in A&E or in hospital beds. Unfortunately, over the last 10 or 15 years we have seen the opposite. If we are serious about improving the nation’s health, prevention must sit at the heart of every decision we make.
Public health professionals bring a vital perspective—one that looks beyond treating illness to understanding and tackling its root causes. They consider the wider determinants of health, from housing and education to inequality and the environment, and they help us design services that keep people well, rather than responding only when they become unwell. We need to identify our priorities, ensure resources are allocated appropriately and develop a long-term strategy.
New clause 79 proposes to create a new committee. As somebody who worked in the NHS for many years, I have seen that there is no shortage of committees, senior leaders, management or meetings in our healthcare system. In fact, there are too many. What is missing are people to work on the frontline; that is what we saw over the 14 years under the Conservatives—and the Lib Dems were part of that.
One reason why I became active in politics was that I saw the frontline struggling. I worked as a nurse on the frontline in mental health services, and what we saw was money being diverted to create more senior leadership, more groups, more meetings and more management, while we were missing the people who actually did the work on the frontline. The new clause asks us to create a new committee, but we have enough committees and managers. In fact, through the Bill, we are trying to modernise the system by getting rid of some of those managers—that is the most important thing I can identify in the Bill. However, lots of the new clauses I have seen today and in the last Committee sitting have proposed creating more committees and directors. We are missing a point here. The Committee has an opportunity to reform our health system. If Members speak to a nurse or doctor who works in a hospital in our system, they will say, “We need more nurses, healthcare assistants and doctors, not more managers or directors.”
Not only in this new clause, but in many of the new clauses we are talking about, we need to think about embedding the public health voice within integrated care boards. Stronger integrated care boards will enable us to act early, reduce health inequalities and deliver care closer to home.
Natasha Irons (Croydon East) (Lab)
My hon. Friend is making powerful comments. I was struck by his argument that we need to focus more on what we do in communities. In Croydon East, a community diagnostic centre has opened, which is important because people in my community have a healthy life expectancy 10 years lower than that of people living a mile down the road. Does my hon. Friend agree that we should be focusing on those real, tangible interventions at the heart of the communities that need help the most? That is what this Government are trying to do.
Sojan Joseph
I absolutely agree, and I can give an example. Last week, as part of the ICB’s new independent neighbourhood health centre, one of the GP practices in my constituency started to proactively go and see all elderly patients. It is not just giving those patients appointments when they fall ill; it is proactively visiting them. We need that kind of support so that we can prevent illnesses and prevent people from needing to go to hospital.
Liz Twist (Blaydon and Consett) (Lab)
Does my hon. Friend agree that, as well as the physical aspects of health and extending life expectancy, we need to look at preventive measures for mental health? That will ensure that people live as good and full a life as they can, and receive the treatment they need. Does my hon. Friend see that as integral to any public health strategy?
Sojan Joseph
My hon. Friend makes a sensible comment. I work closely with her on mental health, and she is absolutely right. Some of the policies the Government have introduced, such as giving children early access to mental health provision, will be absolutely vital to prevent them from becoming unwell later on. The Government are also rolling out a new mental health strategy focused on prevention, which will be important. We need to be more lean and productive, rather than creating more managers and committees.
Edward Argar (Melton and Syston) (Con)
The hon. Gentleman will probably be aware of the King’s Fund report from late last year, which covers the years 2010 to 2025. It highlighted that the growth rate was only 5% for managers during those 15 years, but 94% for children’s nurses and 55% for doctors, and other groups had similar increases. We are seeing investment and workforce increases in the right areas.
It is right that we acknowledge, as I suspect the hon. Gentleman will, that the one group where we have not seen that same growth is community health visitors and community health workers. Alongside the massive investment and increase in doctors in the past 15 years, that group, and the role it plays, deserves focus from whichever party is in government.
Sojan Joseph
I agree. We need more band 5 nurses or healthcare assistants who can check blood pressure or blood sugar in patients’ homes. When someone rings their GP surgery, they should be able to meet a nurse or a healthcare worker to carry out some basic checks, rather than being delayed from seeing somebody until, a few weeks, months or a year later, they end up in A&E. That is where the focus should be.
I do not support the new clauses, and I urge the Committee to think about some of the other new clauses that propose creating more directors or committees. We need to focus on making our health system more productive.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I rise to speak to new clauses 14, 79 and 80, tabled by the Liberal Democrats. New clause 14 would require the Secretary of State, within six months, to establish a statutory target for healthy life expectancy in England and then to produce a strategy every two years to meet that target. This is not the first time the House has heard about life expectancy targets; as I am sure you will remember, Ms Lewell, the previous Government’s 2022 levelling-up White Paper talked about narrowing the gap in healthy life expectancy between the areas where it is highest and lowest, and aimed for healthy life expectancy to rise.
As the hon. Member for Winchester said, life expectancy has increased quite dramatically over the last century, but that is largely due to improvements in child mortality. That is a good thing, but it is worth looking at how healthy life expectancy is calculated. The Sullivan method starts by looking at mortality rates over a specific timeframe for a specific population, and then takes data from a cross-sectional study where people are asked to rate their own health, multiplies them together and produces a figure for healthy life years. Therefore, the main element that separates healthy life expectancy from unhealthy life expectancy is survey responses; it is not a clinical metric. If somebody on a huge amount of medication and treatment feels healthy, they are healthy. If someone on very minor treatment feels unhealthy, they are unhealthy. It is a self-reported measure.
The Government’s website says that if mortality improves by 2%, healthy life expectancy increases a very small amount; if self-reported feeling healthy goes up 2%, there is a much bigger increase in healthy life expectancy. We want people not just to live longer but to live well, but it is a case of how we measure it and how we ensure that there are no perverse incentives. We should look at it over time in the same individuals. How do people feel when they get up in the winter, when it is cold, dark, raining or icy? They may feel less healthy than when the sun is shining, it is the weekend or England have won the world cup.
The Government’s own figures show that musculoskeletal health is particularly important. Musculoskeletal conditions are prevalent among 17.2% of the population, and people with them are three times more likely to have self-reported ill health. We have asked before if the Government will introduce a modern service framework on musculoskeletal disease, having scrapped our long-term conditions strategy. I would be grateful if the Minister could say whether the Government have given more consideration to that and are now willing to do an MSF on musculoskeletal health.
New clause 79 would require the Government to create a committee across Government, including the Prime Minister, all Cabinet members and one Minister from each Department. The idea behind the new clause—that we need to work together—is important, but I would be grateful for the Minister’s comments on how feasible, practical and effective that would be.
Finally, new clause 80 concerns the duty to promote public health. Of course, it is the Minister’s duty to do his or her job, and part of that is promoting public health. What does the Minister think the practical effects of that new clause would be on bureaucracy in Departments?
Dave Robertson (Lichfield) (Lab)
It is always a pleasure to see you in the Chair, Ms Lewell. I will speak briefly on new clauses 79 and 80. I really like the intent of these new clauses, and the idea of Government working better and more together, public health being more of an agenda, and trying to get people working together in that framework. I am pretty sure that every Member in the House would support that. I do, however, have some serious concerns about the wording.
New clause 79 proposes a new committee, whose membership would include at least one Minister from each Department and all Cabinet Ministers—I presume that that is in addition, so it would be all Cabinet members plus one other Minister from each Department, which makes it seem like quite an unwieldy committee. There comes a point when a committee, if it has 70 people in it, ceases to be a committee, particularly when it will also need to be chaired, have clerks and have various people in the room. I have concerns about its size. I also have concerns about the frequency with which it would meet, and the requirement that every single Cabinet Minister must attend a minimum of three times a year, which is the implication of the wording.
Dr Prinsley
Public health used to be clearly under the aegis of the national health service. Some years ago, public health officers became employees of the local authorities, and the thing became somewhat separated from the NHS. Does my hon. Friend agree that we must join public health more closely to the activities of the national health service? Public health was at the very foundations of the national health service. I do not know whether other Members have, like me, read A. J. Cronin’s famous book, “The Citadel”, which describes the health service’s origins; in fact, I understand it was the book that the original politicians had all read. It has a marvellous description of a typhus epidemic, caused by an infected drain running down the middle of a street in a little Welsh mining village. The doctors had been completely unable to get any of the authorities to deal with it, so one night—they were ex-military—they put a little dynamite in the drain and blew the whole thing up. That is well described in the book, and it just shows how public health was absolutely integrated into the foundational principles of the national health service.
Dave Robertson
My hon. Friend makes an important point about the centrality of public health to the founding of the NHS. Earlier in Committee, I said that the NHS was the greatest gift the Labour party had ever given the country, and I fundamentally believe that. He is absolutely right to mention the centrality of public health in that process. I also thank him for his recommendation of a book to read over recess—that is always a pleasure.
To return to new clause 79, I want to focus on what we are asking when we say that all Cabinet members have to attend this new committee. That would include the Secretary of State for Defence, and although I understand cross-Government working and the need for Departments to work more closely together, I am scratching my head over what actions we expect the Secretary of State for Defence to take to support public health, and especially over the fact that they will be required to attend this committee a minimum of three times a year with, in my reading of the wording, another Defence Minister.
Dr Chambers
I pay tribute to the Royal Army Veterinary Corps. It does good work in trying to eradicate rabies in countries with street dogs, as part of hearts-and-minds engagement. We can work public health into pretty much any Department.
Dave Robertson
I absolutely join the hon. Member in thanking those service personnel who do so much good around the world, but I wonder whether it is appropriate to ask the Secretary of State for Defence to focus on public health. It is absolutely right that the Defence Department could do things, but does the Secretary of State need to be so centrally involved in this committee that they will have to attend three times a year, in addition to another Minister, who will have to attend a minimum of four times a year? Yes, a variety of Departments would be able to do that.
Dr Chambers
Just to blow my own trumpet, my greatest academic achievement was getting correspondence published in Nature on the impact of conflict on antimicrobial resistance. It might interest Members to know that, in Ukraine, 80% of wounds have novel bacteria that are displaying multi-drug resistance, which has become a limiting factor in getting soldiers back on to the frontline. We are trying to reframe issues such as antimicrobial resistance as national security and defence issues, rather than purely public health issues.
Dave Robertson
I very much appreciate that intervention, and I congratulate the hon. Gentleman on getting published in a very important journal. I am not in any way saying that the Secretary of State should not have any regard—[Interruption.] Now that he has made a joke, I want to say that I think he looks like a trombonist, rather than a trumpeter.
There is a very important point to draw out here. Although Departments can think about the public health impacts of the work that they undertake—I am sure many Ministers will do so—I am not sure there needs to be such a requirement to focus on public health for the Ministry of Defence, which obviously has a very significant, serious role.
New clause 80 would require all Ministers to have regard to public health. I really appreciate and value that—I think this is a good debate for us to have—but if the Minister for investment has managed to secure an investor to save a large business that is essential to the economy of an area, do I want them to be held up by having to demonstrate that the investment will ensure public health? I am not sure I do. A lot of decisions have to be made very quickly. I am not going to go through a long list of Ministers; we would all be here until next week. I just think the wording of the new clause is too broad, and I am not sure I can support it in its current form because it would place too much of a requirement on too many Departments to focus too much on areas that are not their core responsibilities.
Joe Robertson (Isle of Wight East) (Con)
It is a pleasure to serve with you in the Chair, Ms Lewell. I find myself unequal to the level of analysis and detail that the hon. Member for Lichfield brought to public health in the Ministry of Defence.
I will add just a few brief thoughts. The good intention of extending the life expectancy of the people in this country—although my hon. Friend the Member for Sleaford and North Hykeham made the good point that it is about living well, not just for a long time—is not always best served by creating committees, and additional duties, reports and responsibilities in legislation.
The hon. Member for Winchester argued—I paraphrase, but it is a matter of record—that he would like all Departments to have an eye on the health of the nation. That sounds sensible. There are other things that I would hope all Ministers have an eye on in everything they do, such as the wealth of the nation and inequality, but I would not advocate for embedding those things—I hope they would come with good governance, public duty and responsibility—in legislation as a duty, a committee, a set of meetings and a report. Indeed, it is things done with good intentions that lead to growing bureaucracy, which slows down decision making and requires more people to be employed to discharge those duties at a growing cost to the public purse. It is something that western democracies do all too well, and not always for the good. I would not want this well-intended set of new clauses to lead to growing bureaucracy with very little benefit. The benefit that the hon. Gentleman wants to see, which I agree with, can be best delivered in other ways.
Karin Smyth
I am grateful to hon. Members for bringing this discussion to the Committee. The Government are clearly committed to enabling people to live longer. It is one of the successes of recent years that, at the foundation of the health service, the average life expectancy was I think 60 or 62, while, now, it is in the early to mid-80s. That is a massive change in the last 80 years or so.
As well as improving the healthy life expectancy of the population, we are determined to address the stark inequalities that blight our nation’s health. We know that the most disadvantaged in society often face the biggest health challenges, and that the current model of care works least well for those who already experience disadvantage, who are also far more likely to have complex needs.
In fact, my own entry into working for the NHS, back in the 1990s, was on the back of the 1980 Black report, which some Members might remember well. The then Conservative Government sat on that for ages; it was such an awful reflection on the first 35 years of the health service, that health inequalities had not improved, that they sought not to publish it. That struck me as so shocking that it led me to want to pursue a life doing something about it.
I see that in my own constituency, where the legacy of the tobacco industry—which my hon. Friend the Member for Bury St Edmunds and Stowmarket mentioned—has led to a very high prevalence of smoking-related disease. In some parts of my constituency, that is up to 34%.
Liz Twist
I would point to examples such as in the north-east of England, where the work on smoking has been incredibly effective and still continues, and makes that real shift and change. Does my hon. Friend agree that it is those practical examples that we need to see, and to support along the way?
Karin Smyth
I thank my hon. Friend for that point about prevalence in the north-east. Often, the prevalence of these diseases is also to do with post-industrial work, which many people had to do without concern or knowledge about the effects on their health.
My hon. Friend the Member for Croydon East mentioned practical examples as well: the opening and building of things such as community diagnostic centres in places that are accessible and open to the public, and neighbourhood health. That is entirely the drive that we have: for services where people are, and where the greatest health need is, and not expecting people to travel.
In terms of smoking, one of the greatest legacies of the last Labour Government was of course the ban on indoor smoking. My mother was a barmaid for all her adult life; it is hard to imagine that people were just standing there at her place of work, blowing smoke at her while she was working. I tell my children, “Yes, we used to sit on aeroplanes with people smoking,” and that, unbelievably, some people smoked at the back of buses on the way back from school, and so on and so forth. It is really quite shocking.
The Tobacco and Vapes Act 2026, which we have also talked about in this Committee, is also a real testament to the work of this House, but didn’t it take a long time, Ms Lewell? I pay tribute to the right hon. Member for Richmond and Northallerton (Rishi Sunak) for pursuing that in the face of great adversity from his own party at the time. That was not, obviously, by the Members present, who all have a high concern about health, but perhaps by others on the Conservative Benches at the time, and then indeed in the Lords, who sought to thwart it—thwart is a strong word in this context; obviously, they made their points, but they sought to stop that Bill making progress at various stages.
Some of my colleagues were coming back at different times, saying that they were working on the Tobacco and Vapes Bill, and I said, “What, still? Really? Has it not come through yet?” That showed how hard it is, when something so well evidenced and so supported by public health experts, on something so detrimental to public health—particularly for people living in poorer communities, such as the one I represent in Bristol South—still takes such a time to get through.
Dr Johnson
The Minister is very, very aware of my views and opinions on the Tobacco and Vapes Act, particularly on vaping and stopping vaping among children. That Act, a bit like this Bill, left lots of opportunities for the Government to provide for regulations. Anyone who has been in a shop in the past few days will have seen vapes still behind the counter, still very visible, very colourful and in lots of different flavours and suchlike. Can the Minister update the Committee, and therefore the House, on when she expects the regulations provided for by the Tobacco and Vapes Act to come into force, so that we can actually apply the law, as opposed to just having it sat on the statute book?
Karin Smyth
Well, I thank the hon. Member for her support. As I said, I did not expect that people here present, who understand the impact of that work, were the ones who were thwarting that. I do not have off the top of my head exactly when the regulations under that Act will come forward, but I am sure we can furnish the hon. Member with details as soon as possible. We all want to see that happening—in particular, the work going on around high streets, such as prevention of fraud by shops for all sorts of things, not just vapes. Obviously, that is high on the agenda, as it is for some of my colleagues as well. Those places and people are blighting our high streets.
Dr Prinsley
I sit on the Home Affairs Committee, and we have lately been discussing the matter of serious organised crime, and vape shops in particular. It turns out that many of the vape shops are in fact not really shops; they are places for laundering money. Specifically, they launder money in relation to drug businesses and the drug trade, which is another huge public health matter that I am sure the Minister will agree needs to be dealt with. We were informed that about 10% of this country’s adult population are using illicit drugs, and that for the most part those are being delivered via the post office. Does the Minister agree that that is a massive public health issue that will also need to be urgently addressed?
Karin Smyth
I thank my hon. Friend for his expertise and that work on the Home Affairs Committee. Again, it shows the Committee the wide range of work that goes on. Of course, many hon. Members are campaigning and working hard. Those shops are blights on our communities, and as with most illicit drug dealing, they affect the most vulnerable in places where they can pick on the most vulnerable. They are in areas of high deprivation, and that is something we need to stop. I commend all the communities and community leaders that work so hard to stop that happening in their areas. We must address it.
Returning to new clause 14, while I fully recognise and share the ambition that sits behind the new clause, introducing a new statutory duty is not the right way to achieve it. A healthy life expectancy is a long-term outcome shaped by a wide range of factors across society and Government, many of which cannot be meaningfully addressed through a rigid statutory timetable. Requiring the Secretary of State to set a statutory target within six months, publish a refreshed cross-Government strategy every two years and make formal statements to Parliament risks creating a process-heavy framework that prioritises reporting over delivery.
What matters most is sustained practical action to improve prevention, tackle health inequalities, expand access to care and address those wider determinants of health. That is why the Government have already published our 10-year health plan to improve the nation’s health, of which healthy life expectancy is one measure. That is central to us in bringing forward the 10-year plan. Publishing a new strategy every two years would be duplicative and would not help to deliver the plan that we already have in place. Work is already underway, and I am sure the House will hold us to account for the progress we make, as it rightly should. I believe we share the same aim that the new clause seeks, but we differ on the best means to get there.
On new clause 79, I assure the Committee that the Government are already working across Departments to improve health and reduce inequalities, ensuring that action on health is embedded across Government. For example, through the warm homes plan and rented sector reform, we are supporting healthier homes and reducing health harms associated with poor housing. Through the “Keep Britain Working” review, we are addressing the links between work, health and wellbeing. Through the environment improvement plan, we are tackling the health harms of air pollution, and in lifting hundreds of children out of poverty, we will transform their health and life chances.
Those endeavours demonstrate that improving health outcomes is already embedded across Government activity and does not depend on the creation of a new statutory committee. While I have considerable sympathy with the aim of the new clause, and I am a strong supporter, as I hope I have assured the Committee, of supporting those wider determinants of health, I am not persuaded that placing detailed internal Government structures into primary legislation is either necessary or desirable. We heard well from my hon. Friend the Member for Lichfield about some of the unintended complications about the new clause.
As we have repeatedly said, in the Bill we are not seeking to be unduly prescriptive or create unnecessary bureaucracy that may risk slowing down delivery. Indeed, we are aiming to reduce that bureaucracy. Furthermore, the Government must retain the flexibility to organise in a way that best supports delivery as the context evolves. The Government already bring Departments together to advance shared goals and will continue to strengthen collaboration wherever it is needed.
On new clause 80, I am again not convinced that creating a new statutory duty on every Minister is either necessary or the most effective means of achieving the objective of the hon. Member for Winchester. The Secretary of State for Health and Social Care already has a statutory duty to protect public health and powers to take the appropriate steps to improve the health of the people of England. We have already discussed clause 4, which reformulates the Secretary of State’s duty on health inequalities. Those provide a clear statutory framework for improving health and addressing inequalities.
Beyond that, the Government do not operate in departmental silos. Ministers consider the implications of decisions and work collectively in the public interest, including on health impacts where relevant, which is particularly important to this Government. The proof is in the action we have started to take across Government to improve health. Although I agree entirely that health should be considered across Government, imposing a broad new legal duty on every Minister would risk creating unnecessary bureaucracy without meaningfully improving outcomes, as my hon. Friend the Member for Lichfield highlighted.
Creating new procedure and reporting requirements is not in the spirit of this Bill, which has flexibility and a focus on delivery at its heart. We also heard that from the shadow Minister. Our focus is and must remain on delivering improvements in health outcomes, supporting prevention and tackling the causes of ill health, rather than creating additional statutory red tape. The objective of new clause 80 can be achieved without placing a new statutory requirement on every Minister.
The shadow Minister asked me about plans for a modern service framework for MSK, and we currently do not have plans to develop one. The national quality board will assess all proposals for new MSFs against clear criteria, which we have highlighted before, ensuring that we prioritise the area where a framework will have the greatest impact for patients.
Dr Johnson
I understood that one of the Government’s greatest priorities was to reduce waiting lists, but one of the things that people are waiting for the most is musculoskeletal or orthopaedic treatment. Why is it not a priority for the Government?
Karin Smyth
There is a long priority list for MSFs that was left by the last Government for different reasons. There are lots of things will bring down MSK waiting lists, such as more diagnostic facilities. As the shadow Minister knows, 80% of people on the waiting list are waiting for diagnostics, which is why we are fast-tracking and pushing more. As my hon. Friend the Member for Croydon East said, community diagnostic centres in places such as Croydon East will get people through for the diagnostics they need. There are also some things that the shadow Minister’s party seems to continue to oppose, such as advice and guidance for GPs so that, if there are alternatives to deal with MSK, of which there is already a lot of evidence, they can refer people to a more appropriate or faster access route in the meantime. Those actions are being taken.
She is quite right that orthopaedics is a large part of the waiting list. However, diagnostics, access to faster treatment and using the independent sector where appropriate will particularly target orthopaedic waiting lists as part of our elective reform plan.
Dr Johnson
I am not opposed to the principle of GPs seeking advice or guidance; the issue is the compulsory nature of that and GPs not being able to refer.
Karin Smyth
The shadow Minister is tempting me to divert away from addressing the main point, but I will take her point on board. I am glad that the Conservatives do not oppose the principle of advice and guidance, because evidence suggests that it is a good route to patients having care closer to home and getting faster treatment. She knows this because it has been clarified, but if there is any doubt: there is no compulsion on GPs to do that.
The hon. Member for Winchester talked about his expertise and blowing his own trumpet with regard to antimicrobial resistance. He jests slightly about that expertise, but he raises a really important point about AMR that I am sure we will talk about more when we discuss new clause 32. He is absolutely right that it is an important public health issue that crosses many divides, and I look forward to discussing that later.
Dr Chambers
I thank all Members for their contributions to the discussion. The hon. Member for Lichfield made the good point that a committee of 70 people may not be that efficient. He should come to the Lib Dem parliamentary party meetings, which are incredibly efficient. We have incredibly insightful discussions, which is what makes us such an effective force, so I would not knock a committee of 70 people.
I appreciate the Minister’s acknowledgment of the important of cross-party work for public health. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 15
Impact of trade deals on the NHS
“(1) Any trade negotiation which would require NHS spending or funding to exceed £100 million must be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure.
(2) Before laying regulations under subsection (1) the Secretary of State must publish an impact assessment about how the trade negotiation will affect NHS frontline services and patients.”—(Dr Chambers.)
This new clause would require any trade negotiation which would require NHS spending or funding to exceed £100 million to be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure.
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss new clause 76—Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing—
“(1) The Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing may be ratified only if—
(a) a Minister of the Crown has laid before the House of Commons a copy of the Arrangement, and
(b) the Arrangement has been approved by a resolution of the House of Commons on a motion moved by a Minister of the Crown.
(2) Before tabling a motion under subsection (1)(b) the Secretary of State must publish and lay before the House of Commons an impact assessment on the potential effects on the health service of implementation of the Arrangement.”
This new clause would require the Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing to be brought before the House for a vote.
Dr Chambers
New clause 15 would require that the Secretary of State lay before Parliament any trade negotiation requiring NHS spending or funding exceeding £100 million, in the form of regulations subject to the affirmative procedure. New clause 76 would require that the arrangement between the United States and the United Kingdom on pharmaceutical pricing be laid before the House to be voted on.
The Institute for Fiscal Studies has indicated that, by 2036, the UK-US pharmaceuticals deal will have cost as much as £9 billion. That money could be transformative for the NHS. It could be put towards ending corridor care, as the Committee discussed earlier, or towards hiring thousands of ward staff, buying countless radiotherapy machines and starting to deliver high-quality care and help at home for the elderly and disabled.
To make matters worse, Trump’s ambassador hauled in the head of the National Institute for Health and Care Excellence—the expert independent body that considers value for money in the NHS—to rebuke him over his opposition to the deal. It is utterly outrageous that a British public servant has been dressed down by a foreign regime for putting the interests of British patients and the British taxpayer first. It is crazy that billions of pounds of NHS funding is being spent to placate Trump, at the expense of the patient wellbeing. We want to support the British life sciences sector. That should be a domestic matter for the UK Government to address holistically, through negotiations with the sector; it should not be dictated from Washington.
Hiking payments for medicine is the wrong approach for patients who badly need investment in frontline staff, hospitals and equipment. The lack of transparency over the full cost has already created great uncertainty in the sector, and it is astonishing that such a major decision will be made without the say of the British people via a vote in Parliament. The Government refused even to publish an assessment of the impact of the deal, which has raised suspicion and caused some to think that something is being hidden. Through the people who elected us, this House—not the White House—decides on matters of national importance. The Liberal Democrats have tabled these new clauses to allow the House to have a proper vote on the deal.
Dr Johnson
I will be relatively brief. New clause 15 would require the Secretary of State to lay before Parliament any trade negotiation requiring NHS spending or funding exceeding £100 million, in the form of regulations subject to the affirmative procedure. New clause 76 would require the arrangements between the United States and the United Kingdom on pharmaceutical pricing to be laid before the House to be voted on.
A key concern is costing. There have been various estimates of the additional cost of medicines. The former Secretary of State, the right hon. Member for Ilford North (Wes Streeting), said that he would not change or cut the NHS budget to pay for that increased cost. Will the Minister tell us the estimated extra cost of medicines, and where that money will come from, if not from the DHSC budget?
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairship, Ms Lewell. Like the shadow Minister, I will be relatively brief. [Interruption.] It was not clear whether that was a sound of appreciation or disappointment from the Minister. I will assume that she receives everything I say with the same noise and grace.
Yesterday, the Secretary of State appeared before the Health and Social Care Committee—on which my hon. Friend the Member for Isle of Wight East and I sit—and was questioned at some length by the Chair, the hon. Member for Oxford West and Abingdon (Layla Moran), about the UK-US trade deal. It was striking that the Secretary of State appeared unable to answer the basic question of whether an impact assessment could be presented to the Committee—under whatever terms of secrecy or confidentiality the Department wanted to place on it—to allow us to assess the costs, as the hon. Member for Winchester outlined, and, one would hope, the benefits.
The Secretary of State was very clear that there were benefits, but he was unable to outline what they were. He cited commercial confidentiality, which I do understand; there will be commercially confidential elements to the deal. What was really striking, however, was that even though the Select Committee was very happy to receive the information under whatever strictures he wanted to put on it, so that we could scrutinise it, it was not given. That is serious cause for concern.
I understand what the hon. Member for North Shropshire seeks to achieve through new clauses 15 and 76, but there are some problems in their drafting. There will be commercially confidential elements to the deal, so laying it before the House essentially completely unredacted, as new clause 15 would require, might pose real problems. Likewise, I assume that the intention of new clause 76 is to focus specifically on the UK-US trade deal as currently formulated.
Dr Prinsley
Much of the conversation around those trade deals relates to pharmaceuticals from the United States. Our patients should be able to access the best available treatments, whatever deals we cook up. We must support innovative research based in our own country, particularly clinical trials for new medicines. To do that, we need to support clinical academics—the doctors who work in universities and organise research. Does the hon. Gentleman acknowledge that the number of clinical academics fell under the previous Conservative Administration? Most clinical academics are now very senior, and we are not recruiting replacements effectively. We need to look after our home-grown pharmaceutical industry so that we do not need such trade deals.
Gregory Stafford
I certainly agree with the hon. Gentleman’s penultimate point: we need to support home-grown clinical academics and the life sciences industry in this country. As he has drawn me down that line, I declare that my wife works in the life sciences industry in the UK. I entirely agree with him on that point. However, if he is saying that a corollary is that we should not do pharmaceutical trade deals with other countries, I do not agree, because UK patients need the best medicines no matter where they come from. If that was not what he was saying and I am putting words into his mouth, I apologise, but that is how it sounded to me. I agree that we should support the home-grown, but obviously we need access to medicines from around the world.
That brings me to my concerns about new clause 76. I understand why the hon. Member for Winchester supports it, but the way it is written means that, for the lifetime of the Act, any trade deal with America would have to follow those strictures. Although I accept that he does not like the current deal or the incumbent in the White House, it seems odd that we are singling out in statute, and putting a stricture on, one country over every other. I still probably would not have voted for it, but the new clause might have been more acceptable had it referred to any trade deal with any country, or even a group of countries—I know he is a big fan of one particular group of countries. That might have made it difficult. It would be dangerous essentially for the Bill to put a stricture on a trade deal with one specific country—especially one that is probably our strongest ally. I think that sits very badly.
Sojan Joseph
Does the hon. Gentleman agree that the existing constitutional arrangements already provide mechanisms, ministerial accountability and parliamentary scrutiny? Singling out one country is a politicising measure, and it will have long-term consequences for our relationship.
Gregory Stafford
Yes, I agree entirely with the hon. Gentleman. It would be a very slippery slope to write that into legislation. I understand the motivation—as I often do—behind Liberal Democrat new clause 76, but I do not think its drafting is appropriate in this context, and I cannot support it.
Joe Robertson
As my hon. Friend the Member for Farnham and Bordon said, we on the Health and Social Care Committee heard from the Secretary of State yesterday. These new clauses were obviously drafted in advance, but the timing of their consideration is rather good.
We had the opportunity to ask the Secretary of State, who sits right at the top of the Department, some fairly basic questions about the deal that will apparently see the NHS pay 25% more for US drugs than it does currently. We asked, for example, how much it will cost. The Chair of the Select Committee, the hon. Member for Oxford West and Abingdon, skewered the Secretary of State within minutes. A short while later, once the Secretary of State had had the chance to reflect on her queries, I had the opportunity to ask some even more basic questions. I asked not what the figure was, but whether one even existed or whether any analysis had been done. We ended up going backwards.
We parliamentarians and the public still do not know the answers to some basic questions, even though a deal has been done. Do we know how much it will cost? Does a figure exist? Has an analysis been done? Are we talking about a figure or a bracket? On what basis was the deal agreed? We received absolutely no answers at all to those questions. To conclude, I posed a fairly obvious question: how on earth can we strike a deal to pay 25% more for drugs that we already get without knowing how much it will cost? No answer was given to that question either.
It is no wonder that these fundamental questions have effectively come in the middle of the Bill’s passage. This is not the place for them, but in the absence of basic answers, I can see why the hon. Member for Winchester and others have raised these issues. I will ask the same questions of the Minister. If her boss cannot answer them, perhaps she can, as the Department has had 24 hours to reflect. How much will the deal with the US cost? Are there—even if the Government do not want to disclose them—a figure and an impact assessment?
If the Government can confirm that a figure or bracket exists, why are they not willing to discuss them? If the Government can confirm that some sort of impact assessment has been done, when did it happen and why are they not disclosing it? Until we get those answers, so that people can see the fundamental considerations on which the Government base their decisions, this is a fairly unappealing way of going about securing investment for life sciences.
The Secretary of State talked about the benefits of this deal, and I am sure that there are benefits. I do not disagree with the principle of paying more for drugs if it has benefits for research and development—I understand and support that principle—but I want to be able to see what those intended benefits are, in some form of document or analysis. I do not want bare statements that say, “Research and development is good.” We all know that; I want to see the cost.
New clause 15 would also set a cost threshold of £100 million. The Government are not in a position to confirm whether the US deal would qualify under clause 15. It would at least force the Government’s hand. I suspect that the sum is far higher—into the billions—but we do not know. We are left to sit and speculate, despite the Secretary of State’s appearance before the Health and Social Care Committee. He must have expected that question to be asked. He was flanked by the permanent secretary of the Department and the chief executive of NHS England. By the way, he was a Treasury Minister prior to becoming the Secretary of State just two months ago. We had all the key people in the room to give some sort of indication about cost and benefit, yet none was forthcoming.
Although I cannot back the new clause, because I do not think statute is the right place to ask these questions, I completely understand why it was tabled. She will not accept the new clause, but could the Minister at least answer some of the questions that parliamentarians and the public are asking?
Karin Smyth
I am happy to talk about the impact of trade arrangements on NHS spending and how arrangements are scrutinised by Parliament. I am grateful to the Liberal Democrats for the new clauses.
Our relationship with industry, life sciences and the pharmaceutical sector, as my hon. Friend the Member for Bury St Edmunds and Stowmarket said, is crucial not only to our patients and constituents, but to growth in our country. Many hon. Members will have companies large and small in their constituencies—my hon. Friend the Member for Aylesbury has Lynam Pharma in hers. Important local companies are doing great work, innovating and bringing great people together to work on behalf of the life sciences sector and our country. They make us proud to be a leading country in this area, and I give credit to the Prime Minister for his leadership to put this country back in its rightful place on the international stage, addressing yet another part of our international reputation that was trashed by the Conservative party. [Interruption.] You started it.
On new clause 15, parliamentary scrutiny is crucial to ensure that trade deals negotiated by this Government are in the best interests of the UK. That is why the Government are committed to transparency and to enabling effective scrutiny of our trade agenda. Nowhere is scrutiny more important than in considering the potential impact of trade agreements on public services such as the NHS. The Government have a clear framework in place for scrutiny of the trade agreements that we have negotiated. This process strikes the right balance between ensuring that appropriate parliamentary accountability can take place and preserving our ability to negotiate agreements effectively. That is important to ensure that the UK can negotiate credibly with its partners and secure in trade deals positive outcomes for the public and British businesses, while upholding and protecting the role of Parliament.
Helen Morgan
The disquiet about the deal comes from the fact that the sums involved are huge—possibly £9 billion a year, or even more towards the back of the 10-year period—according to big companies in the sector. The Association of the British Pharmaceutical Industry was not involved in the negotiation of the deal; it was negotiated with the US. We fully support of the life sciences sector in this country, and there is a complex debate to be had about access to novel medicines for people with unusual and rare diseases, and about balancing that with everybody else’s access to volume services on the frontline, but that important discussion should be had by Parliament and the British people, not between a trade negotiator and Donald Trump’s White House. That is where our disquiet comes from, and it is why we tabled these new clauses.
Karin Smyth
I understand the intent of the hon. Member for North Shropshire and her commitment to parliamentary scrutiny, as well as that of her hon. Friend the Member for Oxford West and Abingdon. I hope that some of my points will address that.
New clause 15 duplicates existing processes and creates responsibilities for the Secretary of State for Health that would cut across our important procedures for scrutiny. No trade agreement can, by itself, change UK domestic law or require new public expenditure without the usual domestic processes being followed. Any changes to legislation necessary to implement a trade agreement would be subject to parliamentary scrutiny in the usual way. It is right that the Government be held to account, to ensure that trade deals deliver for the country. However, those processes are already in place and are working.
Joe Robertson
To strip this back further, can the Minister confirm whether a deal has been done?
Karin Smyth
I am not party to the negotiations. That is above my pay grade, like the conversation yesterday that the hon. Gentleman alluded to. I will get back to him on any outstanding questions, as the Department will to the Select Committee with other details.
Dave Robertson
To quote the Precision Health Technologies Accelerator at the University of Birmingham, very close to my Lichfield constituency, its leadership has been supportive of the removal of tariffs from pharmaceuticals, saying that the introduction of the tariffs could lead to
“supply chains collapsing and patients suffering.”
That is an enormous growth opportunity for the West Midlands combined authority, for Birmingham and for the wider region. There have been a lot of discussions, but I wanted to make sure that the views of organisations that will benefit are on the record, because this will be so beneficial for my region.
Karin Smyth
My hon. Friend clearly highlights the advantages for his constituents and the importance, particularly for that university and universities across the country, of such outward-facing arrangements, which benefit constituencies in many ways, not only through employment, but through the pharmaceuticals and medical devices, and so on, that help all our constituents.
New clause 76 specifically references the trade arrangement between the United States and the United Kingdom. That landmark partnership with the United States Government on pharmaceuticals pricing and tariffs is in the best interest of UK patients, supporting the NHS and the economy. As a result of the changes to the UK’s medicines pricing, NHS patients will get improved access to lifesaving treatments. New medicines have already been recommended under the updated approach, including a brain cancer drug available to patients as young as 12 and a last-resort treatment for a rare, aggressive stomach cancer—something that I think the entire House and the Committee would support.
Liz Twist
I want to emphasise a point that has already been made, which is the positive impact of the agreement for people with rare and undiagnosed conditions. As the Minister will know, I have worked with a number of those organisations, and this is certainly an opportunity for innovative treatments to be funded, as they might not have been before. I thank the Minister for that.
Karin Smyth
Again, this is an area of work that my hon. Friend has led on for many years, as I have seen, often when many others have not been around to support it. With so many organisations and charities lobbying on behalf of so many people who are desperate for rare diseases in particular to be highlighted—those diseases that affect a small number of people, many of them children—that work is crucial. Her work in leading in this place is exemplary. That is exactly where we aim to get by working with our partners in difficult circumstances. Trade deals and negotiations are necessarily difficult—otherwise, they would be easy—but the hard work yields results for people. As I have said, this Government have taken an outward approach to working with our partners and with industry.
We have already taken steps towards achieving our commitments, most notably increasing the NICE cost-effectiveness threshold. The Government previously updated Parliament in two ministerial statements, and of course MPs quite rightly have the option to continue to table parliamentary questions. Officials should be able to produce confidential advice for Ministers, to inform trade or other negotiations, and we must maintain that confidentiality in this case, as the impact assessment contains commercially sensitive assumptions. It is scenario-based and remains linked to live policy development. On that basis, I ask the hon. Member for Winchester to withdraw the new clause.
Dr Chambers
I thank the Minister for her comments. It is good to hear cross-party recognition of how important the life sciences sector is in the UK, to universities and businesses as knowledge transfer partnerships. This is a huge opportunity not only to improve the health of the nation and the treatments available, but to boost the economy.
We will withdraw new clause 15, but I thought the hon. Member for Isle of Wight East spoke extremely well about his concerns relating to the trade deal.
Joe Robertson
I think that the hon. Member has spoken very well, too, and I am grateful to him for airing this important subject through his new clause.
Dr Chambers
I appreciate that. Just to reiterate, I am talking specifically about the trade deal with the United States, not about every single trade deal. We completely accept that primary legislation is not necessarily the best way to scrutinise a trade deal, but given the lack of options at the moment, we must use every political mechanism available to create transparency.
Dr Johnson
This Government came to power saying that they would be more transparent, but they have not been. It took us months to get numbers out of the Government about the Chagos Islands deal.
Dr Chambers
I am grateful to the shadow Minister for that intervention.
Unless something changes significantly by the time we get to vote on new clause 76, which I understand will not be today, we will press it to a vote for transparency’s sake, but we will withdraw new clause 15. I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
New Clause 16
Duty to promote the health and wellbeing of carers
“After section 14Z44 of the NHS Act 2006 insert—
‘Duty to promote the health and wellbeing of carers
(1) Each integrated care board must exercise its functions with a view to improving and maintaining the physical health, mental health, and wellbeing of carers within its area.
(2) In exercising its duties under this section, an integrated care board must have regard to—
(a) reduction of health inequalities experienced by carers,
(b) prevention of deterioration in carers’ physical and/or mental health,
(c) involvement of carers in decisions relating to the care of persons for whom they provide care, and
(d) the need to ensure carers are able to access appropriate preventative and other health services and support.
(3) An integrated care board must take reasonable steps to ensure that NHS bodies and providers of NHS services within its area—
(a) consider the health and wellbeing needs of carers in care planning and discharge processes,
(b) involve carers appropriately in decisions relating to care and treatment, and
(c) provide carers with information about support available to them for their health and wellbeing.
(4) In preparing a Joint Forward Plan, an integrated care board must include—
(a) an assessment of the health and wellbeing needs of carers within its area,
(b) steps the integrated care board proposes to take to improve outcomes for carers, and
(c) measures for reducing inequalities experienced by carers.
(5) In this section, “carer” has the meaning given by section 10 of the Care Act 2014 and includes a young carer within the meaning of section 96 of the Children and Families Act 2014.’”—(Dr Chambers.)
This new clause would introduce a duty for integrated care boards to promote the health and wellbeing of carers.
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss the following:
New clause 17—Duty to identify and record unpaid carers—
“After section 14Z44 of the NHS Act 2006 insert—
‘Duty to identify and record unpaid carers
(1) An integrated care board must take reasonable steps to identify persons within its area who are unpaid carers.
(2) An integrated care board must make arrangements to ensure that NHS bodies and providers of NHS services within its area—
(a) maintain appropriate systems for recording whether a person is an unpaid carer,
(b) use consistent coding standards for the recording of unpaid carers in health records,
(c) review and update records relating to unpaid carers at appropriate intervals, and
(d) ensure that the identification and recording of unpaid carers forms part of—
(i) primary care registration processes,
(ii) hospital discharge procedures,
(iii) care planning processes, and
(iv) other relevant patient contact pathways.
(3) For the purposes of this section, “carer” has the meaning given by section 10 of the Care Act 2014 and includes a young carer within the meaning of section 96 of the Children and Families Act 2014.’”
This new clause would introduce a duty for integrated care boards to identify and record unpaid carers when they come into contact with NHS services.
New clause 18—National Respite Care Scheme—
“(1) Within six months of the passage of this Act, the Secretary of State must establish a National Respite Care Scheme.
(2) The scheme under subsection (1) must make provision for—
(a) a local authority carrying out a carer’s assessment under section 10 of the Care Act 2014 to be required to consider whether a carer is able to take sufficient breaks from their caring responsibilities.
(b) unpaid carers to receive support to take breaks from their caring responsibilities to—
(i) maintain their physical and mental health and emotional wellbeing,
(ii) participate in work, education, training or recreation, and
(iii) participate in family and community life.
(c) a carer to receive appropriate support if a local authority carrying out an assessment under subsection (2)(a) determines that a carer is unable to take sufficient breaks from caring.
(3) Under subsection (2), “support” may include—
(a) replacement care for the cared-for person;
(b) respite services;
(c) any other steps a local authority considers appropriate as support.
(4) The Secretary of State must provide sufficient support to local authorities to ensure the scheme under subsection (1) is delivered in every local authority.
(5) For the purposes of this section “unpaid carer” has the meaning given by section 10 of the Care Act 2014 and includes a young carer within the meaning of section 96 of the Children and Families Act 2014.”
This new clause would require the Secretary of State to establish a National Respite Care Scheme.
New clause 89—Duty of health bodies to provide information and advice to carers—
“(1) Within six months of the passage of this Act, the Secretary of State must make provision for an information and support service for unpaid carers.
(2) The service under subsection (1) must include—
(a) provision for an unpaid carer to access information regarding recommended care and treatment needs for the person for whom they are caring,
(b) information about services, support and assistance available from the National Health Service to assist unpaid carers in their caring role,
(c) information about the availability of support for unpaid carers provided by local authorities,
(d) information about support available to promote and maintain the health, wellbeing and resilience of unpaid carers,
(e) information about arrangements for obtaining advice, training, advocacy or peer support relevant to unpaid carers’ caring role, and
(f) any other provisions which the Secretary of State considers appropriate for supporting unpaid carers in relation to their delivery of care.
(3) In exercising the duty under subsection (1), the Secretary of State must prioritise proactive identification of unpaid carers and ensuring that information and advice is accessible, proportionate and appropriate to the needs of unpaid carers.
(4) In exercising the duty under subsection (1), the Secretary of State must have regard to an unpaid carer’s willingness and ability to provide care.
(5) The Secretary of State must take reasonable steps to ensure that unpaid carers are made aware of the information and advice available under this section.
(6) For the purposes of this section, ‘unpaid carer’ has the meaning given to ‘carer’ in section 10 of the Care Act 2014.”
This new clause would create a duty for the Secretary of State to provide certain information and advice to unpaid carers.
Dr Chambers
I will speak to new clauses 16, 17 and 18 together. They relate to the duty on integrated care boards to promote the health and wellbeing of carers. Certainly, as the Liberal Democrat spokesperson for mental health, and having been a carer myself—like many people in this room—I have a particular interest in the mental health of carers. Sometimes we forget that, as well as the patient, the carer also needs a huge amount of support, as what they do can be very draining.
Unpaid carers are essential to the sustainability of the NHS and social care system, but carers consistently experience poorer physical and mental health outcomes than non-carers, and frequently struggle to access support for their own health needs. There are approximately 4.7 million unpaid carers in England. They provide support valued at an estimated £152 billion annually—equivalent to the annual NHS budget.
Evidence consistently shows that unpaid carers experience worse health outcomes than non-carers. The GP patient survey 2025 showed that 72% of carers report a long-term condition or disability compared with 61% of non-carers. The Office for National Statistics reports that one in four adults providing unpaid care described being in “not good health”, compared with one in five adults who are not providing unpaid care. The probability of reporting being in “not good health” was higher for people providing more hours of unpaid care. Some 49% of unpaid carers reported at least one adverse health effect from providing that care. Low mental wellbeing was more common among unpaid carers, at about 20%, than among those not providing unpaid care, at 15%.
An academic study analysing GP patient survey data found that, for those caring for more than 50 hours a week, the health impact of being a carer is equivalent to losing 18 days of full health every year. A study has also found that carers cancel medical treatments and appointments because nobody is available to step into their caring role, and that, because of their caring responsibilities, carers cannot find appointments at times when they can attend.
A more targeted approach to support unpaid carers could help to prevent the onset of deteriorating carer health and wellbeing as a result of their caring roles. Although ICBs have broad duties relating to population health and inequalities, there is currently no explicit statutory duty requiring ICBs to improve the health and wellbeing of unpaid carers specifically.
Liz Twist
It is a pleasure to serve with you in the Chair, Ms Lewell. I listened with great interest to the hon. Member for Winchester talking about the new clauses; they have a great deal of similarity to new clause 89, in the name of my hon. Friend the Member for Shipley (Anna Dixon). We all know that it is absolutely vital to look after our carers. They do a huge amount of work to support us and make sure that people are kept at home and cared for.
New clause 89 covers a number of issues, and would create a duty on health bodies to provide information and advice to unpaid carers and task the Secretary of State with providing that service. It would ask first for information about medicine and medicine records, which we talked about a few days ago. Beyond that, it asks for information about services and support available from the NHS to help in their role as carers, and about support for their own needs and health, which are hugely important. It also asks for information about the support available to them and how to get more advice in their role.
I will not go over all the arguments again, but we heard about Carers UK’s “State of Caring” survey in 2025. Some 29% of carers say that they need more information and advice about caring, such as support with clinical tasks or managing someone’s condition. Many of them provide support with medication and administering it. Many also monitor blood pressure or sugar level, dress wounds and use equipment. In all these new clauses about carers, the discussion is about how we can best support carers in that role. They have a vital role, and I know that the Government recognise the important contribution they make to healthcare, so it is important that we consider the issue here.
Dr Johnson
This group of new clauses is about carers and how we look after them. They do so much work for so many people across the country by looking after their loved ones. Many of them are not necessarily in good health themselves, and some are even children. These new clauses have a positive intention: to try to improve carers’ lives and make sure that they are recognised.
I congratulate the hon. Member for Winchester on his success in keeping open his respite care centre. Perhaps he could share his notes with me, because the Reform county council in Lincolnshire is currently trying to close Swallow Lodge, a respite care centre that provides for people of working age who have severe disabilities. The council wants to close it, and the people there are devastated by that suggestion. We had a public meeting, which many people came to, and they had not been consulted at that point. I think that an assumption was made that they are not able to communicate, but many of them are able to do so with support. However, that communication had not happened.
It has caused fear for people. They are worried about where they will go instead and whether it will be suitable. What about the people they made friendships with at the centre? Many of them have elderly parents—in their 80s, in some cases. It is also economically short-sighted, because people may end up going into full-time care, which will ultimately cost the council more.
The council has now been persuaded to do a full consultation, which will happen over the next few months. If the hon. Member can share anything with me that was successful for him that could help me keep Swallow Lodge open against the Reform county council’s changes, I would be very grateful.
Sojan Joseph
As the chair of the APPG on adult social care, I pay tribute to unpaid carers for the enormous contribution they make to their families, their communities and wider society. I often have meetings with them, and as part of my job before I became an MP—I worked in the NHS—I had a lot of contact with carers. I have seen so many vulnerable patients benefit from the enormous amount of work that carers do. In some services, such as the mental health service, there is already provision for identifying carers, carers’ assessments and support for carers. Carers provide extraordinary support, often at great personal sacrifice.
Although the intention here is to make the wellbeing of carers a statutory duty, we need to be careful that we do not put any statutory responsibility for that on the NHS and create more administrative burden for it. I would appreciate it if the Minister would respond to that point, and if the Government would consider something to support carers, while not putting any more administrative burden on the NHS, where we are focusing on providing more support on the frontline.
New clauses 16 and 17 would impose new obligations on integrated care boards to promote carers’ wellbeing and to identify and record unpaid carers whenever they come into contact with NHS services. I want to make it clear that we should not create any more administrative burdens for NHS frontline services. Although identifying and supporting carers is important, the requirement would add to the administrative burden on NHS organisations at a time when they should be focusing on delivering frontline care.
We should be cautious about creating new statutory duties that divert resources and staff time away from patients. The proposal for a national respite care scheme is similarly well intentioned, but it risks imposing a centralised, one-size-fits-all model across a system that already makes local authorities and health boards responsible for assessing local needs and delivering support. Again, although we need more support for carers, we should be careful that we are not duplicating any of the services that are already available. Some charities also do a brilliant job of supporting carers. The provisions in these new clauses should be looked into, but we need to be cautious that we do not create more burdens for our existing systems.
Joe Robertson
I am grateful to the hon. Member for Winchester for introducing these new clauses and for the debate that that is allowing us to have. Unpaid carers are too often a silent and fundamentally unappreciated part of society, which the system could not cope without. They are family members who are thrown into the role of looking after their loved ones, which they did not expect to have to do. Most of them have no formal qualifications, but through love and family ties, they provide unpaid support, which in many cases has a negative effect on the financial wellbeing of the household and involves a huge amount of emotional toil.
The crisis in social care has lasted for decades under different Governments, who have struggled to tackle it, and it is putting increasing pressure on family carers. Many do not see themselves as a carer—they see themselves as a husband, wife, daughter, son or friend—but they provide millions of hours of care and support, year in and year out. My former role was at a national nursing charity that seeks to support the families of those living with dementia. I saw for myself how much wraparound care can achieve in relieving pressure and unnecessary suffering, not just for the person living with dementia—it does not have to be dementia, but that is what I have experience of—long-term frailty or conditions that require support, but for their family and carer. Very often, the biggest care need for the person living with dementia is the biggest need their family carer has; if we can sort the family carer’s biggest need, they can go on and do so much more for the person they love.
I thank the hon. Member for Winchester for allowing us to have this debate. I urge the Government, if they do not adopt these new clauses, to do all they can to relieve the pressure on unpaid carers up and down the country and to provide support for them.
Karin Smyth
Like the hon. Member for Isle of Wight East, I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. All Members are committed to ensuring that carers receive the care and support they need. The Government recognise that unpaid carers play a vital role in sustaining the health and wellbeing of millions of people across our country. I pay tribute to them, and recognise all the work they have contributed to. I also note the work done by my hon. Friend the Member for Ashford on the APPG with Members from across the House.
The hon. Member for Winchester highlighted the shocking impact on the physical and mental health of people who are caring, which we heard about in the evidence session. That is an important issue, and it is good that we can now talk more about the mental health of carers. As he rightly said, many of us are carers. It is not an easy thing to do.
I pay tribute to the hon. Member for Isle of Wight East for his comments about the importance of wraparound care to people who do not want to leave the one they care for. I recognise that respite care is important.
I wish the hon. Member for Sleaford and North Hykeham good luck in her campaign in her constituency with the Reform council.
Dr Johnson
I thank the Minister for her good wishes. The council has not just proposed closing Swallow Lodge; it has also recently closed the memory support service. I listened to what my hon. Friend the Member for Isle of Wight East said about services for people with dementia, and this is another area where people will suffer because of the closure of vital services.
Karin Smyth
When the hon. Lady gets back to her constituency, I am sure she will be campaigning heavily on behalf of her constituents.
We acknowledge the need to support carers’ health and wellbeing, but we do not think new clause 16 is necessary, because the existing legal framework already requires the system to support them. The new clause duplicates existing duties and risks adding complexity, rather than improving support in practice. Carers are explicitly referenced in the NHS constitution, which establishes the principles and values of the NHS in England and sets out the aim of improving the health and wellbeing of the population. The Secretary of State for Health, all NHS bodies, private and voluntary sector providers supplying NHS services, and local authorities in the exercise of their public health functions are required by law to take account of the constitution in their decisions and actions. Local authorities and NHS bodies also have a duty of co-operation in respect of their functions relating to carers.
Finally, under the Bill, the Secretary of State will take on NHS England’s role in promoting the involvement of each patient in decisions relating to their illness, care or treatment. That duty includes the involvement of carers and representatives.
Liz Twist
As the Minister says, many people in this room have had experience of being a carer for a family member. She said that there is already a legal framework, but carers are clearly saying that they need a bit more. How will the Government ensure that we provide not just words and legal documents, but help on the ground?
Karin Smyth
I was just moving on to talk about some of the work beyond the legislative framework.
Beyond the legislative framework, our focus is on delivering practical improvements because, as my hon. Friend says, that is absolutely what people want. We are committed to ensuring that carers have the support they need. Through measures in the 10-year health plan, we are already equipping and supporting carers by making them more visible, empowering their voices in care planning, joining up services and streamlining their care tasks by introducing a new My Carer section on the NHS app. We are also working with Ministers from the Department for Work and Pensions, the Department for Business and Trade and the Department for Education to consider how best to recognise and support unpaid carers. The Government are preparing a cross-Government action plan for unpaid carers, to be published this year.
Dr Prinsley
Will the Minister acknowledge that the uplift in the carer’s earnings allowance is a very significant measure that this Government did introduce?
Karin Smyth
I thank my hon. Friend. That is indeed one of the ways in which, working through the DWP and across Government, we have sought to bring in, as my hon. Friend the Member for Blaydon and Consett said, practical measures to make carers visible and to support them. That is exactly the sort of thing we wanted to do and have done, and it does start to recognise the work that people do.
Let me turn to new clause 17 and new clause 89, which my hon. Friend the Member for Blaydon and Consett talked about and which was tabled by my hon. Friend the Member for Shipley, whose expertise and commitment in this area are well known across the House. The new clauses look at the identification of, and provision of information to, unpaid carers. I agree on the importance of ensuring that carers are properly recorded and identified in the system and provided with relevant information and advice so that they can be better supported and involved in care decisions.
However, we do not believe that explicit requirements to identify and record particular patient and carer groups are appropriate for legislation. We have made clear commitments in the NHS 10-year health plan and are taking practical steps to improve identification, support carers and involve them in care planning. If we need to mandate compliance, that is best done by including requirements in national NHS contracts or in statutory guidance or directions, where we can provide more detail and directly address barriers.
Information about unpaid carers will be captured systematically to ensure that their responsibilities are recognised and supported, and developments such as the single patient record, which we have discussed in Committee, will make that easier in the future. That is a really important step forward.
We are also looking to support general practice in better identifying and recording which of their patients are unpaid carers, to help ensure that those carers can get the support they need in the community. NHS England recently published guidance to support that, and work is ongoing to ensure more consistent coding of unpaid carers by general practitioners.
We are also working to improve the quality of local authority data on unpaid carers. The Partners in Care and Health programme, launched with the Local Government Association, is working with local authorities to improve their data and address barriers to data sharing between local systems.
Dr Prinsley
Since I have been an MP, I have visited a number of schools in my constituency, and I have always been struck by the number of children who are carers. [Hon. Members: “Hear, hear.”] I think that is a very under-recognised group of people, whose lives are completely dominated by the fact that they are carers for their parents.
Karin Smyth
I thank my hon. Friend. I heard audible voices of approval for that point. I think that when any of us know or encounter children, whether it be in our own circle or when we visit schools in our constituency, we are very much struck by those who are at school and are themselves caring. I think most schools do a tremendous job where they recognise that. Often children, like adults, do not want to inform their school or local people that that is what they are doing—they are very proud—and perhaps the person they are caring for does not know how to do that. I have certainly seen in my constituency schools starting to recognise and support the needs of those children, in a way that is dignified and respecting of privacy.
I did allude to some of the work that we are doing across Government, including with the Department for Education, to recognise, and to find ways to support, those young people, many of whom want to support their loved ones. I think we have all seen great ways to support them. When we are addressing young children in classrooms, I am always conscious of the need to think about the circumstances in which we are talking to them. There are a lot of teenage carers as well. My hon. Friend the Member for Bury St Edmunds and Stowmarket is absolutely right to highlight that.
More broadly, apart from data sharing and addressing barriers, the My Carer section of the NHS app will allow people to securely prove that they are providing care. That will streamline the care responsibilities of carers significantly—again, that can be done without having to confront the situation in public, if that is what people want—while giving them a means to seek advice or reassurance directly from a range of professionals when they need it.
I am also not convinced that the challenge of providing effective support would be solved by an additional legal duty. The existing legal framework already requires the system to support carers, including through the provision of information and advice. As the Committee has discussed, practical steps are what is needed. Progress is being made locally through issuing practical toolkits to help hospitals implement their legal duties under the Health and Care Act 2022. This year, the Government will also commission the better care fund support programme, led by the Local Government Association, to work with the NHS and social care partners to strengthen their approach to involving unpaid carers in discharge planning.
New clause 18 would establish a national respite care scheme. The Government do not feel that that is necessary, as the legal framework already provides rights for carers to access support, including respite services. Under the Care Act 2014, where a carer appears to have support needs, whether those are current or in the future, local authorities are required to carry out a carer’s assessment. Where carers have eligible needs, local authorities have duties and powers to meet them. That establishes a framework where needs assessments and subsequent care planning focuses on the individual and their circumstances, rather than prescribing a particular service or solution. In other words, respite care is already one of the many forms of care and support that might be offered as part of the process, where it is appropriate to meet the needs of the individual carer.
Funding and mechanisms are in place to enable local areas to deliver support for carers. Under the better care fund framework, there is £9 billion for integrated care boards and local authorities to make joint plans and to pool budgets to deliver better, joined-up care. In developing their better care fund plans, ICBs and local authorities should consider how pooled funding can help the NHS and local authorities to meet duties on unpaid carers, including around short breaks and respite services.
The Government are also making available more than £4.6 billion of additional funding for adult social care in 2028-29, compared with 2025-26, to support the sector to make improvements. Local areas will determine how best to use the money to support carers, depending on local need and with reference to their statutory responsibilities.
For those reasons, I ask the hon. Member for Winchester to withdraw new clause 16, and hon. Members not to press new clauses 17, 18 and 89 to a vote.
Dr Chambers
I thank Committee members for their contributions. The hon. Member for Isle of Wight East spoke particularly well and emotively—I know that he worked for Dementia UK before entering Parliament. My mother was a carer for my father, who had dementia, and my sister and I gave her respite care, although probably not enough of it. I know that many Committee members will have been in a similar situation, as it is a common disease, and it is becoming increasingly common. I also thank the Minister for her comments and reassurance.
The hon. Member for Bury St Edmunds and Stowmarket made a point about children being carers. I sat on the Mental Health Bill Committee last year, and to give an example of how impactful such Committees can be, it is now a requirement, as a result of the Committee’s consideration, to identify whether mental health patients have children who are carers. That was not the case before, and we appreciated the Government engaging with us on that issue. It is often teenagers who care for adults with severe mental health issues, but they were not even identified before, so they could not be given the support they required. That has changed now, and it is fantastic to see that, through Committee scrutiny, we can make a tangible difference to people’s lives.
I will not press new clauses 16 and 17 to votes, but the Liberal Democrats do think that it would be sensible and impactful to establish a national respite care scheme, so I will press new clause 18 to a Division. On new clause 16, I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 18
National Respite Care Scheme
“(1) Within six months of the passage of this Act, the Secretary of State must establish a National Respite Care Scheme.
(2) The scheme under subsection (1) must make provision for—
(a) a local authority carrying out a carer’s assessment under section 10 of the Care Act 2014 to be required to consider whether a carer is able to take sufficient breaks from their caring responsibilities.
(b) unpaid carers to receive support to take breaks from their caring responsibilities to—
(i) maintain their physical and mental health and emotional wellbeing,
(ii) participate in work, education, training or recreation, and
(iii) participate in family and community life.
(c) a carer to receive appropriate support if a local authority carrying out an assessment under subsection (2)(a) determines that a carer is unable to take sufficient breaks from caring.
(3) Under subsection (2), ‘support’ may include—
(a) replacement care for the cared-for person;
(b) respite services;
(c) any other steps a local authority considers appropriate as support.
(4) The Secretary of State must provide sufficient support to local authorities to ensure the scheme under subsection (1) is delivered in every local authority.
(5) For the purposes of this section ‘unpaid carer’ has the meaning given by section 10 of the Care Act 2014 and includes a young carer within the meaning of section 96 of the Children and Families Act 2014.”—(Dr Chambers.)
This new clause would require the Secretary of State to establish a National Respite Care Scheme.
Brought up, and read the First time.
Question put, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss the following:
New clause 62—Family support duty following serious childhood diagnosis—
“(1) Where a child is diagnosed with cancer or another life-threatening condition, the responsible NHS provider must, within 14 days of diagnosis, ensure that the child’s family is offered appropriate information, support and coordination services.
(2) For the purposes of subsection (1), the responsible NHS provider must offer—
(a) access to a named family support coordinator;
(b) information regarding welfare benefits, financial support and relevant public services;
(c) information regarding employment rights and workplace support available to parents and carers;
(d) signposting to appropriate mental health and psychological support services;
(e) information regarding relevant local and national charities, support organisations and peer-support services;
(f) a written Family Support Plan setting out the support available to the family during treatment; and
(g) notification and information sharing in accordance with subsection (3).
(3) The responsible NHS provider must provide the child’s registered general practitioner and where different, the registered general practitioners of the child’s parents or primary carers, with a Family Support Summary.
(4) A Family Support Summary must include—
(a) the child’s diagnosis;
(b) the proposed treatment plan;
(c) the expected duration and intensity of treatment, where known;
(d) information regarding the potential impact of the diagnosis and treatment on parents, carers and siblings; and
(e) any recommendations regarding wellbeing support, monitoring or referral for the family unit.
(5) Following receipt of a Family Support Summary, the relevant general practice shall be encouraged to consider the wellbeing needs of parents, carers and siblings and, where appropriate, provide information, assessment, referral or signposting to suitable support services.
(6) NHS England must publish guidance for NHS providers on the discharge of duties under this section.
(7) In this section—
‘child’ means a person under the age of 16;
‘family’ includes parents, guardians, primary carers and siblings;
‘life-threatening condition’ means a condition designated as such by the Secretary of State in guidance.”
This new clause places a duty on NHS providers to offer practical information, coordination and support to families within 14 days of a child being diagnosed with cancer or another life-threatening condition.
New clause 63—Parent mental health and bereavement support duty—
“(1) Where a child is diagnosed with a life-threatening condition, the responsible NHS provider must ensure that the psychological wellbeing of parents, guardians, primary carers and siblings is considered as part of the child’s care pathway.
(2) Within 14 days of diagnosis, the responsible NHS provider must offer—
(a) a parental psychological wellbeing assessment;
(b) access to a designated family support practitioner, psychologist, counsellor or other appropriately qualified professional;
(c) information regarding the psychological impact of serious childhood illness, including trauma, anxiety, depression, stress and bereavement;
(d) a written Family Mental Health Support Plan;
(e) notification to the child’s registered general practitioner and, where different, the registered general practitioners of parents or primary carers.
(3) During active treatment, the responsible NHS provider must ensure that parents and primary carers are offered periodic psychological wellbeing reviews.
(4) The responsible NHS provider must offer an additional psychological wellbeing review following any—
(a) significant deterioration in the child’s condition,
(b) relapse,
(c) progression of disease,
(d) transition to palliative care, or
(e) other material change in prognosis.
(5) The responsible NHS provider must ensure that support under this section is offered proactively and must not be dependent upon a parent, guardian, carer or sibling requesting support, identifying their own need, or making a self-referral.
(6) Following the death of a child, the responsible NHS provider must—
(a) offer a bereavement wellbeing assessment to parents or primary carers;
(b) offer access to bereavement counselling, psychological support or equivalent specialist services;
(c) make proactive contact with the family within 14 days of the child’s death;
(d) offer further follow-up support at intervals specified in guidance issued by NHS England;
(e) ensure that referral pathways are available where significant psychological distress, trauma, anxiety, depression or post-traumatic stress symptoms are identified.
(7) The responsible NHS provider must ensure that information regarding available support services is provided to siblings and that age-appropriate emotional support pathways are available where required.
(8) NHS England must publish guidance regarding—
(a) parental psychological wellbeing assessments;
(b) family mental health support following serious childhood diagnosis;
(c) bereavement support following the death of a child;
(d) support for siblings affected by serious childhood illness;
(e) referral pathways into specialist mental health services;
(f) minimum standards for proactive family mental health support.
(9) NHS England must publish and lay before Parliament an annual report on compliance with this section.
(10) In this section—
‘child’ means a person under the age of 16;
‘family’ includes parents, guardians, primary carers and siblings;
‘life-threatening condition’ means a condition designated by the Secretary of State in regulations.
(11) The Secretary of State must, within three years of the commencement of this section, undertake a review of its operation and lay a report before Parliament.”
This new clause would establish a statutory duty on NHS providers to identify and support the psychological wellbeing of parents, carers and siblings following the diagnosis of a life threatening childhood condition. It would create a proactive, opt-out family mental health pathway from diagnosis through treatment and, where applicable, bereavement.
New clause 64—Review of uncertain imaging findings in high-risk childhood illness—
“(1) Where imaging undertaken in relation to a child with a high-risk cancer or other life threatening condition identifies findings that are—
(a) inconclusive,
(b) indeterminate, or
(c) suspicious,
the responsible NHS provider must ensure that the findings are reviewed by a consultant clinician responsible for the child's care.
(2) Following such review, the responsible NHS provider must ensure that the child’s parent, guardian or primary carer is informed—
(a) of the nature of the uncertainty identified;
(b) whether disease progression, relapse or recurrence can be confidently excluded;
(c) what further investigations or surveillance are being considered; and
(d) the risks and benefits associated with immediate further imaging, alternative imaging modalities, or continued observation.
(3) Where disease progression or relapse cannot be confidently excluded, the responsible NHS provider must consider whether additional imaging or investigation should be undertaken within 14 days or as soon as clinically practicable, whichever is sooner.
(4) The outcome of any discussion held under subsection (2), including the views expressed by the child's parent, guardian or primary carer, must be recorded in the child's medical records.
(5) NHS England must publish guidance on the operation of this section, including circumstances in which further imaging should be considered following uncertain or indeterminate findings.”
This new clause requires consultant review of uncertain imaging findings in children with designated high-risk conditions. The amendment also aims to ensure that parents are informed of the uncertainty, the available options and the risks and benefits of those options before a decision is made.
Dr Johnson
The hon. Member for Dewsbury and Batley (Iqbal Mohamed), who tabled new clause 25, asked me to speak to it, which I shall do briefly. This is a very serious issue. Critically ill children are infants, children and adolescents with life-threatening illness or injury, often requiring intensive, continuous care to survive conditions from leukaemia to meningococcal disease, traumatic brain injuries and major surgery such as spinal surgery. I should say that I am a consultant paediatrician, but I have worked in paediatric intensive care as a junior—now called a resident—doctor.
The new clause as drafted does not, I think, do what the hon. Member was aiming for. When I read it through, I think he is looking at cases such as the tragic one of little Charlie Gard, whom we all remember died of encephalomyopathic mitochondrial DNA depletion syndrome, known as MDDS. It is incredibly rare. That tragic case highlighted the potential for disputes between parents and doctors, which, thankfully, are unusual.
The new clause is headed, “Parents of critically ill children: communication and involvement in decision-making”. Of course parents should be involved in decision making about their children, but it is worth noting that the median time that children spend in ICU is two days and that, thankfully, most of them get better—very few do not. The new clause talks about teachers being involved, which in most cases is unnecessary and impractical; in many cases, a child may be admitted on a Friday and discharged from the ICU by the Monday. In the majority of cases, there is no practical reason for teachers to be involved.
I understand the desire for parents to be part of every meeting, but sometimes clinicians need to be able to talk frankly about cases. Sometimes they will have multidisciplinary meetings where they talk about a plethora of different cases, or they may compare one case with another in terms of what they have seen, the findings of scans and the like, so it is not possible to have parents in every single meeting, although it is of course desirable for them to be aware of the discussions.
Other parts of the new clause, including provision for parents to know about everything and to set out how communication and language needs may be met, seem reasonable. It mentions independent mediation where there is disagreement, which is a beneficial way to go about things, but we must not legislate so as to get in the way of urgent care, because most critically ill children in intensive care have urgent care needs that need dealing with now, not in a week’s time. Forming ethics committees to make decisions takes a long time, and that would get in the way of urgent care.
I think the hon. Member for Dewsbury and Batley is aiming for legislation that relates to chronically mechanically ventilated children with significant medical conditions, rather than children with an acute critical illness, but I said I would move the new clause and I have. I think he is trying to provide better care for some of the sickest children. That is a desirable aim and I know he cares deeply about it, but the new clause as drafted would not do what I think he aims for, and it could get in the way of paediatricians and others managing some of the sickest children in the country, so I will not press it to a vote.
Karin Smyth
I am grateful to the hon. Member for Dewsbury and Batley for tabling new clause 25, and grateful to the hon. Member for Sleaford and North Hykeham for her comments on it. It is a genuine pleasure to hear the expertise of clinicians such as her who work in the field of children’s health. She is obviously very passionate about that, and I thank her for bringing her expertise and commitment to looking after children, including critically ill children, to the Committee.
I recognise the profound impact that receiving a diagnosis of a life-threatening condition has on a child and their wider family. At such an overwhelming time in their lives, it is vital that families feel supported, informed and able to navigate the care and services available to them. We recognise that families can face huge variation in the support available and that they have to navigate complex systems at a particularly difficult time. I know that many hon. Members support many families in such circumstances in their constituencies. The Government are committed to ensuring that families have access to the support they need in the most straightforward way possible.
New clause 25 seeks to place a duty on the Secretary of State to issue guidance to integrated care boards on communications with parents of critically ill children and on parents’ involvement in decision making in respect of the treatment or care of their child. We heard from the Opposition spokesperson about some of the operational issues with some of its provisions, but there are no issues with its intent: of course parents should be involved and have good decision making at such a time.
Decisions about the care of a critically ill child can of course be distressing. We need to ensure that we get the process right from the beginning. That starts with good communication, sensitive handling and ensuring best practice across the system. Healthcare professionals should always act in the best interests of their patients; the views of parents are of course very important, but the child’s best interests are paramount, and we should not do anything that undermines that crucial principle. It is important that families and medical professionals communicate and, where possible, reach agreement on the care and treatment that is in the best interests of the child.
To support that, there are already many excellent examples of guidance and best practice across the health system. The Royal College of Paediatrics and Child Health is currently updating its framework for clinical practice on navigating decisions to provide, limit or withdraw treatment towards the end of a child’s life. That framework will include communication principles, legal and ethical principles, and clinical and practical considerations, including the role of clinical ethics services. It will also include guidance on navigating disagreements for professionals, children, young people and their families. An e-learning platform is available to staff working at all levels in children’s healthcare. The training programme provides professionals with a suite of resources to enhance knowledge, skills and confidence. It supports healthcare providers to recognise, manage and de-escalate conflict between families and healthcare providers where it occurs, and to signpost to both professional resources and resources for families. The actions I have outlined will continue to help and support the existing best practice.
Dr Johnson
The Minister is setting out the important guidance that can be provided to clinicians managing the care of children who are seriously unwell. I want to add for the record that I am a member of the Royal College of Paediatrics and Child Health, which is producing that guidance; I am grateful to her for setting out its importance. End-of-life-care decisions are very difficult. They need to be taken in conjunction with families but—the Minister is absolutely right—they must be made in the best interests of the child in all cases.
Karin Smyth
I am sure that the college will make best use of the hon. Member’s clinical expertise and her expertise as a legislator to get that guidance right. We work with royal colleges to ensure that we get the best clinical evidence into guidelines. I hope the actions I have outlined will continue to help and support the existing best practice, training and guidance on shared decision making and dispute resolution, so that it is embedded across the system.
There are a number of other important measures in this group that have not been mentioned. Let me just say that, alongside some of the things I have outlined, we want to progress system-wide reforms to improve the way children and young people, and their families, are supported across many conditions. We are working to bring forward a modern service framework for children and young people that will set out how we will improve quality for children and young people’s services in the longer term, as part of our 10-year health plan.
Dr Johnson
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 28
Appeals against health and social care provision in EHC plans
“(1) The Special Educational Needs and Disability Regulations 2014 (S.I. 2014/1530) are amended in accordance with subsections (2) and (3).
(2) After regulation 42, insert—
‘42A Other matters relating to EHC plans against which appeals may be brought
(1) In addition to the matters set out in section 51(2) of the Act, a child’s parent or a young person may appeal to the First-tier Tribunal against the matters set out in paragraph (2), subject to section 55 of the Act (mediation).
The matters are—
(a) a decision of a local authority, following an EHC needs assessment, that it is not necessary for health care provision or social care provision to be made for the child or young person in accordance with an EHC plan;
(b) where an EHC plan is maintained for the child or young person—
(i) the child’s or young person’s health care or social care needs as specified in the plan;
(ii) the health care provision or social care provision specified in the plan.’
(3) In regulation 43 (appeals), after paragraph (2) insert—
‘(3) When determining an appeal on the matters set out in regulation 42A(2)(a), the First-tier Tribunal has the power to order that—
(a) health care needs, or health care needs of a particular kind, which relate to the child or young person's special educational needs are specified in the EHC plan in accordance with regulation 12(1)(c);
(b) social care needs, or social care needs of a particular kind, which relate to the child or young person's special educational needs or to a disability are specified in the EHC plan in accordance with regulation 12(1)(d).
(4) When determining an appeal on the matters set out in regulation 42A(2)(b), the First-tier Tribunal has the power to order that—
(a) the health care needs specified in the EHC plan in accordance with regulation 12(1)(c) are amended;
(b) the social care needs specified in the EHC plan in accordance with regulation 12(1)(d) are amended;
(c) health care needs, or health care needs of a particular kind, which relate to the child or young person's special educational needs are specified in the EHC plan in accordance with regulation 12(1)(c) where those needs have not been specified in the plan; and
(d) social care needs, or social care needs of a particular kind, which relate to the child or young person's special educational needs or to a disability are specified in the EHC plan in accordance with regulation 12(1)(d) where those needs have not been specified in the plan.
(5) When determining an appeal on the matters set out in regulation 42A(2)(a), the First-tier Tribunal has the power to order that—
(a) health care provision, or health care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(g);
(b) social care provision, or social care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(h).
(6) When determining an appeal on the matters set out in regulation 42A(2)(b), the First-tier Tribunal has the power to order that—
(a) the health care provision specified in the EHC plan in accordance with regulation 12(1)(g) is amended;
(b) the social care provision specified in the EHC plan in accordance with regulation 12(1)(h) is amended;
(c) health care provision, or health care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(g) where that provision has not been specified in the EHC plan; and
(d) social care provision, or social care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(h) where that provision has not been specified in the EHC plan.
(7) When the First-tier Tribunal makes an order in respect of health care needs or health care provision, it must send a copy of the order to the responsible commissioning body.
(8) When sending a copy of an order, the First-tier Tribunal may also send a copy of the decision which disposes of any appeal brought under section 51(1) of the Act or under regulation 42A to the responsible commissioning body.
(9) The responsible commissioning body must respond within 5 weeks beginning with the date of the order to—
(a) the child's parent or the young person, and
(b) the local authority that maintains the EHC plan.
(10) The time limit specified in paragraph (9) does not apply where the First-tier Tribunal directs that a different time limit is to apply for the responsible commissioning body's response.
(11) A response under paragraph (9) must—
(a) be in writing,
(b) state what steps, if any, the responsible commissioning body has decided to take following its consideration of the order, and
(c) give reasons for any decision not to follow the order, or any part of it.
(12) The local authority must send a copy of the response received from the responsible commissioning body under paragraph (9)(b) to the Secretary of State within 1 week beginning with the date it was received.
(13) When the First-tier Tribunal makes an order in respect of social care needs or social care provision, the local authority must issue the amended EHC plan to the child's parent or the young person within 5 weeks beginning with the date of the order.
(14) The time limit specified in paragraph (13) does not apply where the First-tier Tribunal directs that a different time limit is to apply.
(15) The local authority must send a copy of the amended EHC plan under paragraph (13) to the Secretary of State within 1 week beginning with the date on which this is issued to the child's parent or the young person.’
(4) The Special Educational Needs and Disability (First-tier Tribunal Recommendations Power) Regulations 2017 (S.I. 2017/1306) are revoked.
(5) In consequence of the revocation made by subsection (3), the following 15 provisions of the Special Educational Needs and Disability Regulations 2014 are also revoked—
(a) regulation 10(3)(e);
(b) regulation 14(2)(e);
(c) regulation 201(11)(e);
(d) regulation 21(10)(e);
(e) regulation 22(5)(e);
(f) regulation 25(2)(e); and
(g) regulation 31(3)(e).”—(Dr Chambers.)
This new clause extends the powers of the First-tier Tribunal so that when it is determining an appeal it may order that Education, Health and Care plans must include health and social care needs and provision, rather than just making recommendations on these matters.
Brought up, and read the First time.
Dr Chambers
I beg to move, That the clause be read a Second time.
New clause 28, tabled in the name of the Chair of the Health and Social Care Committee, my hon. Friend the Member for Oxford West and Abingdon, extends the powers of the first-tier tribunal so that, when it determines an appeal, it may order that education, health and care plans must include health and social care needs and provision, rather than just making recommendations on those matters.
I am sure all Members are probably in a similar situation in that EHCPs, in their various forms, are one of the main reasons we get contacted by constituents; they certainly fill up my inbox. Following the Education Committee’s report, “Solving the SEND Crisis”, which identified significant gaps in accountability and engagement from the DHSC and health services in the special educational needs and disabilities—or SEND—system, the Health and Social Care Committee held a one-off evidence session to build on those findings, looking at the delivery of the health aspects of EHCPs.
The Health and Social Care Committee followed up a recommendation that the Education Committee had made that the powers of the SEND tribunal service should be extended to allow it to issue binding recommendations to health services, not just education providers. SEND tribunals are independent national tribunals that decide appeals against local authority decisions about the special educational needs of children and young people, including decisions made about an EHCP. Currently, they can make binding recommendations in relation to education provision, but not in relation to health and social care needs.
The Education Committee argued:
“This would ensure that when a failure to deliver a health provision specified in an EHC plan occurs, health bodies are legally obligated to take corrective action.”
When the Health and Social Care Committee raised that with witnesses in its evidence session, several were supportive of placing this duty in legislation, although they noted that it would require other reforms to workforce and commissioning arrangements to be successful. New clause 28 would provide a level playing field between education bodies and ICBs, so that ICBs are also under a legal obligation to comply with recommendations from SEND tribunals.
Dr Johnson
I should say that I am a member of the Education Committee. As the hon. Member for Winchester says, new clause 28 would extend the powers of the first-tier tribunal so that, when determining an appeal, it may order that EHCPs must include health and social care needs and provision, rather than just making recommendations on those matters.
It is clearly important that children with special educational needs get the support they need. We are all very aware, from our inboxes, that that does not always happen. I do not know whether putting this into legislation would make it happen, or whether it would need much more work than one clause, but clearly it is a very important aim and I support the principle of it. I would be grateful for the Minister’s comments on how she thinks this could work in practice and whether it is legislation or a more widespread plan that is required.
Gregory Stafford
I rise briefly to speak on this as well. I should note for the record that I am the vice-chair of the all-party parliamentary group on special educational needs and disabilities.
The hon. Member for Winchester, on behalf of the hon. Member for Oxford West and Abingdon, made the case very strongly. I am a member of the Health and Social Care Committee, and we took evidence as he described. The lack of a statutory obligation in the current EHCP process is a fundamental problem. We need to ensure that the health elements are put on the same footing as the social care ones. As I am sure is the case in every hon. and right. hon Member’s constituency inbox, the number of children who are receiving or require support with special educational needs and disabilities, and the frustrations with the process both locally and nationally, are rightly something that we, as parliamentarians and policymakers, need to get a grip on.
Karin Smyth
May I add to the comments of the hon. Member for Farnham and Bordon by paying tribute to the families in my constituency of Bristol South who are also struggling? The care of a child is obviously one of the most difficult and important things that a person can do. When that child is in distress and not supported by the system, it is a very hard place for a parent to be. As I think all hon. Members have said, that is an issue that arises a lot in our inboxes, our emails and our constituency surgeries, and it has been difficult to address. I commend the Education Secretary and her team of Ministers for bringing this work forward and starting to tackle the issue.
Dr Prinsley
My wife is an educational psychologist, so I have lived this, in a vicarious fashion, for the last 30 years or more. I understand how the system for special educational needs has evolved, particularly the role of the psychological services and how children are supported. As a result of a series of reforms, in particular during the years of austerity, the services provided by local authorities to schools—particularly the schools’ psychological services—became much more focused on psychologists providing reports to inform the distribution of resources, and much less focused on educational psychologists actually being in schools supporting children. I would like to see a change, such that educational psychologists and their expertise are back in schools, in classrooms, supporting teachers. Time and again when I visit schools, they say, “Let’s get educational psychology support back into schools.” I think that is something my wife would support.
Karin Smyth
I thank my hon. Friend for that. I put on record my thanks—our thanks—to his wife for her work in this area and for making him so aware of the issues, because he is absolutely right. This is a long-in-gestation issue that some of us have watched sadly get worse in our constituencies over recent years. Children only get one chance to come through this system, which is why people feel so passionately about it.
Sojan Joseph
I pay tribute to all the parents and schoolteachers who engaged with me last summer, following the White Paper and the SEND consultation. It has been a huge problem in Kent. Kent county council has been under Conservative administration for the last 25 years. In recent years, it was in special measures because of its SEND provision. Parents really struggled. My inbox is filled with these issues. We know that 98% of SEND provision tribunals rule in the parents’ favour. There has been a long wait. Does the Minister agree that, whether we accept the new clause or not, we need to look into how the NHS and local authorities can work together to make it easier for children, families and schools to get proper provision in place?
Karin Smyth
I thank my hon. Friend for his description of what has happened in Kent, which has been under Conservative administration for so long. He is absolutely right about the White Paper. The hard work that my right hon. Friend the Secretary of State and the ministerial team have done across the country, regardless of the local political administration, is exemplary. I will come on to talk about the tribunals.
The Government’s SEND reforms aim to transform outcomes for children and young people with SEND and their families, ensuring that the right support is available at the right time and preventing needs from escalating or reaching crisis in the first place. That is why the reforms aim to build a system that parents can trust with collective responsibility in local areas and strong partnership working across education, health and care. That is what parents expect us to be doing.
Liz Twist
I recently held consultation meetings on the proposed SEND reforms in Blaydon and Consett. The message from parents was clear in both places: they wanted greater integration of health into EHCPs. I welcome the Government’s commitment to asking ICBs to work more closely with local authorities to develop SEND reform plans and tackle this issue. Does the Minister agree that it is important for ICBs to take that on board?
Karin Smyth
I thank my hon. Friend for going to hear directly from her constituents. She is right: that message is fairly consistent. Last year, my hon. Friend the Member for Bristol East (Kerry McCarthy), my right hon. Friend the Member for Bristol North West (Darren Jones) and I played a pivotal role in bringing our ICB and local authorities together as local Members of Parliament. That was a result of our experience with parents and constituents. Members of Parliament from across the House—this is not a party political point—can bring parents together to highlight this issue and use parliamentary power to bring together organisations that sometimes do not listen or know the best way to communicate. Our role in that has been pivotal. The Secretary of State for Education has taken that learning forward across the country.
That is why we are taking the steps to deliver the programme. ICBs have been asked to work with local authorities to develop local SEND reform plans. Those plans will lay the foundation for long-term reform, enabling ongoing monitoring of progress, and draw on knowledge, skills and lived experience held locally. That builds on work that is under way to improve accountability and set expectations of joint working, which is what parents and families expected to happen, but was not happening. Each ICB is expected to have an executive lead on SEND. The NHS medium-term planning framework for the next three years made it clear that ICBs and providers must meet their statutory duties and support delivery of the reforms.
Ofsted and the Care Quality Commission will continue to check how local services, including health, work together for children and young people and hold them accountable. We will also update the SEND code of practice and publish new guidance so that local SEND partnerships have clearer expectations to work to. That is why we have not proposed changes to health and social care appeals to the SEND tribunal or made the decisions binding. This reflects the need for ICBs and NHS providers to retain the flexibility to plan services across their wider populations and prioritise support according to clinical and population need. This aligns with our commitment in the 10-year health plan to create a new NHS operating model where ICBs are the strategic commissioners of local healthcare services. It is worth noting that while tribunal decisions on health and care are non-binding, local authorities and ICBs are expected to follow them, and in most cases do. If they do not follow recommendations, they must send a response setting out the next steps they have decided to take and why.
There is no doubt that health and social care have crucial roles in SEND reforms, with shared ambitions across education, health and care for earlier intervention and support. I reassure the Committee that we are exploring further opportunities to strengthen accountability, as stated in the SEND consultation document. We are considering responses to the consultation, which closed on 18 May, and will set out our next steps in due course. For those reasons, I ask the hon. Member for Winchester to withdraw the new clause.
Dr Chambers
I thank everyone for their comments. I thank the Minister for her reassurances on the seriousness of this issue. Given that we are waiting for the response to the report, I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
Ordered, That further consideration be now adjourned.—(Emma Foody.)